scholarly journals Delayed linkage to HIV care among asylum seekers in Quebec, Canada

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nadine Kronfli ◽  
Blake Linthwaite ◽  
Nancy Sheehan ◽  
Joseph Cox ◽  
Isabelle Hardy ◽  
...  
Keyword(s):  
Median Time ◽  
Asylum Seekers ◽  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Late Presenters ◽  
Hiv Care Cascade ◽  
Increased Risk ◽  
Linkage To Hiv Care

Abstract Background Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. Methods We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. Results Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. Conclusions While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

scholarly journals Time From HIV Diagnosis to Viral Suppression: Survival Analysis of Statewide Surveillance Data in Alabama, 2012 to 2014 (Preprint)

2019 ◽  
Author(s):  
D Scott Batey ◽  
Xueyuan Dong ◽  
Richard P Rogers ◽  
Anthony Merriweather ◽  
Latesha Elopre ◽  
...  
Keyword(s):  
Public Health ◽  
Median Time ◽  
Viral Suppression ◽  
Geographic Area ◽  
Hiv Care ◽  
Newly Diagnosed ◽  
Geographic Variability ◽  
Hiv Diagnosis ◽  
Public Health Action ◽  
Global Estimate

BACKGROUND Evaluation of the time from HIV diagnosis to viral suppression (VS) captures the collective effectiveness of HIV prevention and treatment activities in a given locale and provides a more global estimate of how effectively the larger HIV care system is working in a given geographic area or jurisdiction. OBJECTIVE This study aimed to evaluate temporal and geographic variability in VS among persons with newly diagnosed HIV infection in Alabama between 2012 and 2014. METHODS With data from the National HIV Surveillance System, we evaluated median time from HIV diagnosis to VS (&lt;200 c/mL) overall and stratified by Alabama public health area (PHA) among persons with HIV diagnosed during 2012 to 2014 using the Kaplan-Meier approach. RESULTS Among 1979 newly diagnosed persons, 1181 (59.67%) achieved VS within 12 months of diagnosis; 52.6% (353/671) in 2012, 59.5% (377/634) in 2013, and 66.9% (451/674) in 2014. Median time from HIV diagnosis to VS was 8 months: 10 months in 2012, 8 months in 2013, and 6 months in 2014. Across 11 PHAs in Alabama, 12-month VS ranged from 45.8% (130/284) to 84% (26/31), and median time from diagnosis to VS ranged from 5 to 13 months. CONCLUSIONS Temporal improvement in persons achieving VS following HIV diagnosis statewide in Alabama is encouraging. However, considerable geographic variability warrants further evaluation to inform public health action. Time from HIV diagnosis to VS represents a meaningful indicator that can be incorporated into public health surveillance and programming.

scholarly journals 764. Correlates of Lost to Follow-up Among Newly Diagnosed Older People with HIV in Ukraine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S427-S428
Author(s):  
Amy J Allen ◽  
Oleksandr Zeziulin ◽  
Oleksandr Postnov ◽  
Julia Rozanova ◽  
Taylor Litz ◽  
...  
Keyword(s):  
Older People ◽  
Retrospective Chart Review ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Loss To Follow Up ◽  
Increased Risk ◽  
Lost To Follow Up ◽  
The City

Abstract Background Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia. Older People with HIV (OPWH) are at increased risk of poor outcomes compared to younger patients. We examined the prevalence and correlates of loss to follow-up (LTFU) among newly diagnosed patients in Ukraine. Methods Retrospective chart review was conducted of 400 patients newly diagnosed with HIV July 1, 2017 - Dec 1, 2018. Data was collected from clinics in the city of Odessa and surrounding regions. OPWH were ≥50 years old at diagnosis and LTFU was defined as no contact with the HIV clinic for 90 days. Demographic, clinical characteristics, and follow-up outcomes were examined, and multivariate logistic regression was used to estimate the adjusted odds ratios at 95% confidence intervals. Results Of the 400 people living with HIV, median age was 50 (IQR35-55), 196 (49%) were women, and 177 (44%) had CD4&lt; 200cell/mm3 at diagnosis. Overall, 65 (16.5%) were LTFU from diagnosis and 54/65 (83%) were lost after their first appointment at the HIV clinic. Among those lost to follow-up, 49 (75%) were ≥50 at the time of diagnosis. Multivariate analysis showed LTFU was associated with age &gt;50years (aOR 3.6, CI 1.8-7.3, p=0.001), lack of ART prescription (aOR 16.4, CI 8.5-31.8, p= 0.001), and living outside the city of Odessa (aOR 2.9, CI 1.5-5.7, p=0.002). Figure 1 shows the breakdown of lost to follow-up for OPWH. Figure 1. Retainment in HIV Care for OPWH compared to those &lt;50 years old. Conclusion LTFU among OPWH is significantly greater than younger people with HIV, and associated with lack of ART and living in nonurban settings. OPWH may benefit from differentiated HIV service delivery to reduce loss to follow up and interventions tailored to improving HIV outcomes for OPWH in resource-limited settings are urgently needed. Disclosures All Authors: No reported disclosures

scholarly journals Time From HIV Diagnosis to Viral Suppression: Survival Analysis of Statewide Surveillance Data in Alabama, 2012 to 2014

10.2196/17217 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e17217 ◽  
Author(s):  
D Scott Batey ◽  
Xueyuan Dong ◽  
Richard P Rogers ◽  
Anthony Merriweather ◽  
Latesha Elopre ◽  
...  
Keyword(s):  
Public Health ◽  
Median Time ◽  
Viral Suppression ◽  
Geographic Area ◽  
Hiv Care ◽  
Newly Diagnosed ◽  
Geographic Variability ◽  
Hiv Diagnosis ◽  
Public Health Action ◽  
Global Estimate

Background Evaluation of the time from HIV diagnosis to viral suppression (VS) captures the collective effectiveness of HIV prevention and treatment activities in a given locale and provides a more global estimate of how effectively the larger HIV care system is working in a given geographic area or jurisdiction. Objective This study aimed to evaluate temporal and geographic variability in VS among persons with newly diagnosed HIV infection in Alabama between 2012 and 2014. Methods With data from the National HIV Surveillance System, we evaluated median time from HIV diagnosis to VS (<200 c/mL) overall and stratified by Alabama public health area (PHA) among persons with HIV diagnosed during 2012 to 2014 using the Kaplan-Meier approach. Results Among 1979 newly diagnosed persons, 1181 (59.67%) achieved VS within 12 months of diagnosis; 52.6% (353/671) in 2012, 59.5% (377/634) in 2013, and 66.9% (451/674) in 2014. Median time from HIV diagnosis to VS was 8 months: 10 months in 2012, 8 months in 2013, and 6 months in 2014. Across 11 PHAs in Alabama, 12-month VS ranged from 45.8% (130/284) to 84% (26/31), and median time from diagnosis to VS ranged from 5 to 13 months. Conclusions Temporal improvement in persons achieving VS following HIV diagnosis statewide in Alabama is encouraging. However, considerable geographic variability warrants further evaluation to inform public health action. Time from HIV diagnosis to VS represents a meaningful indicator that can be incorporated into public health surveillance and programming.

scholarly journals 1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S473-S473
Author(s):  
Christina Rizk ◽  
Alice Zhao ◽  
Janet Miceli ◽  
Portia Shea ◽  
Merceditas Villanueva ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Linkage To Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Newly Diagnosed ◽  
New Haven ◽  
Care Continuum ◽  
Art Initiation ◽  
Ryan White ◽  
Hiv Viral Suppression

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

scholarly journals Patient-level Factors Associated with HIV Suppression at Admission Across a Large Integrated Healthcare System

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S422-S422
Author(s):  
Marileys FigueroaSierra ◽  
Monica Schmidt ◽  
Melanie D Spencer ◽  
Michael Leonard
Keyword(s):  
Acute Care ◽  
Viral Suppression ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Care ◽  
Median Income ◽  
Newly Diagnosed ◽  
Black Race ◽  
Patient Level ◽  
Number Of Patients

Abstract Background Linkage to care is a critical step for achieving HIV viral suppression and improving outcomes in newly diagnosed individuals. An unexpectedly high number of patients who have undiagnosed HIV or ineffective viral suppression are identified upon admission to acute care. This study aims to understand factors that may be associated with lack of viral suppression for patients who are newly diagnosed at admission. Methods Patients with HIV, admitted to one of our eight acute care facilities were identified (n = 1,632) from medical records. Of these, 94 were newly diagnosed and 1,538 had a prior diagnosis of HIV. Factors that may impact the viral suppression status (&lt;200 copies/mL) prior to admission were examined. Median income and percentage of individuals living below poverty were inferred from the American Community Survey (U.S. Census) data based on a patient’s zipcode. All other factors were extracted from the medical record at the time of admission. Chi square tests and t-tests were used to compare patients who were virally suppressed to those who were not. Results The average age was 48 years old and 60% were male and 82% black race. Patients who presented and were not virally suppressed were more likely to be between the ages of 40–60 and of black race. Distributions of age groups and race were significantly different between those virally suppressed and those who were not suppressed at admission (P &lt; 0.05 for both). Blacks and whites between 40 and 60 years were more likely than other race and age groups to present at admission without viral suppression. Patients from geographic areas associated with high poverty and lower median income were less likely to be virally suppressed at admission (23.2% vs. 25.2%; P &lt; 0.05 for poverty and $41,183 vs. $43,757; P &lt; 0.05) for income. Conclusion These results indicate that age, race and geographically inferred income and poverty are significantly different between patients who are virally suppressed at admission and those who have a detectable viral load. Further investigation is needed to better understand how these patient-level factors, including socioeconomics, impact linkage to care as well as how best to allocate resources to better engage and retain patients in HIV care to improve their long-term outcomes. Disclosures All authors: No reported disclosures.

Resolution of possible acquired protein S deficiency after viral suppression in HIV infection

2021 ◽  
Vol 14 (11) ◽  
pp. e244983
Author(s):  
Leigh Cervino ◽  
Jillian Raybould ◽  
Patricia Fulco
Keyword(s):  
Viral Suppression ◽  
Treatment Guidelines ◽  
Protein S ◽  
People Living With Hiv ◽  
Protein S Deficiency ◽  
Anticoagulation Management ◽  
S Deficiency ◽  
Increased Risk ◽  
Undiagnosed Hiv ◽  
Living With Hiv

Current literature suggests an increased risk of venous thromboembolism (VTE) in people living with HIV (PLWH) with poorly controlled viraemia and immunodeficiency. VTE treatment guidelines do not specifically address anticoagulation management in PLWH. We report a case of a 33-year-old woman diagnosed with an unprovoked pulmonary embolism (PE) and deemed protein S deficient. Three years later, she was diagnosed with AIDS. Antiretroviral therapy (ART) was promptly initiated with viral suppression and immune reconstitution within 12 months. Eight years after her initial PE, the patient self-discontinued warfarin. Multiple repeat protein S values were normal. ART without anticoagulation has continued for 3 years with no thrombotic events. This case describes a patient with VTE presumably secondary to undiagnosed HIV with possible consequent acquired protein S deficiency. Additional research is needed to understand the characteristics of PLWH with VTE who may warrant long-term anticoagulation as opposed to shorter courses.

scholarly journals “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

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.

scholarly journals Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011–2017)

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Nang Thu Thu Kyaw ◽  
Srinath Satyanarayana ◽  
Htun Nyunt Oo ◽  
Ajay M V Kumar ◽  
Anthony D Harries ◽  
...  
Keyword(s):  
Hiv Care ◽  
People Living With Hiv ◽  
Spline Regression ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Need To Evaluate ◽  
Glycemic Targets ◽  
Living With Hiv ◽  
The Relationship ◽  
Tuberculosis Disease

Abstract Background There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease. Methods We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality. Results Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68–310) cell/mm3, the median RBG level (IQR) was 88 (75–106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%–6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1–1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8–1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110–140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2–1.4; restricted spline: aHR, 1.1; 95% CI, 1.0–1.1) compared with those with RBG &lt;110 mg/dL. Conclusions Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

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