scholarly journals Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zubair Lukyamuzi ◽  
Samuel Etajak ◽  
Thomas Katairo ◽  
David Mukunya ◽  
Moses Tetui ◽  
...  
Keyword(s):  
Health Care ◽  
Viral Load ◽  
Healthcare Workers ◽  
Care Center ◽  
Hiv Care ◽  
Art Adherence ◽  
Intervention Period ◽  
Viral Load Suppression ◽  
Related Factors ◽  
Adherence Counseling

Abstract Background Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda. Methods This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers. Results A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC. Conclusions The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.

Pilot Program of Shared Assistance with Primary Care in Patients Living with HIV, and Satisfaction with The Healthcare Received

2021 ◽  
Author(s):  
Melchor Riera ◽  
Adria Ferre ◽  
Alfredo Santos-Pinheiro ◽  
Helem Hayde Vilchez ◽  
Maria Luisa Martin-Peña ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Viral Load ◽  
Hiv Infection ◽  
Shared Care ◽  
Hiv Care ◽  
Pilot Program ◽  
Art Adherence ◽  
Primary Health

Abstract Background: There are few shared assistance programs with Primary Health Care (PHC) in PLWH. The aim was to develop a Pilot Program of shared HIV care in PLWH ensuring proper HIV control. Methods: Design: Prospective pilot project of a shared care intervention.Setting: HIV specialized outpatient consultations for HIV infection at Son Espases University Hospital which serves 2000 patients. Subjects: Patients who attended HIV specialized consultation between January 1st and June 30th, 2017. Intervention: Basal questionnaire on health services used by patients. HIV Training Program on HIV in Primary Health Care (PHC). Pilot Program of shared assistance (PPAC) with PHC. Main Outcomes: Maintenance of undetectable HIV viral load, antiretroviral therapy (ART) adherence, AIDS and non-AIDS events, loss of follow up, and satisfaction questionnaire. Results: The basal questionnaire was filled out by 918 patients, with 108 (11.7%) patients reporting neither knowing nor having been visited by their GP. A total of 93 patients were included in the PPAC, with a mean age of 49.9 years (SD 11.7), and an average of 14.6 years since the HIV diagnosis. Eleven patients were followed up for less than six months and were excluded from the analysis. Median follow-up during the PPAC of the remaining 82 patients was 728 days (IQR 370-1070). Sixteen patients dropped out of the PPAC (19.5%), three died, three were lost to follow up, one was withdrawn due to medical criteria, and nine withdrew voluntarily.No patient presented any AIDS defining events, although eight patients presented non-AIDS events. All the patients had undetectable viral load (VL) and average ART adherence was 99.4% (SD1.4). The patient’s satisfaction score with PPAC was 8.64 (SD2.5).Conclusion: It is possible to establish shared care programs with PHC in selected patients with HIV infection, thereby reducing hospital visits while maintaining good adherence and virological control and achieving high patient satisfaction.

Importance of HIV Care Continuum

2020 ◽  
pp. 50-67
Author(s):  
Simon George Taukeni ◽  
Eveline Ndinelao Kalomo
Keyword(s):  
Viral Load ◽  
Research Direction ◽  
Cultural Barriers ◽  
Hiv Care ◽  
Future Research ◽  
Hiv Care Continuum ◽  
Viral Load Suppression ◽  
Hiv Counseling ◽  
Care Continuum ◽  
Counseling And Testing

This chapter seeks to create further awareness and public health education on the importance of the human immunodeficiency virus (HIV) care continuum as one of the key policy focal areas to significantly reduce the HIV epidemic. Specific efforts were directed into the need to implement comprehensive HIV care continuum. The chapter argues that rolling out HIV counseling and testing, enrolled and linked patients to care, prescribing antiretroviral therapy, viral load testing and monitoring are key to achieve viral load suppression. Recommendations and future research direction have put much emphasis on an effort to address psychosocial factors such as stigma, inadequate healthcare facilities, laboratory testing equipment, social and cultural barriers to testing and treatment, to improve access and overall implementation of HIV care continuum.

scholarly journals What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248410
Author(s):  
Nolwenn Conan ◽  
Cyrus P. Paye ◽  
Reinaldo Ortuno ◽  
Alexander Chijuwa ◽  
Brown Chiwandira ◽  
...  
Keyword(s):  
Young Adults ◽  
Viral Load ◽  
Health Facility ◽  
Population Based ◽  
Hiv Care ◽  
Hiv Positive ◽  
Viral Load Suppression ◽  
Hiv Rna ◽  
Hiv Test ◽  
Cascade Of Care

Introduction The Malawi Ministry of Health (MoH) has been in collaboration with Médecins sans Frontières (MSF) to increase access to quality HIV care through decentralization of antiretroviral therapy (ART) diagnosis and treatment from hospital to clinics in Nsanje District since 2011. A population-based household survey was implemented to provide information on HIV prevalence and cascade of care to inform and prioritize community-based HIV interventions in the district. Methods A cross-sectional survey was conducted between September 2016 and January 2017. Using two-stage cluster sampling, eligible adult individuals aged ≥15 years living in the selected households were asked to participate. Participants were interviewed and tested for HIV at home. Those tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their ART status. All participants tested HIV-positive at the time of the survey were advised to report their HIV test result to the health facility of their choice that MSF was supported in the district. HIV-RNA VL results were made available in this health facility. Results Among 5,315 eligible individuals, 91.1% were included in the survey and accepted an HIV test. The overall prevalence was 12.1% (95% Confidence Interval (CI): 11.2–13.0) and was higher in women than in men: 14.0% versus 9.5%, P<0.001. Overall HIV-positive status awareness was 80.0% (95%CI: 76.4–83.1) and was associated with sex (P<0.05). Linkage to care was 78.0% (95%CI: 74.3–81.2) and participants in care 76.2% (95%CI: 72.4–79.5). ART coverage among participants aware of their HIV-positive status was 95.3% (95%CI: 92.9–96.9) and was not associated with sex (P = 0.55). Viral load suppression among participants on ART was 89.9% (95%CI: 86.6–92.4) and was not statistically different by sex (p = 0.40). Conclusions Despite encouraging results in HIV testing coverage, cascade of care, and UNAIDS targets in Nsanje District, some gap remains in the first 90, specifically among men and young adults. Enhanced community engagement and new strategies of testing, such as index testing, could be implemented to identify those who are still undiagnosed, particularly men and young adults.

scholarly journals The critical role of infection prevention overlooked in Ethiopia, only one-half of health-care workers had safe practice: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Biniyam Sahiledengle ◽  
Yohannes Tekalegn ◽  
Demelash Woldeyohannes
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Healthcare Workers ◽  
Infection Prevention ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Infection Prevention And Control ◽  
Related Factors ◽  
Safe Practice ◽  
Pooled Prevalence

AbstractBackgroundEffective infection prevention and control measures, such as such hand hygiene, the use of personal protective equipment, instrument processing, safe injection, and safe disposal of infectious wastes in the healthcare facilities maximize patient outcomes and are essential to providing effective, efficient, and quality health care services. In Ethiopia, findings regarding infection prevention practices among healthcare workers have been highly variable and uncertain. Therefore, this systematic review and meta-analysis estimate the pooled prevalence of safe infection prevention practices and summarize the associated factors among healthcare workers in Ethiopia.MethodsPubMed, Science Direct, Google Scholar, and the Cochrane library were systematically searched. We included all observational studies reporting the prevalence of safe infection prevention practices among healthcare workers in Ethiopia. Two authors independently extracted all necessary data using a standardized data extraction format. Qualitative and quantitative analyses were employed. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the studies. A random-effects meta-analysis model was used to estimate the pooled prevalence of safe infection prevention practice.ResultsOf the 187 articles identified through our search, 10 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of safe infection prevention practice in Ethiopia was 52.2% (95%CI: 40.9-63.4). The highest prevalence of safe practice was observed in Addis Ababa (capital city) 66.2% (95%CI: 60.6-71.8), followed by Amhara region 54.6% (95%CI: 51.1-58.1), and then Oromia region 48.5% (95%CI: 24.2-72.8), and the least safe practices were reported from South Nation Nationalities and People (SNNP) and Tigray regions with a pooled prevalence of 39.4% (95%CI: 13.9-64.8). In our qualitative syntheses, healthcare workers socio-demographic factors (young age, female gender), behavioral-related factors (being knowledgeable and having a positive attitude towards infection prevention), and healthcare facility-related factors (presence of running water supply, availability of infection prevention guideline, and receiving training) were important variables associated with safe infection prevention practice.ConclusionsOnly half of the healthcare workers in Ethiopia practiced safe infection prevention. Furthermore, the study found out that there were regional and professional variations in the prevalence of safe infection prevention practices. Therefore, the need to step-up efforts to intensify the current national infection prevention and patient safety initiative as key policy direction is 41 strongly recommended, along with more attempts to increase healthcare worker’s adherence towards infection prevention guidelines.

scholarly journals A comparison of medication adherence and viral suppression in antiretroviral treatment-naïve patients with HIV/AIDS depending on the drug formulary

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245185
Author(s):  
Kyung Sun Oh ◽  
Euna Han
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Antiretroviral Treatment ◽  
Art Adherence ◽  
Pill Burden ◽  
Viral Load Suppression ◽  
Hiv Rna ◽  
Single Tablet Regimen ◽  
Treatment Naïve ◽  
Hiv Aids

Antiretroviral treatment (ART) adherence is highlighted in management of patients living with human immunodeficiency virus. In South Korea, ART medication research has rarely been conducted due to the low economic burden associated with government-funded treatment. This cross-sectional study aimed to compare the pill burden impact between ART regimen compliance and HIV-RNA viral load suppression. Data were collected from 2008 to 2016 at a general hospital in South Korea. A total of 210 HIV/AIDS treatment-naïve patients were grouped as follows: single-tablet regimen (STR, one tablet/day), mild pill burden (two-four tablets/day), and heavy pill burden (≥ five tablets/day). Patients were analyzed according to gender, age at index date, medical insurance type, comorbidities, depression, HIV/AIDS disease burden as indicated by HIV-RNA viral load and CD4, and laboratory variables. In a multivariate logistic regression model, the STR group demonstrated adherence 5.10 times more often than the heavy pill burden group. Females and patients with an initial viral load of 500,000 or more were 0.090- and 0.040-fold less adherent to the ART regimen. Among these patients, 95% or more of the MPR group were 7.38 times more likely to have a lower limit of detection (LLOD) of viral load suppression. The highest initial viral load group was 0.090-fold less likely to have an LLOD than the reference group. These results suggest that a single-tablet regimen could improve medication adherence and the clinical virologic outcome. Therefore, general population research on ART adherence and polypharmacy is needed.

scholarly journals Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes

2018 ◽  
Author(s):  
Denis Nash ◽  
McKaylee M. Robertson ◽  
Kate Penrose ◽  
Stephanie Chamberlin ◽  
Rebekkah S. Robbins ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Viral Load ◽  
Relative Risk ◽  
York City ◽  
Hiv Care ◽  
Newly Diagnosed ◽  
Viral Load Suppression ◽  
History Of

AbstractThe New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15·3% were newly diagnosed; among the 84·7% previously diagnosed, 14·2% were consistently suppressed, 28·9% were inconsistently suppressed, and 41 ·6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59·9% of CCP and 53·9% of non-CCP participants had viral load suppression (Relative Risk=1.11, 95%CI:1.08-1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09-1.23) and 1.32 (95%CI:1.23-1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance.

scholarly journals Mask-associated de novo headache in healthcare workers during the Covid-19 pandemic.

2020 ◽  
Author(s):  
Jose M Ramirez-Moreno ◽  
David Ceberino ◽  
Alberto Gonzalez ◽  
Belen Rebollo ◽  
Pablo Macias ◽  
...  
Keyword(s):  
Health Care ◽  
Health Professionals ◽  
Healthcare Workers ◽  
Social Impact ◽  
De Novo ◽  
Health Workers ◽  
Online Questionnaire ◽  
Related Factors ◽  
Cross Sectional ◽  
The Impact

Introduction: The pandemic caused by the new coronavirus (COVID-19) has led to changes in the development of health care activities by health professionals. We analysed whether there is an association between the appearance of de novo headache according to the type of mask used, the related factors, as well as the impact of the headache on health professionals. Method: cross-sectional study in a tertiary hospital in Extremadura, Spain. We administered an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting. Results: n=306, 244 women (79.7%), with an average age of 43 years (range 23-65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filtering masks. Of all those surveyed, 158 (51.6%) presented de novo headache. The occurrence of headache was independently associated with the use of a filtering mask, OR 2.14 (IC95% 1.07-4.32), being a nurse OR 2.09 (IC95% 1.18-3.72) or another health worker OR 6.94 (IC95% 3.01-16.04) or having a history of asthma OR 0.29 (IC95% 0.09-0.89). Depending on the type of mask used there were differences in headache intensity. And the impact of headache in the subjects who used a filtering mask was worse in the all aspects evaluated. Conclusions: The appearance of de novo headache is associated with the use of filtering masks and is more frequent in certain health care workers, causing a greater occupational, family, personal and social impact.

scholarly journals Prospective Observational Study of Screening Asymptomatic Healthcare Workers for SARS-CoV-2 at a Canadian Tertiary Care Center

2020 ◽  
Author(s):  
Deepali Kumar ◽  
Victor H Ferreira ◽  
Andrzej Chruscinski ◽  
Vathany Kulasingam ◽  
Trevor J Pugh ◽  
...  
Keyword(s):  
Health Care ◽  
Healthcare Workers ◽  
Protein Microarray ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Nasopharyngeal Swab ◽  
Care Workers ◽  
Protein Microarray Analysis ◽  
Care Worker

We screened three separate cohorts of healthcare workers for SARS-CoV-2 via nasopharyngeal swab PCR. A seroprevalence analysis using multiple assays was performed in a subgroup. The asymptomatic health care worker cohorts had a combined positivity rate of 29/5776 (0.50%, 95%CI 0.32-0.75) compared to the symptomatic cohort rate of 54/1597 (3.4%) (ratio of symptomatic to asymptomatic 6.8:1). Sequencing demonstrated several variants. The seroprevalence (n=996) was 1.4-3.4% depending on assay. Protein microarray analysis showed differing SARS-CoV-2 protein reactivities and helped define likely true positives vs. suspected false positives. Routine screening of asymptomatic health care workers helps identify a significant proportion of infections.

scholarly journals A modified HIV continuum of care: A six-year evaluation of a viral load cascade at a hospital-based clinic in Kingston, Jamaica

2019 ◽  
Vol 30 (8) ◽  
pp. 748-755 ◽  
Author(s):  
Geoffrey J Barrow ◽  
Margaret L Brandeau
Keyword(s):  
Viral Load ◽  
Statistical Analysis ◽  
Viral Suppression ◽  
Care Delivery ◽  
Continuum Of Care ◽  
Hiv Care ◽  
Viral Load Suppression ◽  
Outcome Indicators ◽  
Care Continuum ◽  
Hiv Continuum Of Care

To achieve the goal of HIV viral suppression, provision of medication alone is not sufficient. Concomitant frameworks to evaluate HIV care delivery programmes are needed. This study examined the care continuum at a hospital-based HIV clinic in Kingston, Jamaica using a modified HIV continuum of care, with an increased focus on viral load indicators (viral load samples taken, results returned and viral suppression). A statistical analysis of patient flow through the care continuum to identify gaps in programme delivery was performed. Key programmatic areas for process improvement and the utility of this approach for viral load suppression interpretation were identified. Between 2010 and 2015, more than 1600 patients had been registered for care and more than 1000 had accessed antiretroviral therapy at this location. Consistent trends in programme performance were seen from 2010 to 2012. Although declines in the proportion of viral load samples taken and results returned occurred because of laboratory failures in 2013, the trend of increasing numbers and proportions of virally suppressed patients continued. Statistical analysis indicated that improvements in laboratory quality (fraction of viral load samples returned with accurate test results) could increase viral load suppression among patients at the clinic by up to 17%. Refining care delivery processes can significantly improve HIV viral load suppression rates. Expanding monitoring frameworks to include all of the essential processes that affect final outcome indicators can provide valuable insight into trends of outcome indicators and programme performance.

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