scholarly journals Factors affecting statin uptake among people living with HIV: primary care provider perspectives

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Allison J. Ober ◽  
Sae Takada ◽  
Deborah Zajdman ◽  
Ivy Todd ◽  
Tamara Horwich ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Community Health ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Standard Practice ◽  
Risk Threshold ◽  
Health Clinics ◽  
Community Health Clinics ◽  
Living With Hiv

Abstract Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin prescribing for PLWH receiving care in eight community health clinics across Los Angeles, California. Methods We conducted semi-structured telephone interviews with clinic leadership and providers across community health clinics participating in a larger study (INSPIRE) aimed at improving statin prescribing through education and feedback. Clinics included federally qualified health centers (N = 5), community clinics (N = 1) and county-run ambulatory care clinics (N = 2). Leadership and providers enrolled in INSPIRE (N = 39) were invited to participate in an interview. We used the Consolidated Framework for Implementation Research (CFIR) to structure our interview guide and analysis. We used standard qualitative content analysis methods to identify themes within CFIR categories; we also assessed current CVD risk assessment and statin-prescribing practices. Results Participants were clinic leaders (n = 6), primary care physicians with and without an HIV specialization (N = 6, N = 6, respectively), infectious diseases specialists (N = 12), nurse practitioners, physician assistants and registered nurses (N = 7). Ninety-five percent of providers from INSPIRE participated in an interview. We found that CVD risk assessment for PLWH is standard practice but that there is variation in risk assessment practices and that providers are unsure whether or how to adjust the risk threshold to account for HIV. Time, clinic and patient priorities impede ability to conduct CVD risk assessment with PLWH. Conclusions Providers desire more data and standard practice guidance on prescribing statins for PLWH, including estimates of the effect of HIV on CVD, how to adjust the CVD risk threshold to account for HIV, which statins are best for people on antiretroviral therapy and on shared decision-making around prescribing statins to PLWH. While CVD risk assessment and statin prescribing fits within the mission and workflow of primary care, clinics may need to emphasize CVD risk assessment and statins as priorities in order to improve uptake.

Imaging modalities for cardiovascular phenotyping in asymptomatic people living with HIV

2021 ◽  
pp. 1358863X2097870
Author(s):  
Maria Bonou ◽  
Chris J Kapelios ◽  
Eleni Athanasiadi ◽  
Sophie I Mavrogeni ◽  
Mina Psichogiou ◽  
...  
Keyword(s):  
Cardiac Computed Tomography ◽  
Imaging Modalities ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Improve Risk Stratification ◽  
Positron Emission ◽  
Pet Ct ◽  
Living With Hiv ◽  
Subclinical Cvd ◽  
Related Mortality

Cardiovascular disease (CVD) has emerged as a leading cause of non-HIV-related mortality among people living with HIV (PLWH). Despite the growing CVD burden in PLWH, there is concern that general population risk score models may underestimate CVD risk in these patients. Imaging modalities have received mounting attention lately to better understand the pathophysiology of subclinical CVD and provide improved risk assessment in this population. To date, traditional and well-established techniques such as echocardiography, pulse wave velocity, and carotid intima thickness continue to be the basis for the diagnosis and subsequent monitoring of vascular atherosclerosis and heart failure. Furthermore, novel imaging tools such as cardiac computed tomography (CT) and cardiac CT angiography (CCTA), positron emission tomography/CT (PET/CT), and cardiac magnetic resonance (CMR) have provided new insights into accelerated cardiovascular abnormalities in PLWH and are currently evaluated with regards to their potential to improve risk stratification.

scholarly journals An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Poggio Rosana ◽  
Goodarz Danaei ◽  
Laura Gutierrez ◽  
Ana Cavallo ◽  
María Victoria Lopez ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Primary Care ◽  
Community Health ◽  
Community Health Workers ◽  
Feasibility Study ◽  
Health Workers ◽  
Health Coverage ◽  
Cvd Risk Factors ◽  
Cvd Risk

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

scholarly journals Limited Utility of Cardiovascular Risk Scores for People Living with HIV in Malawi

2020 ◽  
Author(s):  
Chia Goh ◽  
Henry Mwandumba ◽  
Alicja Rapala ◽  
Willard Tingao ◽  
Irene Sheha ◽  
...  
Keyword(s):  
Risk Score ◽  
Low Income ◽  
Intima Media Thickness ◽  
Risk Groups ◽  
Carotid Intima Media Thickness ◽  
Endothelial Damage ◽  
Risk Scores ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Living With Hiv

HIV is associated with increased cardiovascular disease (CVD) risk. Despite the high prevalence of HIV in low income subSaharan Africa, there are few data on the assessment of CVD risk in the region. In this study, we aimed to compare the utility of existing CVD risk scores in a cohort of Malawian adults, and assess to what extent they correlate with established markers of endothelial damage: carotid intima media thickness (IMT) and pulse wave velocity (PWV). WHO/ISH, SCORE, FRS, ASCVD, QRISK2 and D:A:D scores were calculated for 279 Malawian adults presenting with HIV and low CD4. Correlation of the calculated 10year CVD risk score with IMT and PWV was assessed using Spearmans rho. The median (IQR) age of patients was 37 (31 to 43) years and 122 (44%) were female. Median (IQR) blood pressure was 120/73mmHg (108/68 to 128/80) and 88 (32%) study participants had a new diagnosis of hypertension. The FRS and QRISK2 scores included the largest number of participants in this cohort (96% and 100% respectively). D:A:D, a risk score specific for people living with HIV, identified more patients in moderate and high risk groups. Although all scores correlated well with physiological markers of endothelial damage, FRS and QRISK2 correlated most closely with both IMT [r2 0.51, p<0.0001 and r2 0.47, p<0.0001 respectively] and PWV [r2 0.47, p<0.0001 and r2 0.5, p<0.0001 respectively]. Larger cohort studies are required to adapt and validate risk prediction scores in this region, so that limited healthcare resources can be effectively targeted.

Abstract MP16: Perivascular Adipose Tissue Inflammation Impairs Microvascular Endothelial Function In People Living With HIV

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Dan Wang ◽  
Cheng Wang ◽  
Seble Kassaye ◽  
Princy Kurmar ◽  
Jennifer Verbesey ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Ros Generation ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Perivascular Adipose Tissue ◽  
Microvascular Endothelial ◽  
Adipose Inflammation ◽  
Living With Hiv ◽  
Endothelium Dependent Relaxation ◽  
Microvascular Endothelial Function

Introduction and hypothesis: We had reported that people living with HIV (PLWH) have microvascular endothelial dysfunction and increased ROS. We now tested the hypothesis that perivascular adipose tissue (PVAT) could enhance oxidative stress and inflammation and impair the function of subcutaneous microarterioles (SMAs) in PLWH. Methods: SMAs were obtained from young, virally-suppressed HIV-infected subjects (n=11) or matched controls (n=11). Subjects were without associated CVD risk factors. Microvascular reactivity and PVAT function were accessed by myograph from isolated subcutaneous vessels with or without PVAT of skin biopsy. Results: The HIV-infected group had significantly (P<0.05) increased adipose MDA, TNFα, IL-1α, leptin and reduced adiponectin. The PVAT-denuded SMAs from the HIV group had significantly (P<0.05) impaired acetylcholine-induced endothelium-dependent relaxation factor (EDRF, 26±4 vs 38±3%) and NO activity (0.35±0.03 vs 0.58± 0.07 Δfluoresence unit) and significantly (P<0.05) increased contraction to U-46,619 (200±8 vs 141±7%) and endothelin 1 (ET1, 167±12 vs 118±17%) and ROS generation (0.32 ± 0.06 vs 0.1 ± 0.03 (E/DHE fluoresce unit). PVAT enhanced EDRF (50±4 vs 38±3 %) and NO (0.84 ±0.1 vs 0.58±0.07 Δfluoresence unit ) only in controls (P<0.05). The reduction of U46,619 anti-contractivity by PVAT is decreased in HIV (48±7 vs 85±9%, P<0.05). Conclusion: HIV-infected individuals have intrinsic vascular defects from ROS augmented by extrinsic vascular defects from adipose inflammation that impairs the beneficial microvascular PVAT signaling. Therefore, targets for potential prevention of cardiovascular morbidity in PLWH should include the elimination of ROS and inflammation in both microvessels themselves and the surrounding extravascular PVAT.

scholarly journals Transfer of primary care patients receiving chronic care: the next step in the continuum of care

2019 ◽  
Vol 11 (6) ◽  
pp. 432-439
Author(s):  
Jasantha Odayar ◽  
Landon Myer
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Diabetes Patient ◽  
Patient Transfer ◽  
People Living With Hiv ◽  
Middle Income ◽  
Continuous Care ◽  
Minimal Data ◽  
Poor Outcomes ◽  
Living With Hiv

Abstract The burden of chronic conditions is increasing rapidly in low- and middle-income countries. Chronic conditions require long-term and continuous care, including for patients transferring between facilities. Patient transfer is particularly important in the context of health service decentralization, which has led to increasing numbers of primary care facilities at which patients can access care, and high levels of migration, which suggest that patients might require care at multiple facilities. This article provides a critical review of existing evidence regarding transfer of stable patients receiving primary care for chronic conditions. Patient transfer has received limited consideration in people living with HIV, with growing concern that patients who transfer are at risk of poor outcomes; this appears similar for people with TB, although studies are few. There are minimal data on transfer of patients with non-communicable diseases, including diabetes. Patient transfer for chronic conditions has thus received surprisingly little attention from researchers; considering the potential risks, more research is urgently required regarding reasons for and outcomes of transfers, transfer processes and interventions to optimize transfers, for different chronic conditions. Ultimately, it is the responsibility of health systems to facilitate successful transfers, and this issue requires increased attention from researchers and policy-makers.

scholarly journals Community health worker interventions to promote psychosocial outcomes among people living with HIV—A systematic review

PLoS ONE ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. e0194928 ◽  
Author(s):  
Hae-Ra Han ◽  
Kyounghae Kim ◽  
Jeanne Murphy ◽  
Joycelyn Cudjoe ◽  
Patty Wilson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Psychosocial Outcomes ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals The Use of a Family History Risk Assessment Tool within a Community Health Care System: Views of Primary Care Providers

2012 ◽  
Vol 21 (5) ◽  
pp. 652-661 ◽  
Author(s):  
Carol A. Christianson ◽  
◽  
Karen Potter Powell ◽  
Susan Estabrooks Hahn ◽  
Susan H. Blanton ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Health Care ◽  
Family History ◽  
Community Health ◽  
Assessment Tool ◽  
Primary Care Providers ◽  
Community Health Care ◽  
Care Providers ◽  
Community Health Care System

scholarly journals Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study (Preprint)

2020 ◽  
Author(s):  
Sean Arayasirikul ◽  
Caitlin Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson
Keyword(s):  
Primary Care ◽  
Young People ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Computer Assisted ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

BACKGROUND Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. OBJECTIVE This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV 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. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. RESULTS The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ<sup>2</sup><sub>1</sub>=4.68, <i>P</i>=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. CONCLUSIONS Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals LOWER PERCEIVED-STIGMATIZATION BY HEALTH WORKERS AMONG HIV-AIDS PATIENTS OF KEY POPULATION BACKGROUNDS

2020 ◽  
Vol 8 (2) ◽  
pp. 90
Author(s):  
Jihan Qonitatillah ◽  
Samsriyaningsih Handayani ◽  
Ernawati Ernawati ◽  
Musofa Rusli
Keyword(s):  
Quality Of Life ◽  
Community Health ◽  
Health Center ◽  
Health Workers ◽  
Community Health Center ◽  
People Living With Hiv ◽  
Key Population ◽  
Living With Hiv ◽  
Hiv Aids

The stigma of people living with HIV-AIDS (PLWHA) by health workers may have a broad impact, so it is necessary to identify the factors that influence the occurrence of stigma. Identification of factors that cause a decrease in stigmatization by health workers will have an impact on improving the quality of life of people with HIV, increasing compliance with medication, and ultimately reducing the incidence of HIV infection itself. The purpose of this study was to analyze factors related to PLWHA’s perception of stigma among health workers in the community health center.  This research applied a cross-sectional design using interviews. Ninety-four patients from the Infectious Disease Intermediate Care of Dr. Soetomo Hospital Surabaya, a tertiary level hospital, were interviewed. The stigma perception was assessed using a questionnaire modified from the Standardized Brief Questionnaire by Health Policy Project with Cronbach’s Alpha of 0.786. The data were simultaneously analyzed with binary multiple regressions on IBM SPSS Statistics 22.0 for Windows software. There were 30 out of 94 patients with key population backgrounds, and most population was injecting drug users (IDUs) and female sex workers (FSWs). PLWHA perceived most stigmatized community health workers when they drew blood, provided care, and considered they were involved in irresponsible behavior. There were relationships between age(p=0.008), marital status(p=0.013), and the history of key population (p=0.006)to people living with HIV-AIDS (PLWHA)’s perception of stigma among health workers in East Java community health center. Future research on factors influencing HIV-related stigma is needed to improve patients’ quality of life.

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