Public health counselling following an HIV diagnosis among men who have sex with men: tensions between individual needs and health protection mandates

2020 ◽  
pp. 174498712093296
Author(s):  
Lauren Orser ◽  
Patrick O'Byrne
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Public Health Nurses ◽  
Hiv Diagnosis ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Health Counselling

Background In Ontario, provincial regulations stipulate that public health units must complete post-test counselling with all persons newly diagnosed with human immunodeficiency virus. Public health nurses conduct this follow-up and are responsible for ensuring appropriate surveillance and management of human immunodeficiency virus with the primary objective of reducing ongoing human immunodeficiency virus transmission in their health jurisdiction. To date, little research has explored the effectiveness of this mandatory public health counselling from the perspective of patients – the majority of whom are men who have sex with men. Aims To address gaps in public health nursing practice, a pilot study was conducted with men who have sex with men in Ottawa to explore their attitudes and experiences of receiving mandatory human immunodeficiency virus follow-up after their diagnosis. Methods Qualitative interviews were conducted and interpreted using thematic analysis. Results This analysis revealed a contrariety between the needs of individuals and of public health units, with patients' perceiving their personal wishes to be secondary to public health mandates – and led patients to simultaneously want to evade, and be assisted by, public health nurses. Conclusions Public health units and nurses should consider adopting a more patient-centered approach to HIV case management, which incorporates patients’ experiences of receiving an HIV diagnosis.

scholarly journals Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam

2020 ◽  
Author(s):  
Maartje Dijkstra ◽  
Martijn S van Rooijen ◽  
Mariska M Hillebregt ◽  
Ard van Sighem ◽  
Colette Smit ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Viral Suppression ◽  
Standard Of Care ◽  
Combination Antiretroviral Therapy ◽  
Hiv Diagnosis ◽  
Cart Initiation ◽  
Immunodeficiency Virus ◽  
Targeted Testing ◽  
Sex With Men

Abstract Background Men who have sex with men (MSM) with acute human immunodeficiency virus (HIV) infection (AHI) are a key source of new infections. To curb transmission, we implemented a strategy for rapid AHI diagnosis and immediate initiation of combination antiretroviral therapy (cART) in Amsterdam MSM. We assessed its effectiveness in diagnosing AHI and decreasing the time to viral suppression. Methods We included 63 278 HIV testing visits in 2008–2017, during which 1013 MSM were diagnosed. Standard of care (SOC) included HIV diagnosis confirmation in < 1 week and cART initiation in < 1 month. The AHI strategy comprised same-visit diagnosis confirmation and immediate cART. Time from diagnosis to viral suppression was assessed for 3 cART initiation periods: (1) 2008–2011: cART initiation if CD4 < 500 cells/μL (SOC); (2) January 2012–July 2015: cART initiation if CD4 < 500 cells/μL, or if AHI or early HIV infection (SOC); and (3a) August 2015–June 2017: universal cART initiation (SOC) or (3b) August 2015–June 2017 (the AHI strategy). Results Before implementation of the AHI strategy, the proportion of AHI among HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time (in days) to viral suppression during periods 1, 2, 3a, and 3b was 584 (interquartile range [IQR], 267–1065), 230 (IQR, 132–480), 95 (IQR, 63–136), and 55 (IQR, 31–72), respectively (P < .001). Conclusions Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.

scholarly journals Knowledge and Awareness of Acute Human Immunodeficiency Virus Infection Among Mobile App-Using Men Who Have Sex With Men: A Missed Public Health Opportunity

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Aaron J. Siegler ◽  
Travis Sanchez ◽  
R. Craig Sineath ◽  
Jeremy Grey ◽  
Erin Kahle ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Online Survey ◽  
Mobile App ◽  
Acute Hiv Infection ◽  
Immunodeficiency Virus ◽  
Acute Hiv ◽  
Sex With Men

Abstract In a national online survey, we assessed awareness and knowledge of acute human immunodeficiency virus (HIV) infection manifestation among 1748 men who have sex with men (MSM). Only 39% of respondents were aware that acute HIV infection may be accompanied by symptoms. Education and increased access to acute HIV testing may facilitate MSM to appropriately seek acute HIV testing.

scholarly journals Defining linkage to care following human immunodeficiency virus (HIV) diagnosis for public health monitoring in Europe

2018 ◽  
Vol 23 (48) ◽  
Author(s):  
Sara Croxford ◽  
Dorthe Raben ◽  
Stine F Jakobsen ◽  
Fiona Burns ◽  
Andrew Copas ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Health Monitoring ◽  
Linkage To Care ◽  
Hiv Treatment ◽  
Data Availability ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Public Health Monitoring ◽  
Immunodeficiency Virus

Prompt linkage to human immunodeficiency virus (HIV) care after diagnosis is crucial to ensure optimal patient outcomes. However, few countries monitor this important public health marker and different definitions have been applied, making country and study comparisons difficult. This article presents an expert-agreed, standard definition of linkage to care for a pragmatic approach to public health monitoring, appropriate to the European context. Here, linkage to care is defined as patient entry into specialist HIV care after diagnosis, measured as the time between the HIV diagnosis date and one of the following markers: either the first clinic attendance date, first CD4+ cell count or viral load date, or HIV treatment start date, depending on data availability; Linkage is considered prompt if within 3 months of diagnosis. Application of this definition by researchers and public health professionals when reporting surveillance or research data relating to linkage to care after HIV diagnosis will enable reliable comparisons across countries, better assessment of the success of health services programmes aimed at improving peoples access to HIV treatment and care and the identification of barriers limiting access to HIV care across Europe.

scholarly journals Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe

2021 ◽  
Vol 8 ◽  
Author(s):  
Bruno Sepodes ◽  
João Rocha ◽  
Jorge Batista ◽  
Maria-Eduardo Figueira ◽  
František Dráfi ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Public Health Intervention ◽  
The United States ◽  
World Health ◽  
European Economic Area ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM). In a region such as Europe, with approximately double the USA population, it is estimated that not even 10% have proper access to PrEP, and given the lack of coordination with healthcare, taking PrEP has to be at their own expense. Here, we identify the reasons behind the 4-year lag in the approval of PrEP in the European Union/European Economic Area (and Europe in general) and explore the efficacy and effectiveness of PrEP needed to be confirmed with some implementation or demonstration studies conducted in the region. Independent of the data gathered, access of MSM to PrEP is far from ideal in Europe and much still needs to be done. The demonstration of the cost-effectiveness of PrEP alongside other social and behavioral factors needs to be addressed, while the clear populations within MSM that will benefit from this intervention are properly identified and make use of the latest recommendations of the World Health Organization that consider not only daily PrEP but also event-driven PrEP. The momentum for the proper implementation of PrEP in the EU is not lost, and with the existence of generics and even new formulations, there is a renewed opportunity for unleashing the public health benefits arising from this pharmacological tool with other interventions in place (e.g., condoms, testing, and counseling).

scholarly journals Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis

2013 ◽  
Vol 34 (9) ◽  
pp. 875-892 ◽  
Author(s):  
David T. Kuhar ◽  
David K. Henderson ◽  
Kimberly A. Struble ◽  
Walid Heneine ◽  
Vasavi Thomas ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Hiv Testing ◽  
Public Health Service ◽  
Occupational Exposures ◽  
Expert Consultation ◽  
Postexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
Hiv Exposure

This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologie, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendation—PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1; (6) close follow-up for exposed personnel (Box 2) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendation—if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure (Box 2); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.

Anal Squamous Intraepithelial Lesions (SILs) in Human Immunodeficiency Virus–Positive Men Who Have Sex With Men: Incidence and Risk Factors of SIL and of Progression and Clearance of Low-Grade SILs

2019 ◽  
Vol 222 (1) ◽  
pp. 62-73 ◽  
Author(s):  
V W Jongen ◽  
O Richel ◽  
E Marra ◽  
M L Siegenbeek van Heukelom ◽  
A van Eeden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Hiv Positive ◽  
Low Grade ◽  
Squamous Intraepithelial Lesions ◽  
Immunodeficiency Virus ◽  
Anal Squamous Intraepithelial Lesions ◽  
Sex With Men ◽  
Intraepithelial Lesions

Abstract Background Human immunodeficiency virus (HIV)–positive men who have sex with men (MSM) are at risk of anal squamous cell carcinoma. Data are limited on the natural history of the precursor to this carcinoma, anal squamous intraepithelial lesions (SILs). Methods HIV-positive MSM were screened for histopathological SILs by means of high-resolution anoscopy (HRA). For participants without SILs at baseline, we estimated the cumulative incidence and risk factors for SILs. For those with low-grade SILs (LSILs) at baseline, the risk of progression to high-grade SILs (HSILs) and the clearance rate were estimated at the lesion level. Results Of 807 men without SILs at baseline, 107 underwent follow-up HRA between 1 to 4.5 years later. At the second visit 18 men (16.8%) showed LSIL, and 25 (23.4%) HSIL. Age was associated with incident LSILs (adjusted odds ratio [aOR], 2.10 per 10-year increase in age; P = .01). Of 393 men with LSILs at baseline, 114 underwent follow-up HRA 0.5 to 2.5 years later. Of the 177 LSILs found at baseline, 87 (49.2%) had cleared at the second visit, and 29 (16.4%) had progressed to HSILs. Conclusion Incident LSILs and HSILs were common during follow-up among HIV-positive MSM without dysplasia at baseline. Among men with LSILs at baseline, nearly half of these lesions cleared, and a small portion progressed.

scholarly journals Neurosyphilis: Old Disease, New Implications for Emergency Physicians

2019 ◽  
Vol 4 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Laura Mercurio ◽  
Lynn Taylor ◽  
Angela Jarman
Keyword(s):  
At Risk ◽  
Human Immunodeficiency Virus ◽  
Cranial Nerve ◽  
Emergency Physicians ◽  
Hiv Diagnosis ◽  
Neurologic Deficits ◽  
Epidemiologic Data ◽  
Immunodeficiency Virus ◽  
Risk Patients ◽  
Sex With Men

Recent epidemiologic data demonstrate increasing rates of neurosyphilis, particularly among those in the community of men who have sex with men and those coinfected with the human immunodeficiency virus (HIV). Here we discuss a case of early neurosyphilis and new HIV diagnosis in a 27-year-old previously-healthy trans woman presenting for the second time with progressive, ascending weakness and cranial nerve VI palsy. Emergency physicians should consider this rare but highly morbid diagnosis, given the rising prevalence of neurosyphilis among at-risk patients and those with new neurologic deficits.

scholarly journals Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

2019 ◽  
Vol 71 (8) ◽  
pp. e308-e315
Author(s):  
McKaylee M Robertson ◽  
Sarah L Braunstein ◽  
Donald R Hoover ◽  
Sheng Li ◽  
Denis Nash
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Testing ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Population Based ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

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