Barriers to HIV treatment adherence among adults living with HIV in the eastern Dominican Republic

Despite access to nationally supplied antiretroviral treatment, viral load suppression rates remain suboptimal in the Dominican Republic. Counseling and support services are available but mainly targeted to those identified as having the most need. At Clínica de Familia La Romana (CFLR) in La Romana, all patients undergo a structured baseline interview including exploration of expected barriers to care. We conducted a retrospective cohort study of a random sample of patients at CFLR with treatment initiation between 1 January 2015 and 1 December 2017 to determine if self-identified barriers to HIV care predict viral load suppression. Viral load suppression occurred in 63% of the 203 patients evaluated. Lack of food ( n = 19) was significantly associated with lack of viral suppression (OR 3.0, 95% CI 1.14–7.87). Nondisclosure of HIV status ( n = 24) showed evidence for a protective effect (OR 0.33; 95% CI 0.11–1.0). Further steps should be taken to address food insecurity as well as to understand associated barriers to care among individuals with food insecurity.

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896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1091 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S539-S539

Author(s):

Michelle Zhang ◽

Sharlay Butler ◽

Jason Kennedy ◽

Molly McKune ◽

Ghady Haidar ◽

...

Keyword(s):

Viral Load ◽

Viral Suppression ◽

Retention In Care ◽

Hiv Treatment ◽

Hiv Care ◽

Viral Load Suppression ◽

Sti Prevention ◽

Prevention Services ◽

The Impact ◽

Non Parametric

Abstract Background We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results 1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth. Disclosures Ghady Haidar, MD, Karuys (Grant/Research Support)

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Peers Keep It Real: Re-engaging Adults in HIV Care

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219838858 ◽

2019 ◽

Vol 18 ◽

pp. 232595821983885 ◽

Cited By ~ 3

Author(s):

Maithe Enriquez ◽

An-Lin Cheng ◽

David McKinsey ◽

Rose Farnan ◽

Gerry Ortego ◽

...

Keyword(s):

Viral Load ◽

Change Agents ◽

Hiv Treatment ◽

Hiv Care ◽

Control Group ◽

Viral Load Suppression ◽

Effective Interventions ◽

Peer Intervention ◽

Living With Hiv ◽

Priority Population

Background: After diagnosis, a substantial number of people with HIV disease fall out of care. Effective interventions are needed for this priority population. Methods: The “Peers Keep It Real” study aimed to help adults who were disengaged from HIV treatment. Peers, lay individuals living with HIV, facilitated intervention sessions. Participants were randomized to immediately receive the peer-facilitated intervention or were wait-listed. Results: Considerable attrition occurred in the control group. Pre-/postanalyses showed that among participants (n = 23) who received the intervention, 65% had viral load suppression and 100% remained in care at 12 months postintervention. Impact on viral load was significant ( P = .0326), suggesting that peers are effective change agents who positively impacted outcomes for individuals struggling with adherence to HIV treatment. Conclusion: Future endeavors should consider providing all individuals from this priority population with an active peer intervention from the onset to enhance retention and adherence.

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Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/24043 ◽

2020 ◽

Vol 9 (12) ◽

pp. e24043

Author(s):

Kathryn Elizabeth Muessig ◽

Jesse M Golinkoff ◽

Lisa B Hightow-Weidman ◽

Aimee E Rochelle ◽

Marta I Mulawa ◽

...

Keyword(s):

Hiv Testing ◽

Viral Suppression ◽

The United States ◽

Hiv Care ◽

Hiv Status ◽

Mhealth Intervention ◽

Sex With Men ◽

The University ◽

Living With Hiv ◽

Hiv Negative

Background Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. Objective Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care–related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. Methods We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. Results Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. Conclusions Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. Trial Registration ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. International Registered Report Identifier (IRRID) DERR1-10.2196/24043

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A modified HIV continuum of care: A six-year evaluation of a viral load cascade at a hospital-based clinic in Kingston, Jamaica

International Journal of STD & AIDS ◽

10.1177/0956462419839514 ◽

2019 ◽

Vol 30 (8) ◽

pp. 748-755 ◽

Cited By ~ 1

Author(s):

Geoffrey J Barrow ◽

Margaret L Brandeau

Keyword(s):

Viral Load ◽

Statistical Analysis ◽

Viral Suppression ◽

Care Delivery ◽

Continuum Of Care ◽

Hiv Care ◽

Viral Load Suppression ◽

Outcome Indicators ◽

Care Continuum ◽

Hiv Continuum Of Care

To achieve the goal of HIV viral suppression, provision of medication alone is not sufficient. Concomitant frameworks to evaluate HIV care delivery programmes are needed. This study examined the care continuum at a hospital-based HIV clinic in Kingston, Jamaica using a modified HIV continuum of care, with an increased focus on viral load indicators (viral load samples taken, results returned and viral suppression). A statistical analysis of patient flow through the care continuum to identify gaps in programme delivery was performed. Key programmatic areas for process improvement and the utility of this approach for viral load suppression interpretation were identified. Between 2010 and 2015, more than 1600 patients had been registered for care and more than 1000 had accessed antiretroviral therapy at this location. Consistent trends in programme performance were seen from 2010 to 2012. Although declines in the proportion of viral load samples taken and results returned occurred because of laboratory failures in 2013, the trend of increasing numbers and proportions of virally suppressed patients continued. Statistical analysis indicated that improvements in laboratory quality (fraction of viral load samples returned with accurate test results) could increase viral load suppression among patients at the clinic by up to 17%. Refining care delivery processes can significantly improve HIV viral load suppression rates. Expanding monitoring frameworks to include all of the essential processes that affect final outcome indicators can provide valuable insight into trends of outcome indicators and programme performance.

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Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.24043 ◽

2020 ◽

Author(s):

Kathryn Elizabeth Muessig ◽

Jesse M Golinkoff ◽

Lisa B Hightow-Weidman ◽

Aimee E Rochelle ◽

Marta I Mulawa ◽

...

Keyword(s):

Hiv Testing ◽

Viral Suppression ◽

The United States ◽

Hiv Care ◽

Hiv Status ◽

Mhealth Intervention ◽

Sex With Men ◽

The University ◽

Living With Hiv ◽

Hiv Negative

BACKGROUND Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. OBJECTIVE Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care–related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. METHODS We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. RESULTS Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. CONCLUSIONS Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. CLINICALTRIAL ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/24043

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Determinants of viral load non-suppression among people living with HIV on antiretroviral therapy in Kumasi, Ghana

Ghana Medical Journal ◽

10.4314/gmj.v55i2.3 ◽

2021 ◽

Vol 55 (2) ◽

pp. 111-117

Author(s):

David Ansah ◽

Emmanuel Kumah ◽

Vitalis Bawontuo ◽

Peter Agyei-Baffour ◽

Emmanuel K Afriyie

Keyword(s):

Viral Load ◽

Educational Level ◽

Viral Suppression ◽

Outcome Measure ◽

People Living With Hiv ◽

Viral Load Suppression ◽

Cross Sectional ◽

Factors Associated ◽

Comorbidity Status ◽

Living With Hiv

Objectives: To determine the rate and factors associated with viral load non-suppression among adults living with HIV/AIDS on active anti-retroviral therapy (ART).Design: A retrospective cross-sectional studySetting: Three ART clinics in Kumasi, GhanaParticipants: All HIV-infected adults who were ≥18 years and on active ART for 12 months and whose viral loadnhad been estimated were included.Main outcome measure: Unsuppressed viral load among patients on ARTResults: In all, 483 HIV patients were included in the study, with 369 (76.4%) achieving viral load suppression. Gender, educational level, comorbidity status, and duration on ART were independently associated with viral nonsuppression (p < 0.05).Conclusions: This study has revealed that the rate of viral suppression in the study area is lower than the UNAIDS 90% target. The findings have implications on designing new and stemming up implementation of existing interventions to improve the rate of viral suppression among patients in the study area. It is also necessary that more of such studies are replicated in other parts of the country to identify risk factors for virological failure among patients on ART.

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238. Is There an Ideal Age to Disclose HIV-Status to Youth Who are Unaware that They are Living With HIV to Maximize the Likelihood of Ongoing Viral Load Suppression?

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2019.11.241 ◽

2020 ◽

Vol 66 (2) ◽

pp. S120-S121

Author(s):

Lori Mills ◽

Lauren EB. Marefka ◽

Sequoya A. Eady ◽

Dayna Cook ◽

Tina Simpson ◽

...

Keyword(s):

Viral Load ◽

Hiv Status ◽

Viral Load Suppression ◽

Living With Hiv

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Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression among Young People Living with HIV (Preprint)

10.2196/preprints.33990 ◽

2021 ◽

Author(s):

Sean Arayasirikul ◽

Caitlin M Turner ◽

Dillon Trujillo ◽

Jarett Maycott ◽

Erin C Wilson

Keyword(s):

Mental Health ◽

Viral Load ◽

Young People ◽

Text Messaging ◽

Viral Suppression ◽

Hiv Care ◽

People Living With Hiv ◽

Social Inequities ◽

Sex With Men ◽

Living With Hiv

BACKGROUND The HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, anti-trans discrimination, and racism, shaping not only those at-risk for HIV infection, but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. OBJECTIVE This study assessed 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV (YPLWH) in San Francisco We examined dose-response relationships between intervention exposure (e.g. text messaging) and viral suppression and mental health. Health electronic navigation (eNavigation or eNav) is a 6-month, text message-based, digital HIV care navigation intervention, in which YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included: identifying as a man who has sex with men or a trans woman; being between the ages of 18 and 34 years; and being newly diagnosed with HIV or not being engaged/retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographic, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations (GEE) to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. RESULTS Over the entire 12-month study period showed that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio, aOR = 1.01, 95% CI = 1.00 – 1.02, p = 0.03). We found that mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term: 0.97, 95%CI = 0.96-0.99, p < 0.01). CONCLUSIONS Digital care navigation interventions like Health eNavigation may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics due to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped to improve viral suppression and mental health – intersecting, co-morbid conditions – 6-months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

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Psychiatric Symptoms and Barriers to Care in HIV-Infected Individuals Who Are Lost to Care

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957417711254 ◽

2017 ◽

Vol 16 (5) ◽

pp. 423-429 ◽

Cited By ~ 2

Author(s):

Carmen P. McLean ◽

Natalie G. Gay ◽

David A. Metzger ◽

Edna B. Foa ◽

Keyword(s):

Viral Load ◽

Psychiatric Disorders ◽

Risk Behaviors ◽

Barriers To Care ◽

Psychiatric Symptoms ◽

Self Report ◽

Hiv Care ◽

People Living With Hiv ◽

Blood Draw ◽

Living With Hiv

Past studies of barriers to HIV care have not comprehensively assessed psychiatric symptoms, and few have assessed barriers to care among people living with HIV (PLWH) who are lost to care (LTC). We examined psychiatric symptoms, barriers to HIV care, and immune functioning in PLWH who were retained in care (RIC; n = 21) or LTC (n = 21). Participants completed diagnostic interviews for posttraumatic stress disorder (PTSD) and other psychiatric disorders, self-report measures of HIV risk behaviors and psychiatric symptoms, and a blood draw to assess viral load. Compared to RIC participants, LTC participants met criteria for a greater number of psychiatric disorders and reported greater depressive symptoms and more barriers to HIV care. There were no group differences in PTSD severity, risk behaviors, or viral load, suggesting that LTC individuals experience greater psychiatric problems and perceive more barriers to care than RIC participants, but are not less likely to have achieved viral suppression.

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