Structural factors and best practices in implementing a linkage to HIV care program using the ARTAS model

Abstract Background We assessed trends and identified individual- and county-level factors associated with linkage to HIV care in Tennessee (TN). Methods TN residents diagnosed with HIV from 2012–2016 were included in the analysis (n = 3,750). Linkage was defined by the first CD4 or HIV RNA test date at or after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual- and county-levels. Results Both MSM (aRR 1.16, 95%CI 1.01–1.32) and women who reported heterosexual sex risk factors (aRR 1.28, 95%CI 1.11–1.48) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.72–0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.59, 95%CI 0.40–0.88). Conclusions Disparities persist at both individual and county levels and may warrant structural interventions to address racism and mental health needs.

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1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1228 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S550-S551

Author(s):

Dima Dandachi ◽

Bich Dang ◽

Thomas Giordano Giordano

Keyword(s):

Hiv Transmission ◽

Personal Information ◽

Critical Role ◽

Retention In Care ◽

Hiv Care ◽

Structural Factors ◽

Personal Factors ◽

Response Distribution ◽

Related Factors ◽

Clinic Visits

Abstract Background The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits. Methods We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables. Results 371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Survey items and response distribution Conclusion Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH. Disclosures All Authors: No reported disclosures

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Who Is Not Linking to HIV Care in Tennessee — the Benefits of an Intersectional Approach

Journal of Racial and Ethnic Health Disparities ◽

10.1007/s40615-021-01023-6 ◽

2021 ◽

Author(s):

Leslie J. Pierce ◽

Peter Rebeiro ◽

Meredith Brantley ◽

Errol L. Fields ◽

Cathy A. Jenkins ◽

...

Keyword(s):

Black Males ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hiv Care ◽

Older Individuals ◽

Hiv Diagnosis ◽

Race And Gender ◽

Targeted Interventions ◽

And Gender ◽

Linkage To Hiv Care

Abstract Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.

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Adolescent HIV Care and Treatment in Uganda: Care Models, Best Practices and Innovations to Improve Services

Journal of Ancient Diseases & Preventive Remedies ◽

10.4172/2329-8731.1000150 ◽

2017 ◽

Vol 05 (01) ◽

Cited By ~ 1

Author(s):

Asire B ◽

Nabukeera Barungi N ◽

Elyanu P ◽

Katureebe C ◽

Lukabwe I ◽

...

Keyword(s):

Best Practices ◽

Hiv Care ◽

Care Models ◽

Care And Treatment

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“Is a Bird in the Hand Worth 5 in the Bush?”: A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa369 ◽

2020 ◽

Vol 7 (9) ◽

Author(s):

Darpun D Sachdev ◽

Elise Mara ◽

Alison J Hughes ◽

Erin Antunez ◽

Robert Kohn ◽

...

Keyword(s):

San Francisco ◽

Health Care Providers ◽

Viral Suppression ◽

Hiv Care ◽

Care Providers ◽

Care Continuum ◽

Hiv Surveillance ◽

Relative Risks ◽

Linkage To Hiv Care ◽

Durable Viral Suppression

Abstract Background Health departments utilize HIV surveillance data to identify people with HIV (PWH) who need re-linkage to HIV care as part of an approach known as Data to Care (D2C.) The most accurate, effective, and efficient method of identifying PWH for re-linkage is unknown. Methods We evaluated referral and care continuum outcomes among PWH identified using 3 D2C referral strategies: health care providers, surveillance, and a combination list derived by matching an electronic medical record registry to HIV surveillance. PWH who were enrolled in the re-linkage intervention received short-term case management for up to 90 days. Relative risks and 95% confidence intervals were calculated to compare proportions of PWH retained and virally suppressed before and after re-linkage. Durable viral suppression was defined as having suppressed viral loads at all viral load measurements in the 12 months after re-linkage. Results After initial investigation, 233 (24%) of 954 referrals were located and enrolled in navigation. Although the numbers of surveillance and provider referrals were similar, 72% of enrolled PWH were identified by providers, 16% by surveillance, and 12% by combination list. Overall, retention and viral suppression improved, although relative increases in retention and viral suppression were only significant among individuals identified by surveillance or providers. Seventy percent of PWH who achieved viral suppression after the intervention remained durably virally suppressed. Conclusions PWH referred by providers were more likely to be located and enrolled in navigation than PWH identified by surveillance or combination lists. Overall, D2C re-linkage efforts improved retention, viral suppression, and durable viral suppression.

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Facilitators and barriers to linkage to HIV care and treatment among female sex workers in a community-based HIV prevention intervention in Tanzania: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0219032 ◽

2019 ◽

Vol 14 (11) ◽

pp. e0219032 ◽

Cited By ~ 2

Author(s):

Daniel Nyato ◽

Soori Nnko ◽

Albert Komba ◽

Evodius Kuringe ◽

Marya Plotkin ◽

...

Keyword(s):

Hiv Prevention ◽

Qualitative Study ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Care ◽

Community Based ◽

Prevention Intervention ◽

Hiv Prevention Intervention ◽

Facilitators And Barriers ◽

Linkage To Hiv Care

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Performance and Outcomes of Routine Viral Load Testing in People Living with HIV Newly Initiating ART in the Integrated HIV Care Program in Myanmar between January 2016 and December 2017

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5030140 ◽

2020 ◽

Vol 5 (3) ◽

pp. 140

Author(s):

Sai Soe Thu Ya ◽

Anthony D. Harries ◽

Khin Thet Wai ◽

Nang Thu Thu Kyaw ◽

Thet Ko Aung ◽

...

Keyword(s):

Viral Load ◽

Virologic Failure ◽

Secondary Data ◽

Care Program ◽

Hiv Care ◽

People Living With Hiv ◽

Second Line ◽

Load Testing ◽

One Year ◽

Living With Hiv

Myanmar has introduced routine viral load (VL) testing for people living with HIV (PLHIV) starting first-line antiretroviral therapy (ART). The first VL test was initially scheduled at 12-months and one year later this changed to 6-months. Using routinely collected secondary data, we assessed program performance of routine VL testing at 12-months and 6-months in PLHIV starting ART in the Integrated HIV-Care Program, Myanmar, from January 2016 to December 2017. There were 7153 PLHIV scheduled for VL testing at 12-months and 1976 scheduled for VL testing at 6-months. Among those eligible for testing, the first VL test was performed in 3476 (51%) of the 12-month cohort and 952 (50%) of the 6-month cohort. In the 12-month cohort, 10% had VL > 1000 copies/mL, 79% had repeat VL tests, 42% had repeat VL > 1000 copies/mL (virologic failure) and 85% were switched to second-line ART. In the 6-month cohort, 11% had VL > 1000 copies/mL, 83% had repeat VL tests, 26% had repeat VL > 1000 copies/mL (virologic failure) and 39% were switched to second-line ART. In conclusion, half of PLHIV initiated on ART had VL testing as scheduled at 12-months or 6-months, but fewer PLHIV in the 6-month cohort were diagnosed with virologic failure and switched to second-line ART. Programmatic implications are discussed.

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