scholarly journals Impact of COVID-19 pandemic on HIV viremia: a single-center cohort study in northern Italy

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ilaria Izzo ◽  
Canio Carriero ◽  
Giulia Gardini ◽  
Benedetta Fumarola ◽  
Erika Chiari ◽  
...  
Keyword(s):  
Time Window ◽  
Time Windows ◽  
Continuum Of Care ◽  
Northern Italy ◽  
Hiv Diagnosis ◽  
Hiv Patients ◽  
Before And After ◽  
Missed Visits ◽  
Hiv Continuum Of Care ◽  
The Impact

Abstract Background Brescia Province, northern Italy, was one of the worst epicenters of the COVID-19 pandemic. The division of infectious diseases of ASST (Azienda Socio Sanitaria Territoriale) Spedali Civili Hospital of Brescia had to face a great number of inpatients with severe COVID-19 infection and to ensure the continuum of care for almost 4000 outpatients with HIV infection actively followed by us. In a recent manuscript we described the impact of the pandemic on continuum of care in our HIV cohort expressed as number of missed visits, number of new HIV diagnosis, drop in ART (antiretroviral therapy) dispensation and number of hospitalized HIV patients due to SARS-CoV-2 infection. In this short communication, we completed the previous article with data of HIV plasmatic viremia of the same cohort before and during pandemic. Methods We considered all HIV-patients in stable ART for at least 6 months and with at least 1 available HIV viremia in the time window March 01–November 30, 2019, and another group of HIV patients with the same two requisites but in different time windows of the COVID-19 period (March 01–May 31, 2020, and June 01–November 30, 2020). For patients with positive viremia (PV) during COVID-19 period, we reported also the values of viral load (VL) just before and after PV. Results: the percentage of patients with PV during COVID-19 period was lower than the previous year (2.8% vs 7%). Only 1% of our outpatients surely suffered from pandemic in term of loss of previous viral suppression. Conclusions Our efforts to limit the impact of pandemic on our HIV outpatients were effective to ensure HIV continuum of care.

scholarly journals Analysis of the Consequences of the COVID-19 Pandemic on the Continuum of the Care in a Cohort of HIV-Positive Patients Followed in a Single Center of Northern Italy.

2020 ◽  
Author(s):  
Eugenia Quiros-Roldan ◽  
Paola Magro ◽  
Canio Carriero ◽  
Annacarla Chiesa ◽  
Issa El Hamad ◽  
...  
Keyword(s):  
Antiretroviral Drugs ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Hiv Patients ◽  
Medical Visits ◽  
Missed Visits ◽  
Hiv Continuum Of Care ◽  
New Strategies ◽  
The Continuum

Abstract Background: During the COVID-19 pandemic, hospitals faced increasing pressure, where HIV patients risked to either acquire SARS-Cov-2 and to interrupt the HIV continuum of care.Methods: retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of HIV patients followed by the Spedali Civili of Brescia, between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019.Results: We observed a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020, a raise of missed visits from 5% to 8%, a drop in ART dispensation especially for not-protease inhibitors and an increase of hospitalized HIV patients due to COVID-19.Conclusions: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.

scholarly journals Are COVID-19 mitigation measures reducing preterm birth rate in China?

2021 ◽  
Vol 6 (8) ◽  
pp. e006359
Author(s):  
Zheng Bian ◽  
Xiaoxian Qu ◽  
Hao Ying ◽  
Xiaohua Liu
Keyword(s):  
Preterm Birth ◽  
Birth Rate ◽  
Time Window ◽  
Time Windows ◽  
Mitigation Measures ◽  
Late Preterm Birth ◽  
Child Morbidity ◽  
Preterm Birth Rate ◽  
Underlying Mechanisms ◽  
The Impact

ObjectivePreterm birth is the leading cause of child morbidity and mortality globally. We aimed to determine the impact of the COVID-19 mitigation measures implemented in China on 23 January 2020 on the incidence of preterm birth in our institution.DesignLogistic regression analysis was used to investigate the association between the national COVID-19 mitigation measures implemented in China and the incidence of preterm birth.SettingShanghai First Maternity and Infant Hospital, Shanghai China.ParticipantsAll singleton deliveries abstracted from electronic medical record between 1 January 2014 to 31 December 2020.Main outcome measuresPreterm birth rate.ResultsData on 164 107 singleton deliveries were available. COVID-19 mitigation measures were consistently associated with significant reductions in preterm birth in the 2-month, 3-month, 4-month, 5-month time windows after implementation (+2 months, OR 0.80, 95% CI 0.69 to 0.94; +3 months, OR 0.83, 95% CI 0.73 to 0.94; +4 months, OR 0.82, 95% CI 0.73 to 0.92; +5 months, OR 0.84, 95% CI 0.76 to 0.93). These reductions in preterm birth were obvious across various degrees of prematurity, but were statistically significant only in moderate-to-late preterm birth (32 complete weeks to 36 weeks and 6 days) subgroup. The preterm birth difference disappeared gradually after various restrictions were removed (7th–12th month of 2020, OR 1.02, 95% CI 0.94 to 1.11). There was no difference in stillbirth rate across the study time window.ConclusionSubstantial decreases in preterm birth rates were observed following implementation of the national COVID-19 mitigation measures in China. Further study is warranted to explore the underlying mechanisms associated with this observation.

Four steps to standardize reporting of peritoneal dialysis technique failure: A proposed approach

2020 ◽  
pp. 089686082097693
Author(s):  
Alix Clarke ◽  
Pietro Ravani ◽  
Matthew J Oliver ◽  
Mohamed Mahsin ◽  
Ngan N Lam ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Outcome Measure ◽  
Time Window ◽  
Time Windows ◽  
Dialysis Patients ◽  
Data Set ◽  
The Impact ◽  
Technique Failure ◽  
Standardize Reporting ◽  
Dialysis Technique

Background: Technique failure is an important outcome measure in research and quality improvement in peritoneal dialysis (PD) programs, but there is a lack of consistency in how it is reported. Methods: We used data collected about incident dialysis patients from 10 Canadian dialysis programs between 1 January 2004 and 31 December 2018. We identified four main steps that are required when calculating the risk of technique failure. We changed one variable at a time, and then all steps, simultaneously, to determine the impact on the observed risk of technique failure at 24 months. Results: A total of 1448 patients received PD. Selecting different cohorts of PD patients changed the observed risk of technique failure at 24 months by 2%. More than one-third of patients who switched to hemodialysis returned to PD—90% returned within 180 days. The use of different time windows of observation for a return to PD resulted in risks of technique failure that differed by 16%. The way in which exit events were handled during the time window impacted the risk of technique failure by 4% and choice of statistical method changed results by 4%. Overall, the observed risk of technique failure at 24 months differed by 20%, simply by applying different approaches to the same data set. Conclusions: The approach to reporting technique failure has an important impact on the observed results. We present a robust and transparent methodology to track technique failure over time and to compare performance between programs.

scholarly journals Modeling the Impact of Interventions Along the HIV Continuum of Care in Newark, New Jersey

2013 ◽  
Vol 58 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Ruthie B. Birger ◽  
Timothy B. Hallett ◽  
Anushua Sinha ◽  
Bryan T. Grenfell ◽  
Sally L. Hodder
Keyword(s):  
New Jersey ◽  
Continuum Of Care ◽  
Hiv Continuum Of Care ◽  
The Impact

scholarly journals The contribution of HIV point-of-care tests in early HIV diagnosis: community-based HIV testing monitoring in Catalonia, 1995 to 2018

2020 ◽  
Vol 25 (43) ◽  
Author(s):  
Laura Fernàndez-López ◽  
Juliana Reyes-Urueña ◽  
Anna Conway ◽  
Jorge Saz ◽  
Adriana Morales ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Screening Test ◽  
Point Of Care ◽  
Descriptive Analysis ◽  
Hiv Diagnosis ◽  
Community Based ◽  
Sex With Men ◽  
Hiv Continuum Of Care ◽  
Point Of Care Tests ◽  
The Impact

Background Community-based HIV testing services combined with the use of point-of-care tests (POCT) have the potential to improve early diagnosis through increasing availability, accessibility and uptake of HIV testing. Aim To describe community-based HIV testing activity in Catalonia, Spain, from 1995 to 2018, and to evaluate the impact of HIV POCT on the HIV continuum of care. Methods A community-based network of voluntary counselling and testing services in Catalonia, Spain has been collecting systematic data on activity, process and results since 1995. A descriptive analysis was performed on pooled data, describing the data in terms of people tested and reactive screening test results. Results Between 1995 and 2018, 125,876 HIV tests were performed (2.1% reactive). Since the introduction of HIV POCT in 2007, a large increase in the number of tests performed was observed, reaching 14,537 tests alone in 2018 (1.3% reactive). Men who have sex with men (MSM), as a proportion of all people tested, has increased greatly over time reaching 74.7% in 2018. The highest percentage of reactive tests was found in people who inject drugs followed by MSM. The contribution of community-based HIV testing to the overall total notified cases in the Catalonia HIV registry has gradually increased, reaching 37.9% in 2018, and 70% of all MSM cases. In 2018, the percentage of individuals with a reactive screening test who were linked to care was 89.0%. Conclusion Our study reinforces the important role that community-based HIV POCT has on the diagnosis of HIV in key populations.

scholarly journals Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Weiyi Ni ◽  
Wolfgang G. Kunz ◽  
Mayank Goyal ◽  
Lijin Chen ◽  
Yawen Jiang
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Time Window ◽  
Time Windows ◽  
Sensitivity Analyses ◽  
Health State ◽  
The Impact

Abstract Background Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China. Methods A model combining a short-term decision tree and long-term Markov health state transition matrix was constructed. For each time window of symptom onset to EVT, the probability of receiving EVT or non-EVT treatment was varied, thereby varying clinical outcomes and healthcare costs. Clinical outcomes and cost data were derived from clinical trials and literature. Incremental cost-effectiveness ratio and incremental net monetary benefits were simulated. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model. The willingness-to-pay threshold per quality-adjusted life-year (QALY) was set to ¥71,000 ($10,281). Results EVT performed between 61 and 120 min after the stroke onset was most cost-effective comparing to other time windows to perform EVT among AIS patients in China, with an ICER of ¥16,409/QALY ($2376) for performing EVT at 61–120 min versus the time window of 301–360 min. Each hour delay in EVT resulted in an average loss of 0.45 QALYs and 165.02 healthy days, with an average net monetary loss of ¥15,105 ($2187). Conclusions Earlier treatment of acute ischemic stroke patients with EVT in China increases lifetime QALYs and the economic value of care without any net increase in lifetime costs. Thus, healthcare policies should aim to improve efficiency of pre-hospital and in-hospital workflow processes to reduce the onset-to-puncture duration in China.

scholarly journals Consequences of the COVID-19 pandemic on the continuum of the care in a cohort of people living with HIV followed in a single center of Northern Italy

2020 ◽  
Author(s):  
Eugenia Quiros-Roldan ◽  
Paola Magro ◽  
Canio Carriero ◽  
Annacarla Chiesa ◽  
Issa El Hamad ◽  
...  
Keyword(s):  
Antiretroviral Drugs ◽  
Hiv Care ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Continuous Variables ◽  
Hiv Diagnosis ◽  
Missed Visits ◽  
Hiv Continuum Of Care ◽  
Living With Hiv ◽  
The Continuum

Abstract Introduction: During the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care.Methods: this is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student’s t-tests and the Mann-Whitney test. Proportions for categorical variables were compared using the χ2 test.Results: As of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51,4 ±13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n=3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5% to 8% (p<0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p=0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16,6% vs 21,6%, p<0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known. Conclusions: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.

The impact of a private-public partnership delivery system on the HIV continuum of care in a South Indian city

AIDS Care ◽  
2017 ◽  
Vol 30 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Greer Waldrop ◽  
Suraj Sarvode ◽  
Srirama Rao ◽  
V.H.T. Swamy ◽  
Sunil Suhas Solomon ◽  
...  
Keyword(s):  
Delivery System ◽  
Continuum Of Care ◽  
South Indian ◽  
Indian City ◽  
Hiv Continuum Of Care ◽  
The Impact

EXPRESS: Influence of Time to Endovascular Stroke Treatment on Outcomes in the Early versus Extended Window Paradigms

2021 ◽  
pp. 174749302110063
Author(s):  
Raul Nogueira ◽  
Tudor G Jovin ◽  
Diogo C. Haussen ◽  
Rishi Gupta ◽  
ashutosh Jadhav ◽  
...  
Keyword(s):  
Functional Disability ◽  
Time Window ◽  
Time Windows ◽  
Extended Time ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Time To Treatment ◽  
Stroke Treatment ◽  
The Impact ◽  
The Relationship

Background The effect of time from stroke onset to thrombectomy in the extended time window remains poorly characterized. Aim We aimed to analyze the relationship between time to treatment and clinical outcomes in the early versus extended time windows. Methods Proximal anterior circulation occlusion patients from a multicentric prospective registry were categorized into early (≤6-hours) or extended (>6-24-hours) treatment window. Patients with baseline NIHSS≥10 and intracranial ICA or MCA-M1-segment occlusion and pre-morbid mRS0-1 (“DAWN-like” cohort) served as the population for the primary analysis. The relationship between time to treatment and 90-day mRS, analyzed in ordinal (mRS shift) and dichotomized (good outcome, mRS0-2) fashion, was compared within and across the extended and early-windows. Results A total of 1603 out of 2008 patients qualified. Despite longer time to treatment (9[7-13.9]vs.3.4[2.5-4.3] hours,p<0.001), extended-window patients (n=257) had similar rates of symptomatic intracranial hemorrhage (0.8%vs.1.7%,p=0.293) and 90-day-mortality (10.5%vs.9.6%,p=0.714) with only slightly lower rates of 90-day good outcomes (50.4%vs.57.6%,p=0.047) versus early-window patients (n=709). Time to treatment was associated with 90-day disability in both ordinal (aOR,≥1-point mRS shift:0.75;95%CI[0.66-0.86],p<0.001) and dichotomized (aOR,mRS0-2:0.73;95%CI[0.62-0.86],p<0.001) analyses in the early- but not in the extended-window (aOR, mRS shift:0.96;95%CI[0.90-1.02],p=0.15; aOR,mRS0-2:0.97;95%CI[0.90-1.04],p=0.41). Early-window patients had significantly lower 90-day functional disability (aOR, mRS shift:1.533;95%CI[1.138-2.065],p=0.005) and a trend towards higher rates of good outcomes (aOR,mRS0-2:1.391;95%CI[0.972-1.990],p=0.071). Conclusions The impact of time to thrombectomy on outcomes appears to be time dependent with a steep influence in the early followed by a less significant plateau in the extended window. However, every effort should be made to shorten treatment times regardless of ischemia duration.

scholarly journals Stem Radial Growth Is Negatively Related to Tree Defoliation and Damage in Conifers, Northern Italy

2021 ◽  
Vol 4 ◽  
Author(s):  
Marco Ferretti ◽  
Sucharita Ghosh ◽  
Elena Gottardini
Keyword(s):  
Tree Rings ◽  
Tree Growth ◽  
Radial Growth ◽  
Time Window ◽  
Time Windows ◽  
Northern Italy ◽  
Annual Data ◽  
Crown Defoliation ◽  
The Relationship ◽  
Damage Symptoms

Although several manipulative experiments provided evidence for a negative effect of defoliation on tree growth, results from observational studies were less univocal. This may be due to the ability of observed defoliation to reflect the health status of individual trees, to the influence of site condition and to the amplitude of time window used for growth assessment. Here, we investigated the relationship between two tree health indicators (crown defoliation, damage symptoms) and annual (measured by tree-ring width on 69 Norway spruce trees) and periodical (5-year and 10-year diameter increments, 346 trees from five coniferous species) tree growth. Data originated from 14 (seven for tree rings) ICP Forests Level I plots in Trentino, northern Italy. Diameter, defoliation and damage were measured between 1997 and 2011 as part of the annual crown condition survey, while cores for tree-rings were collected on a sub-sample of trees in 2012. We carried out regression modeling combined with model selection in one-step (periodical data) and two-step (annual data) approaches, using moving averages for the annual data with varying time window widths. Our results indicated an overall negative correlation between defoliation and annual or periodical stem diameter growth. The relationship between defoliation and growth changes in relation to the time window considered, and becomes stronger when data are aggregated over longer time windows (&gt;3 years), when also the occurrence of damage symptoms plays a significant role. The effect of the amplitude of the time windows for data aggregation is probably due to the mechanisms behind the defoliation-growth relationship, which may change according to the causal factors involved. In particular, when larger time windows are considered, short-term fluctuations are likely to be smoothed out, and more general patterns may emerge. We concluded that radial growth is significantly negatively related to defoliation, and this supports the use of defoliation as a rapid indicator for forest health and vitality.

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