scholarly journals Changing Clinician Practices and Attitudes Regarding the Use of Antiretroviral Therapy for HIV Treatment and Prevention

2016 ◽  
Vol 16 (1) ◽  
pp. 81-90 ◽  
Author(s):  
Kate Buchacz ◽  
Jennifer Farrior ◽  
Geetha Beauchamp ◽  
Laura McKinstry ◽  
Ann E. Kurth ◽  
...  
Keyword(s):  
New York ◽  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Unprotected Sex ◽  
Hiv Care ◽  
Web Based ◽  
Treatment And Prevention ◽  
Clinician Practices

As part of the HPTN 065 study in the Bronx, New York and Washington, the authors, we surveyed clinicians to assess for shifts in their practices and attitudes around HIV treatment and prevention. Antiretroviral therapy (ART)-prescribing clinicians at 39 HIV care sites were offered an anonymous Web-based survey at baseline (2010-2011) and at follow-up (2013). The 165 respondents at baseline and 141 respondents at follow-up had similar characteristics—almost 60% were female, median age was 47 years, two-thirds were physicians, and nearly 80% were HIV specialists. The percentage who reported recommending ART irrespective of CD4 count was higher at follow-up (15% versus 68%), as was the percentage who would initiate ART earlier for patients having unprotected sex with partners of unknown HIV status (64% versus 82%), and for those in HIV-discordant partnerships (75% versus 87%). In line with changing HIV treatment guidelines during 2010 to 2013, clinicians increasingly supported early ART for treatment and prevention.

scholarly journals Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas

2018 ◽  
Vol 17 ◽  
pp. 232595821877404 ◽  
Author(s):  
Osaro Mgbere ◽  
Maria Rodriguez-Barradas ◽  
Karen Joan Vigil ◽  
Melanie McNeese ◽  
Fazal Tabassam ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Medical Care ◽  
Treatment Guidelines ◽  
Health Benefits ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Medical Decision ◽  
Care Providers ◽  
Harris County ◽  
Starting Point

Background: The current US HIV treatment guidelines support initiation of antiretroviral therapy (ART) for persons with HIV for personal health benefits and prevention of HIV transmission. However, high levels of adherence to ART are critical to maximize individual and public health benefits. We examined the nonclinical barriers to ART initiation for clinically eligible individuals and the provider- and patient-related factors associated with these barriers among HIV-infected patients in Houston/Harris County, Texas. Methods: We analyzed data obtained from a probability sample of HIV medical care providers (HMCPs) in 13 outpatient facilities in Houston/Harris County, Texas surveyed between June and September 2009. We used an inductive thematic approach to code HMCP responses to an open-ended question that asked the main reasons why providers may delay initiating ART for clinically eligible patients. Results: The reasons cited by providers for delaying ART for clinically eligible patients were adherence (42.5%; 95% confidence interval [CI]: 28.5-57.8), acceptance (30%; 95% CI: 18.1-45.4), and structural concerns (27.5%; 95% CI: 16.1-42.8), with significant variations ( P < .0001) noted across patients’ race/ethnicity and transmission category. HIV medical care providers with 6 to 10 years’ experience in HIV care and those providing medical care for more than 100 patients monthly were about 4 times (adjusted odds ratio [aOR]: 3.80; 95% CI: 1.20-5.92; P = .039) and 10 times (aOR: 10.36; 95% CI: 1.42-22.70; P = .019) more likely to state adherence and acceptance concerns, respectively, as reasons for delaying ART for clinically eligible patients. Conclusion: Our findings highlight the fact that clinical guidelines are only a starting point for medical decision-making process and that patients themselves play an important role. HMCP access to referrals for other medical issues, support services, and treatment education may help improve adherence and patient readiness for ART, thereby avoiding systemic delays.

scholarly journals Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention

2020 ◽  
Vol 17 (8) ◽  
pp. 2892
Author(s):  
Lawrence P.O. Were ◽  
Joseph W Hogan ◽  
Omar Galárraga ◽  
Richard Wamai
Keyword(s):  
Health Insurance ◽  
Pregnant Women ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Disease ◽  
Treatment And Prevention ◽  
Insurance Enrollment ◽  
Lost To Follow Up

Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count <350 and 350>) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24–4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42–28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53–4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10–0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.

scholarly journals The Promise of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are the Data?

2021 ◽  
Vol 20 ◽  
pp. 232595822110090
Author(s):  
Kimberly K. Scarsi ◽  
Susan Swindells
Keyword(s):  
Medication Adherence ◽  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Virologic Suppression ◽  
Social Barriers ◽  
Treatment And Prevention ◽  
Undetectable Viremia ◽  
Long Acting ◽  
Available Information ◽  
Living With Hiv

As with other chronic conditions, adherence to daily medications remains a challenge for many individuals living with HIV due to structural, behavioral, and social barriers. Unfortunately, high levels of adherence to antiretroviral therapy are required to maintain virologic suppression. Alternative approaches are being explored to decrease the burden of daily pill administration, including long-acting injectable, oral, and implantable products. Phase 3 data support the efficacy of nanoformulated injectable cabotegravir and rilpivirine for HIV treatment in patients with undetectable viremia, but we have yet to learn how this strategy may benefit those with medication adherence challenges. Despite this, the affected community and HIV providers are very interested in exploring the role of long-acting therapies to address some types of barriers to medication adherence. This review summarizes available information about the potential for long-acting therapy to improve adherence for some patients and outlines associated opportunities and challenges with the implementation of long-acting therapy for the treatment and prevention of HIV.

scholarly journals Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Shu Su ◽  
Shifu Li ◽  
Shunxiang Li ◽  
Liangmin Gao ◽  
Ying Cai ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Waiting Time ◽  
Cox Regression ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Treatment Data ◽  
Poor Treatment

Background.Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment.Methods.A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015.Results.Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less,P<0.01) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression.Conclusion.Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.

Shadow of HIV exceptionalism 40 years later

2021 ◽  
pp. medethics-2020-106908
Author(s):  
Michela Blain ◽  
Stephaun E Wallace ◽  
Courtney Tuegel
Keyword(s):  
Implicit Bias ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Medical Community ◽  
Aids Epidemic ◽  
Treatment And Prevention ◽  
The Social ◽  
Hiv Exceptionalism ◽  
Medical Advances

During the AIDS epidemic in the 1980s, it was crucial that providers take steps to protect patients by managing HIV with the perspective of ‘HIV exceptionalism’. However, in 2020, the social and historical barriers erected by this concept, as demonstrated in this patient’s case, are considerably impeding progress to end the epidemic. With significant medical advances in HIV treatment and prevention, the policies informed by HIV exceptionalism now paradoxically perpetuate stigma and inequities, particularly for people of colour. To improve overall HIV care, the medical community must move past HIV exceptionalism by liberalising diagnostics, instituting clinician implicit bias training and advocating to fully decriminalise HIV non-disclosure.

scholarly journals The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0231872 ◽  
Author(s):  
Melissa A. Stockton ◽  
Michael Udedi ◽  
Kazione Kulisewa ◽  
Mina C. Hosseinipour ◽  
Bradley N. Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Antiretroviral Therapy ◽  
Treatment Program ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Outcomes ◽  
The Impact

Consistency of Initial Antiretroviral Therapy With HIV Treatment Guidelines in a US Cohort of HIV-Infected Women

2008 ◽  
Vol 47 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Jennifer Cocohoba ◽  
Qiong J Wang ◽  
Christopher Cox ◽  
Stephen J Gange ◽  
Mardge Cohen ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment

scholarly journals Adherence to HIV treatment guidelines for initiation of antiretroviral therapy in Australia

2010 ◽  
Vol 13 (Suppl 4) ◽  
pp. P172 ◽  
Author(s):  
M Bloch ◽  
J Hoy ◽  
N Cunningham ◽  
N Roth ◽  
N Andrianopoulos ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment

scholarly journals Tonse Pamodzi: Developing a combination strategy to support adherence to antiretroviral therapy and HIV pre-exposure prophylaxis during pregnancy and breastfeeding

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253280
Author(s):  
Lauren M. Hill ◽  
Friday Saidi ◽  
Kellie Freeborn ◽  
K. Rivet Amico ◽  
Nora E. Rosenberg ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Intervention Development ◽  
Hiv Treatment ◽  
Child Health Services ◽  
Maternal Child Health ◽  
Combination Strategy ◽  
Antiretroviral Adherence ◽  
Treatment And Prevention ◽  
Adherence Support ◽  
Exposure Prophylaxis

To eliminate mother-to-child transmission of HIV (EMTCT), scalable strategies to enhance antiretroviral adherence for both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are needed as part of integrated HIV and maternal-child health services. We developed Tonse Pamodzi (“all of us together”), an adaptable intervention integrating biomedical and behavioral components to support HIV treatment and prevention. We describe our intervention development process, which comprised formative qualitative research, a review of the literature, and technical input from stakeholders representing the community, health systems, and policymakers. The resulting intervention, described herein, integrates patient-centered counseling and engagement of a patient-selected adherence supporter for pregnant and breastfeeding women initiating ART or PrEP. Patients receiving the intervention engage in Integrated Next Step Counseling (iNSC) sessions delivered by trained counselors to build and maintain adherence skills. Each patient also has the option of selecting an adherence supporter (partner, family member, or friend) who may participate in iNSC sessions and provide adherence support outside of these sessions. This flexible intervention is adaptable not only to ART or PrEP use, but also to the needs and preferences of each woman and the clinical context. If shown to be acceptable and feasible, the Tonse Pamodzi intervention may be an important tool in continuing efforts for EMTCT.

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