A changing demographic – Ten years of HIV care

2021 ◽  
pp. 095646242110436
Author(s):  
Nadra Nurdin ◽  
Siobhan Quirke ◽  
Colm Kerr ◽  
Niamh Allen ◽  
Jane O’Halloran ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
South American ◽  
Health Prevention ◽  
The Past ◽  
B Virus ◽  
South American Origin ◽  
Time Acquisition ◽  
Over Time

We aimed to benchmark the quality of care and describe characteristics of patients newly attending the HIV clinic at differing time points over the past 10 years, against the Infectious Disease Society of America HIV/AIDS performance measures. We performed a retrospective analysis of records for patients newly attending the HIV clinic in 2011, 2016 and 2018. There was an increase in male attendees in 2018 and 2016 compared to 2011 (88%, 88% vs. 59% p < .001), viral suppression rates were 97%, 83% and 99% ( p < .001), respectively. We observed an increase in patients of South American origin over time. Acquisition risk changed, with increased proportion of MSM (24% in 2011 vs 78% in 2018, p < .001), lower rates of heterosexual (20% in 2018 vs 48% in 2011, p < .001) and IDU transmission (1.5% in 2018 vs 24% in 2011, p < .001). There were lower rates of Chlamydia trachomatis and Neisseria gonorrhoeae testing in 2018 (72%, p < .001), compared to 2016 (84%) and 2011 (83%). Hepatitis B virus vaccination and pneumococcal vaccine rates are declining ( p < .001). We demonstrate the changes in both ethnicity and risk of acquisition over time, high rates of antiretroviral therapy prescription and viral suppression, and highlight the importance of health prevention with sexual health screening and vaccination in this population.

scholarly journals Enhancing Collaborative Filtering by User-User Covariance Matrix

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yingyuan Xiao ◽  
Jingjing Shi ◽  
Wenguang Zheng ◽  
Hongya Wang ◽  
Ching-Hsien Hsu
Keyword(s):  
Collaborative Filtering ◽  
Covariance Matrix ◽  
Personalized Recommendation ◽  
Similarity Matrix ◽  
User Similarity ◽  
Filtering Method ◽  
The Past ◽  
Changing Trends ◽  
Over Time

The collaborative filtering (CF) approach is one of the most successful personalized recommendation methods so far, which is employed by the majority of personalized recommender systems to predict users’ preferences or interests. The basic idea of CF is that if users had the same interests in the past they will also have similar tastes in the future. In general, the traditional CF may suffer the following problems: (1) The recommendation quality of CF based system is greatly affected by the sparsity of data. (2) The traditional CF is relatively difficult to adapt the situation that users’ preferences always change over time. (3) CF based approaches are used to recommend similar items to a user ignoring the user’s demand for variety. In this paper, to solve the above problems we build a new user-user covariance matrix to replace the traditional CF’s user-user similarity matrix. Compared with the user-user similarity matrix, the user-user covariance matrix introduces the user-user covariance to finely describe the changing trends of users’ interests. Furthermore, we propose an enhancing collaborative filtering method based on the user-user covariance matrix. The experimental results show that the proposed method can significantly improve the diversity of recommendation results and ensure the good recommendation precision.

scholarly journals Variation in HIV care and treatment outcomes by facility in South Africa, 2011–2015: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003479
Author(s):  
Jacob Bor ◽  
Anna Gage ◽  
Dorina Onoya ◽  
Mhairi Maskew ◽  
Yorghos Tripodis ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Urban Areas ◽  
Viral Suppression ◽  
Laboratory Data ◽  
Hiv Treatment ◽  
Cd4 Count ◽  
Hiv Care ◽  
Western Cape ◽  
Care And Treatment

Background Despite widespread availability of HIV treatment, patient outcomes differ across facilities. We propose and evaluate an approach to measure quality of HIV care at health facilities in South Africa’s national HIV program using routine laboratory data. Methods and findings Data were extracted from South Africa’s National Health Laboratory Service (NHLS) Corporate Data Warehouse. All CD4 counts, viral loads (VLs), and other laboratory tests used in HIV monitoring were linked, creating a validated patient identifier. We constructed longitudinal HIV care cascades for all patients in the national HIV program, excluding data from the Western Cape and very small facilities. We then estimated for each facility in each year (2011 to 2015) the following cascade measures identified a priori as reflecting quality of HIV care: median CD4 count among new patients; retention 12 months after presentation; 12-month retention among patients established in care; viral suppression; CD4 recovery; monitoring after an elevated VL. We used factor analysis to identify an underlying measure of quality of care, and we assessed the persistence of this quality measure over time. We then assessed spatiotemporal variation and facility and population predictors in a multivariable regression context. We analyzed data on 3,265 facilities with a median (IQR) annual size of 441 (189 to 988) lab-monitored HIV patients. Retention 12 months after presentation increased from 42% to 47% during the study period, and viral suppression increased from 66% to 79%, although there was substantial variability across facilities. We identified an underlying measure of quality of HIV care that correlated with all cascade measures except median CD4 count at presentation. Averaging across the 5 years of data, this quality score attained a reliability of 0.84. Quality was higher for clinics (versus hospitals), in rural (versus urban) areas, and for larger facilities. Quality was lower in high-poverty areas but was not independently associated with percent Black. Quality increased by 0.49 (95% CI 0.46 to 0.53) standard deviations from 2011 to 2015, and there was evidence of geospatial autocorrelation (p < 0.001). The study’s limitations include an inability to fully adjust for underlying patient risk, reliance on laboratory data which do not capture all relevant domains of quality, potential for errors in record linkage, and the omission of Western Cape. Conclusions We observed persistent differences in HIV care and treatment outcomes across South African facilities. Targeting low-performing facilities for additional support could reduce overall burden of disease.

scholarly journals STREET ANTHROPOLOGY – A CULTURE OF MOBILITY

space&FORM ◽  
2021 ◽  
Vol 45 ◽  
pp. 109-136
Author(s):  
Marek Czyński ◽  
Keyword(s):  
Cultural Identity ◽  
Economic Capital ◽  
Urban Life ◽  
The Past ◽  
Balanced Approach ◽  
Spatial Policy ◽  
Characteristic Features ◽  
Over Time ◽  
Space Of Flows

The street anthropology is identical with the anthropology of urban life. In the past, a street was a place to socialize and, on equal footing with its architecture, it was part of the cultural identity of its inhabitants. The street reflects residents’ social, cultural and economic capital. Over time, mobility and communication accessibility have dominated the urban spatial policy. The contemporary street has become a "space of flows". The restoration of its original role requires a more balanced approach to cultural factors that determine the quality of life in a city. The article discusses characteristic features that determine patterns of mobility in modern streets.

scholarly journals The cost and effect of expanding a Patient Tracer programme to identify and return patients loss to follow up at a large HIV Clinic in Trinidad

2020 ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Treatment Clinic ◽  
The Status ◽  
Clinic Medical ◽  
The Cost ◽  
Lost To Follow Up ◽  
Over Time

Abstract Background: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study evaluated the effect and cost of expanding an intervention using two Patient Tracers to track and return to care patients lost to follow up at a large HIV Clinic in Trinidad.Methods: Two Social Workers were trained as Patient Tracers and hired initially for 6 months (April –September 2017), then extended to 15 months (April 2017 – June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016 – May 2018 at the HIV Clinic Medical Research Foundation of Trinidad and Tobago. Both the outcomes of the intervention, and costs were assessed over time. Results: Over the 15 month period, of the of 2,473 patients who missed their scheduled visits for one month or more, 261 (10.6%) patients were no longer in active care - 89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2,212 patients eligible for tracing, 1,794 (81.1%) patients were returned to care at an average cost of $38.09 USD per patient returned to care as compared to 589 of 866 (68%) patients returned to care over the 6 month period (p < 0.001) at an estimated cost of $47.72 USD per patient returned to care (p<0.001). Of the 1,794 patients returned to care, 1,686 (94%) were re-initiated/started on anti-retroviral therapy and 72.7% of these were virally suppressed (viral load <1,000 copies/ml) as of December 2018.Conclusions: Patient Tracing is a feasible and effective intervention to identify and resolve the status of patients who are loss to follow up to bring these patients back into care with the aim of achieving viral suppression on antiretroviral therapy. Over time the effect of costs of patients returned to care demonstrated greater yields making patient tracing a sustainable intervention for programmes to identify and return patients to care.

Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States

2013 ◽  
Vol 31 (11) ◽  
pp. 1471-1477 ◽  
Author(s):  
Michael N. Neuss ◽  
Jennifer L. Malin ◽  
Stephanie Chan ◽  
Pamela J. Kadlubek ◽  
John L. Adams ◽  
...  
Keyword(s):  
Clinical Information ◽  
The United States ◽  
Measuring Process ◽  
The Past ◽  
The Mean ◽  
Highly Correlated ◽  
American Society ◽  
Oncology Practice ◽  
Over Time

Purpose The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement. Methods The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement. Results Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time. Conclusion Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.

scholarly journals UFlow 1.0: A Computer Model for Projections of Urban Sprawl

2020 ◽  
Author(s):  
André Koscianski
Keyword(s):  
Urban Sprawl ◽  
Data Availability ◽  
Complex Nature ◽  
Local Conditions ◽  
The Past ◽  
Reverse Mode ◽  
History Of ◽  
Over Time ◽  
Good Agreement

Abstract. Cities concentrate most of the world’s population and are the stage of difficult problems around logistics, economy, or quality of life, to enumerate just a few. As an object of research on itself, a urban agglomeration is difficult to characterize; it is both an ensemble of various disconnected heterogeneous elements, and the product of numerous actions and effects between those elements. Studies of the structure and the functioning of cities date back to one century ago, with an increased interest in the last decades on the phenomenon of expansion and all of its impacts. Models of city growth face the complex nature of this system and are approximative. Different representations seek to balance characteristics as data availability, level of detail of internal processes, or precision. The uflow model approaches the problem with the metaphor of an abstract field, which evolves over time and signals the conversion from empty to urban cells. The procedure for calibration adjusts parameters according to the history of the region under study, and is able to capture local conditions. The implementation takes advantage of parallel hardware, and the simulation can be performed in reverse mode, a feature that can be useful to verify the adaptation of the tool to a given scenario, or to compute approximations of the past state of a region. Tests confirmed the expected behaviour of the algorithms, and good agreement with actual data. The flexibility of the concept of intensity of urbanization is open to the integration of different data sources into the model, and the possibility of simulating their evolution over time.

scholarly journals Unenlagiinae revisited: dromaeosaurid theropods from South América

2011 ◽  
Vol 83 (1) ◽  
pp. 163-195 ◽  
Author(s):  
Federico A. Gianechini ◽  
Sebastian Apesteguia
Keyword(s):  
South America ◽  
South American ◽  
The South ◽  
Important Data ◽  
The Past

Over the past two decades, the record of South American unenlagiine dromaeosaurids was substantially increased both in quantity as well as in quality of specimens. Here is presented a summary review of the South American record for these theropods.Unenlagia comahuensis, Unenlagia paynemili, and Neuquenraptor argentinus come from the Portezuelo Formation, the former genus being the most complete and with putative avian features. Neuquenraptor is more incomplete and exhibits pedal features resembling those of Unenlagia. The earliest and most complete South American dromaeosaurid is Buitreraptor gonzalezoru, whose preserved cranial remains, provides important data in the characterization of unenlagiines. The most recently described,Austroraptor cabazai also with cranial remains, allows further comparisons with Laurasian lineages and a better characterization of unenlagiines. The possible synonymy between nenlagia and Neuquenraptor is discussed. Additional evidences from Brazil and Colombia show that dinosaurs with similar dentition to that of unenlagiines were present in the whole South America. However, it is not possible to discart that these remains may belong to other unknown maniraptoran lineages, considering the increasing number of taxa of this group found in South America.

scholarly journals The HIV Care Continuum: Changes over Time in Retention in Care and Viral Suppression

PLoS ONE ◽  
2015 ◽  
Vol 10 (6) ◽  
pp. e0129376 ◽  
Author(s):  
Baligh R. Yehia ◽  
Alisa J. Stephens-Shields ◽  
John A. Fleishman ◽  
Stephen A. Berry ◽  
Allison L. Agwu ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Changes Over Time ◽  
Over Time

scholarly journals The association of recent incarceration and health outcomes among HIV-infected adults receiving care in the United States

2016 ◽  
Vol 12 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Muazzam Nasrullah ◽  
Emma Frazier ◽  
Jennifer Fagan ◽  
Felicia Hardnett ◽  
Jacek Skarbinski
Keyword(s):  
Health Outcomes ◽  
Healthcare Utilization ◽  
Viral Suppression ◽  
Geometric Mean ◽  
The United States ◽  
Hiv Care ◽  
Cross Sectional ◽  
Content Type ◽  
Factors Associated ◽  
The Past

Purpose The purpose of this paper is to describe factors associated with incarceration as well as the association between recent incarceration and HIV-related sexual risk behaviors, access to insurance, healthcare utilization (emergency department (ED) and hospital use), antiretroviral therapy (ART) prescription, and viral suppression. Design/methodology/approach Using 2009-2010 data from a cross-sectional, nationally representative three-stage sample of HIV-infected adults receiving care in the USA, the authors assessed the demographic characteristics, healthcare utilization, and clinical outcomes of HIV-infected persons who had been recently incarcerated (detention for>24 hours in the past year) using bivariate analyses. The authors used multivariable logistic regression to examine associations of recent incarceration with insurance status as well as clinical and behavioral outcomes. Findings An estimated 22,949 (95 percent confidence interval (CI) 19,062-26,836) or 5.4 percent (CI: 4.7-6.1) of all HIV-infected persons receiving care were recently incarcerated. Factors associated with recent incarceration were age <50 years, being a smoker, having high school diploma or less, being homeless, income at or below the poverty guidelines, having a geometric mean of CD4 count <500 cells/μL, and using drugs in the past 12 months. Results from multivariable modeling indicated that incarcerated persons were more likely to use ED services, and to have been hospitalized, and less likely to have achieved viral suppression. Originality/value Recent incarceration independently predicted worse health outcomes and greater use of emergency services among HIV-infected adults currently in HIV care. Options to improve the HIV continuum of care, including pre-enrollment for healthcare coverage and discharge planning, may lead to better health outcomes for HIV-infected inmates post-release.

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