Kicking the habit – how can we improve the routine care for patients who are well controlled living with HIV?

2020 ◽  
Vol 31 (13) ◽  
pp. 1315-1319
Author(s):  
M Dresser ◽  
J Hussey ◽  
N Premchand
Keyword(s):  
Medication Review ◽  
Routine Care ◽  
Clinic Visit ◽  
National Standards ◽  
Transmission Risk ◽  
Hiv Care ◽  
Cvd Risk ◽  
Retrospective Case ◽  
Mental Health Screen ◽  
Living With Hiv

The objective is to improve and standardise HIV care for people with well-controlled HIV across the region by comparing monitoring within services to UK audit standards. This was a retrospective case note review from 01.01.2018 to 31.12.2018. The standards were sourced from the British HIV Association (BHIVA), the British Association for Sexual Health and HIV (BASHH), and the Faculty of Sexual and Reproductive Health (FSRH). Six services took part with 228 patient records being audited. Two of the 5 national standards were met (blood pressure and medication review). From the 8 areas previously audited in 2014, 6 showed improvements (offer of STI screen, medication review, urinalysis, mental health screen and influenza vaccination documentation). Cardiovascular disease (CVD) risk and transmission risk had poorer documented outcomes. In addition, nearly one-third of patients were over-tested regarding their CD4 count. We recommend that letters should include a standard message about U = U (undetectable = untransmittable) and vaccinations; CVD risk and FRAX should be calculated once a year in place of a routine letter; an annual summary letter should be written in place of a letter after each clinic visit; and consistent use of a proforma, with BHIVA/BASHH/FSRH recommendations on monitoring included.

scholarly journals eHealth Literacy in People Living with HIV: Systematic Review (Preprint)

2017 ◽  
Author(s):  
Hae-Ra Han ◽  
Hyejeong Hong ◽  
Laura E Starbird ◽  
Song Ge ◽  
Athena D Ford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Health ◽  
Transmission Risk ◽  
Hiv Care ◽  
Future Research ◽  
People Living With Hiv ◽  
Study Variable ◽  
Ehealth Literacy ◽  
Living With Hiv

BACKGROUND In the era of eHealth, eHealth literacy is emerging as a key concept to promote self-management of chronic conditions such as HIV. However, there is a paucity of research focused on eHealth literacy for people living with HIV (PLWH) as a means of improving their adherence to HIV care and health outcome. OBJECTIVE The objective of this study was to critically appraise the types, scope, and nature of studies addressing eHealth literacy as a study variable in PLWH. METHODS This systematic review used comprehensive database searches, such as PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, to identify quantitative studies targeting PLWH published in English before May 2017 with eHealth literacy as a study variable. RESULTS We identified 56 unique records, and 7 papers met the eligibility criteria. The types of study designs varied (descriptive, n=3; quasi-experimental, n=3; and experimental, n=1) and often involved community-based settings (n=5), with sample sizes ranging from 18 to 895. In regards to instruments used, 3 studies measured eHealth literacy with validated instruments such as the eHealth Literacy Scale (eHEALS); 2 studies used full or short versions of Test of Functional Health Literacy in Adults, whereas the remaining 2 studies used study-developed questions. The majority of studies included in the review reported high eHealth literacy among the samples. The associations between eHealth literacy and health outcomes in PLWH were not consistent. In the areas of HIV transmission risk, retention in care, treatment adherence, and virological suppression, the role of eHealth literacy is still not fully understood. Furthermore, the implications for future research are discussed. CONCLUSIONS Understanding the role of eHealth literacy is an essential step to encourage PLWH to be actively engaged in their health care. Avenues to pursue in the role of eHealth literacy and PLWH should consider the development and use of standardized eHealth literacy definitions and measures.

scholarly journals Do Persons Living with HIV Continue to Fill Prescriptions for Antiretroviral Drugs during a Gap in Care? Analysis of a Large Commercial Claims Database

2017 ◽  
Vol 16 (6) ◽  
pp. 632-638 ◽  
Author(s):  
Kathy K. Byrd ◽  
Tim Bush ◽  
Lytt I. Gardner
Keyword(s):  
The United States ◽  
Clinic Visit ◽  
Antiretroviral Drugs ◽  
Hiv Care ◽  
Regression Analyses ◽  
Claims Database ◽  
Factors Associated ◽  
Persons Living With Hiv ◽  
Adherence Support ◽  
Living With Hiv

The significance of a gap in HIV care depends, at least partially, on whether patients continue to fill prescriptions for antiretroviral (ARV) drugs during the gap in care. We used a billing claims database to determine the proportion of persons who filled ≥1 prescription for ARV drugs during a gap in care (no clinic visit in >6 months). Persons were stratified into 3 groups: “never” (prescriptions never filled), “sometimes” (prescriptions filled >0%-<100% of months), and “always” (prescriptions filled monthly). Logistic regression analyses were conducted to determine factors associated with “never” filling ARV drugs. Of 14 308 persons, 69% (n = 9817), 13% (n = 1928), and 18% (n = 2563) “never,” “sometimes,” and “always” filled ARV drugs during the gap in care. Persons aged 18 to 29 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 1.39-1.74), women (OR = 1.67, CI 1.52-1.83), and persons from the Northeast region of the United States (OR = 1.86, CI 1.69-2.03) were more likely to never fill ARV drugs than persons aged ≥30 years, men, and persons outside the Northeast, respectively. Efforts should be made to minimize gaps in care, emphasize importance of therapy, and provide adherence support.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

2019 ◽  
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, <i>P</i>&lt;.001) but more likely to be black (82.3% vs 69.5%, <i>P</i>&lt;.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, <i>P</i>&lt;.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, <i>P</i>&lt;.001), have a CD4 &lt;200 cells/µL in 2017 (6.2% vs 4.6%, <i>P</i>&lt;.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, <i>P</i>&lt;.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon

2021 ◽  
Author(s):  
Angela M. Parcesepe ◽  
Molly Remch ◽  
Anastase Dzudie ◽  
Rogers Ajeh ◽  
Denis Nash ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

2021 ◽  
Author(s):  
Tiago Rua ◽  
Daniela Brandão ◽  
Vanessa Nicolau ◽  
Ana Escoval
Keyword(s):  
Positive Impact ◽  
Cost Effective ◽  
Relative Magnitude ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Continuum Of Care ◽  
Clinical Conditions ◽  
Study Designs ◽  
Living With Hiv ◽  
Payment Models

AbstractThe increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system’s financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.

scholarly journals Bijou: Engaging Young MSM in HIV Care Using a Mobile Health Strategy

2021 ◽  
Vol 20 ◽  
pp. 232595822110308
Author(s):  
Tiffany Chenneville ◽  
Hunter Drake ◽  
Kemesha Gabbidon ◽  
Carina Rodriguez ◽  
Lisa Hightow-Weidman
Keyword(s):  
Health Literacy ◽  
Self Efficacy ◽  
Retention In Care ◽  
Knowledge Retention ◽  
Hiv Care ◽  
Ehealth Literacy ◽  
Literacy Engagement ◽  
Southeastern Us ◽  
Post Test ◽  
Living With Hiv

Young men who have sex with men (YMSM) living with HIV experience challenges with retention in care, which negatively affects viral suppression. To address this, researchers piloted Bijou, a program designed to provide health education through electronically delivered behavior and risk reduction modules. Participants were 29 YMSM aged 19-24 living with HIV from the southeastern US. Participants completed pre, post, and 3-month follow-up (3MFU) surveys assessing knowledge, intervention acceptability, satisfaction, self-efficacy, ehealth literacy, and usability. Findings revealed significant improvement in knowledge and e-health literacy from pre-test to post-test but lost significance at 3MFU. Self-efficacy scores did not show significant differences from pre-test to post-test or 3MFU. Participants who completed all modules considered Bijou usable and acceptable; however, many did not complete the program. Findings suggest a need for adaptations to promote knowledge retention, e-health literacy, engagement over time, and research with a larger, more representative sample.

scholarly journals A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya

2021 ◽  
Author(s):  
Ashley Chory ◽  
Grant Callen ◽  
Winstone Nyandiko ◽  
Tabitha Njoroge ◽  
Celestine Ashimosi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Behavioral Health ◽  
Treatment Adherence ◽  
Peer Support ◽  
Mobile Technologies ◽  
Hiv Care ◽  
Individual Counseling ◽  
Middle Income ◽  
Western Kenya ◽  
Living With Hiv

AbstractMobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.

scholarly journals Couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e037468
Author(s):  
Alyssa Paige Tabrisky ◽  
Lara S Coffin ◽  
David P Olem ◽  
Torsten B Neilands ◽  
Mallory O'Neill Johnson
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Virological Suppression ◽  
Hiv Care ◽  
Randomised Control Trial ◽  
Engagement In Care ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
Counselling Intervention

Introduction Advances in HIV treatment have proven to be effective in increasing virological suppression, thereby decreasing morbidity, and increasing survival. Medication adherence is an important factor in reducing viral load among people living with HIV (PLWH) and in the elimination of transmission of HIV to uninfected partners. Achieving optimal medication adherence involves individuals taking their medications every day or as prescribed by their provider. However, not all PLWH in the USA are engaged in care, and only a minority have achieved suppressed viral load (viral load that is lower than the detectable limit of the assay). Sexual and gender minorities (SGM; those who do not identify as heterosexual or those who do not identify as the sex they were assigned at birth) represent a high-risk population for poor clinical outcomes and increased risk of HIV transmission, as they face barriers that can prevent optimal engagement in HIV care. Research in dyadic support, specifically within primary romantic partnerships, offers a promising avenue to improving engagement in care and treatment outcomes among SGM couples. Dyadic interventions, especially focused on primary romantic partnerships, have the potential to have a sustained impact after the structured intervention ends. Methods and analysis This paper describes the protocol for a randomised control trial of a theory-grounded, piloted intervention (DuoPACT) that cultivates and leverages the inherent sources of support within primary romantic relationships to improve engagement in HIV care and thus clinical outcomes among persons who are living with HIV and who identify as SGM (or their partners). Eligible participants must report being in a primary romantic relationship for at least 3 months, speak English, at least one partner must identify as a sexual or gender minority and at least one partner must be HIV+ with suboptimal engagement in HIV care, defined as less than excellent medication adherence, having not seen a provider in at least the past 8 months, having a detectable or unknown viral load or not currently on antiretroviral therapy. Eligible consenting couples are allocated equally to the two study arms: a structured six-session couples counselling intervention (DuoPACT) or a three-session individually-delivered HIV adherence counselling intervention (LifeSteps). The primary aim is to evaluate the efficacy of DuoPACT on virological suppression among HIV+ members of SGM couples with suboptimal engagement in care. The DuoPACT study began its target enrolment of 150 couples (300 individuals) in August 2017, and will continue to enrol until June 2021. Ethics and dissemination All procedures are approved by the Institutional Review Board at the University of California, San Francisco. Written informed consent is obtained from all participants at enrolment, and study progress is reviewed twice yearly by an external Safety Monitoring Committee. Dissemination activities will include formal publications and report back sessions with the community. Trial registration number NCT02925949; Pre-results.

Imaging modalities for cardiovascular phenotyping in asymptomatic people living with HIV

2021 ◽  
pp. 1358863X2097870
Author(s):  
Maria Bonou ◽  
Chris J Kapelios ◽  
Eleni Athanasiadi ◽  
Sophie I Mavrogeni ◽  
Mina Psichogiou ◽  
...  
Keyword(s):  
Cardiac Computed Tomography ◽  
Imaging Modalities ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Improve Risk Stratification ◽  
Positron Emission ◽  
Pet Ct ◽  
Living With Hiv ◽  
Subclinical Cvd ◽  
Related Mortality

Cardiovascular disease (CVD) has emerged as a leading cause of non-HIV-related mortality among people living with HIV (PLWH). Despite the growing CVD burden in PLWH, there is concern that general population risk score models may underestimate CVD risk in these patients. Imaging modalities have received mounting attention lately to better understand the pathophysiology of subclinical CVD and provide improved risk assessment in this population. To date, traditional and well-established techniques such as echocardiography, pulse wave velocity, and carotid intima thickness continue to be the basis for the diagnosis and subsequent monitoring of vascular atherosclerosis and heart failure. Furthermore, novel imaging tools such as cardiac computed tomography (CT) and cardiac CT angiography (CCTA), positron emission tomography/CT (PET/CT), and cardiac magnetic resonance (CMR) have provided new insights into accelerated cardiovascular abnormalities in PLWH and are currently evaluated with regards to their potential to improve risk stratification.

scholarly journals Salud y Orgullo Mexicano: Development of a Culturally Specific Transnational Linkage and Retention in Care Intervention for Mexican Men Who Have Sex with Men Living with HIV in Chicago

2021 ◽  
Author(s):  
Amy K. Johnson ◽  
Román Buenrostro ◽  
Gilberto Soberanis ◽  
Banita McCarn ◽  
Bridget Magner ◽  
...  
Keyword(s):  
Intervention Mapping ◽  
Retention In Care ◽  
Hiv Care ◽  
Individual Level ◽  
Expert Advisory ◽  
Mapping Process ◽  
Sex With Men ◽  
Peer Navigation ◽  
Living With Hiv ◽  
Mexican Men

AbstractThis manuscript documents the development of an innovative individual-level peer navigation intervention “Salud y Orgullo Mexicano” (SOM) designed to increase linkage and retention to HIV care for Mexican men who have sex with men (MSM) in Chicago, Illinois. The intervention was developed via a modified intervention mapping process. Elements of two existing interventions were combined and refined with input from the Mexican MSM community, including informant interviews, an expert advisory board, and a design team. A manualized transnational intervention was developed via intervention mapping. A peer health navigation intervention “SOM” was created using intervention mapping and input from the focus community. Next steps include implementing and evaluating the intervention to determine acceptability and efficacy.

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