scholarly journals Persons living with HIV in sero-discordant partnerships experience improved HIV care engagement compared with persons living with HIV in sero-concordant partnerships: a cross-sectional analysis of four African countries

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Domonique M. Reed ◽  
Allahna L. Esber ◽  
Trevor A. Crowell ◽  
Kavitha Ganesan ◽  
Hannah Kibuuka ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Self Report ◽  
Hiv Care ◽  
Treatment As Prevention ◽  
African Countries ◽  
Cross Sectional ◽  
Psychological Stressors ◽  
Persons Living With Hiv ◽  
Hiv Care Engagement ◽  
Living With Hiv

Abstract Background Persons living with HIV (PLWH) who are members of sero-discordant and sero-concordant relationships may experience psychological stressors or motivators that affect HIV care. We assessed the association between sero-discordance status, antiretroviral therapy (ART) uptake, and viral suppression in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls PLWH and HIV-uninfected individuals at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, we determined ART use through self-report. Viral suppression was defined as HIV RNA < 1000 copies/mL. We analyzed PLWH who were index participants within two types of sexual dyads: sero-discordant or sero-concordant. Binomial regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ART use and viral suppression at study enrollment. Results From January 2013 through March 2018, 223 index participants from sero-discordant dyads and 61 from sero-concordant dyads were enrolled. The majority of the indexes were aged 25–34 years (50.2%), female (53.4%), and married (96.5%). Sero-discordant indexes were more likely to disclose their status to partners compared with sero-concordant indexes (96.4% vs. 82.0%, p < 0.001). After adjustment, sero-discordant index participants were more likely to be on ART (aPR 2.8 [95% CI 1.1–6.8]), but no more likely to be virally suppressed. Results may be driven by unique psycho-social factors and global implementation of treatment as prevention. Conclusions PLWH in sero-discordant sexual partnerships demonstrated improved uptake of ART compared with those in sero-concordant partnerships. Interventions are needed to increase care engagement by individuals in sero-concordant relationships to improve HIV outcomes.

scholarly journals Disparities in HIV/STI burden and care coverage among men and transgender persons who have sex with men in Nairobi, Kenya: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055783
Author(s):  
Adrian D Smith ◽  
Elizabeth Fearon ◽  
Rhoda Kabuti ◽  
Erastus Irungu ◽  
Mary Kungu ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Self Report ◽  
Hiv Care ◽  
Secondary Outcome ◽  
Hiv Status ◽  
African Countries ◽  
Cross Sectional ◽  
Transgender Persons ◽  
Sex With Men ◽  
Hiv 1

ObjectivesThe study aimed to estimate the prevalence of, and associations, with HIV and metrics of HIV care engagement in a representative population of gay, bisexual and other men who have sex with men (GBMSM) and transgender persons (TP) who have sex with men (GBMSM/TP)SettingUrban districts of Nairobi, Kenya.DesignCross-sectional.Participants608 eligible participants were identified through respondent-driven sampling over 19 waves of recruitment arising from ten seeds between May and December 2017. Inclusion criteria were: age >18 years; Nairobi residence; male sex assignment at birth or current identification as male, and recent consensual sex with male partners. Exclusion criteria were: missing or invalid recruitment coupon; repeat registration; intoxication at study visit.Primary and secondary outcome measuresHIV status measured using Determine Alere HIV 1/2 and First Response HIV 1–2.0 and GeneXpert HIV-1 Qual. Self-reported metrics of HIV status awareness, antiretroviral use and objective quantification of viral suppression using GeneXpert HIV-1 VL.Results26.4% (286/618) were HIV positive of whom 76.6% were status aware, 65.3% were on antiretroviral therapy (ART), and 47.4% were virally suppressed (<50 copies/mL). Participants 18–22 years were less likely to be status aware, be receiving ART or to have achieved viral suppression. Mean log viral load was 3.14 log higher in 18–22 years compared with older participants. Bacterial sexually transmitted infections were common at both urethral and rectal sites and most infections were asymptomatic by self-report (rectal 82.2%, urethral 82.3%).ConclusionsEngagement in the HIV diagnosis and care cascade among GBMSM/TP in Nairobi is markedly better than in most sub-Saharan African countries, yet falls short of achievements for the general population in Kenya and for GBMSM in high income settings. Young GBMSM/TP are least well served by the current configuration of adult key population services, and programmes should identify and address the sexual, social and developmental needs of adolescent and young key populations.

scholarly journals Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

2020 ◽  
Author(s):  
Melissa A. Stockton ◽  
Bradley N. Gaynes ◽  
Mina C. Hosseinipour ◽  
Audrey E. Pettifor ◽  
Joanna Maselko ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Load Testing ◽  
Art Initiation ◽  
Retention In Hiv Care ◽  
Hiv Care Engagement ◽  
Care Outcomes ◽  
Sub Saharan ◽  
Living With Hiv

Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

scholarly journals Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries

10.2196/13741 ◽  
2019 ◽  
Vol 7 (11) ◽  
pp. e13741
Author(s):  
Phillipe Lepère ◽  
Yélamikan Touré ◽  
Alexandra M Bitty-Anderson ◽  
Simon P Boni ◽  
Gildas Anago ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
West African ◽  
Hiv Care ◽  
People Living With Hiv ◽  
African Countries ◽  
Cross Sectional ◽  
Factors Associated ◽  
Living With Hiv

Background The use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. Objective The aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. Methods A cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. Results A total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P<.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; P=.01). Conclusions The use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.

scholarly journals Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries (Preprint)

2019 ◽  
Author(s):  
Phillipe Lepère ◽  
Yélamikan Touré ◽  
Alexandra M Bitty-Anderson ◽  
Simon P Boni ◽  
Gildas Anago ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
West African ◽  
Hiv Care ◽  
People Living With Hiv ◽  
African Countries ◽  
Cross Sectional ◽  
Factors Associated ◽  
Living With Hiv

BACKGROUND The use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. OBJECTIVE The aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. METHODS A cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. RESULTS A total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; <italic>P</italic>&lt;.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; <italic>P</italic>=.01). CONCLUSIONS The use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.

A systematic review of the geospatial barriers to antiretroviral initiation, adherence and viral suppression among people living with HIV

Sexual Health ◽  
2019 ◽  
Vol 16 (1) ◽  
pp. 1 ◽  
Author(s):  
Kiffer G. Card ◽  
Nathan J. Lachowsky ◽  
Keri N. Althoff ◽  
Katherine Schafer ◽  
Robert S. Hogg ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Clinical Care ◽  
The United States ◽  
Hiv Care ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Pubmed Database ◽  
Barriers To Art Initiation ◽  
Living With Hiv

Background With the emergence of antiretroviral therapy (ART), Treatment as Prevention (TasP) has become the cornerstone of both HIV clinical care and HIV prevention. However, despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation, adherence and viral suppression have the potential to reduce TasP effectiveness. These barriers have been studied using Geographic Information Systems (GIS). While previous reviews have examined the use of GIS for HIV testing – an essential antecedent to clinical care – to date, no reviews have summarised the research with respect to other ART-related outcomes. Methods: Therefore, the present review leveraged the PubMed database to identify studies that leveraged GIS to examine the barriers to ART initiation, adherence and viral suppression, with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Joanna Briggs Institute criteria were used for the critical appraisal of included studies. Results: In total, 33 relevant studies were identified, excluding those not utilising explicit GIS methodology or not examining TasP-related outcomes. Conclusions: Findings highlight geospatial variation in ART success and inequitable distribution of HIV care in racially segregated, economically disadvantaged, and, by some accounts, increasingly rural areas – particularly in the United States. Furthermore, this review highlights the utility and current limitations of using GIS to monitor health outcomes related to ART and the need for careful planning of resources with respect to the geospatial movement and location of people living with HIV (PLWH).

scholarly journals Persons living with HIV who do not smoke cigarettes: A comparison of ex-smokers and never smokers

2021 ◽  
Vol 14 ◽  
pp. 1179173X2110533
Author(s):  
Jonathan Shuter ◽  
H. Dean Hosgood ◽  
Shaundell Nardin ◽  
Andrea H. Weinberger
Keyword(s):  
Smoking Status ◽  
Care Center ◽  
Current Smoker ◽  
Hiv Care ◽  
Computer Assisted ◽  
Cross Sectional ◽  
Effective Response ◽  
Persons Living With Hiv ◽  
Never Smokers ◽  
Living With Hiv

Background and Aims Approximately half of persons living with HIV (PLWH) in the US smoke cigarettes. Large surveys show that 16.9%–37.3% of PLWH are never smokers compared to 57.5% of US adults. Similar proportions of PLWH and general population adults describe themselves as ex-smokers (20.3% vs 21.9% respectively). Little research has been done to characterize PLWH non-smokers. In this study, we compared a group of well characterized PLWH ex-smokers (i.e., no cigarettes for at least 5 years) to PLWH never smokers with the aim of developing a clearer understanding of the characteristics of these groups and the differences between them. Design Cross-sectional interview study employing audio computer-assisted self-interview (ACASI). Setting Comprehensive HIV care center in New York City. Participants In 2018–2019, we recruited a sample of PLWH never smokers (N = 54) and long-term ex-smokers (no cigarettes for at least 5 years, N = 36). Non-smoking status of participants was verified by exhaled carbon monoxide. Measurements We collected a range of sociodemographic, historical, clinical, and psychobehavioral data pertaining to tobacco use. Results Compared to never smokers, ex-smokers were older, more likely to have heterosexually acquired HIV and less likely to have same-sex-acquired infection, more likely to have parents and/or siblings who smoked, more likely to have current smoker/s in their households, and more likely to have ever used marijuana, cocaine, and/or heroin. Conclusions We describe important demographic and sociobehavioral differences between PLWH never smokers and ex-smokers that may be useful in crafting an effective response to the cigarette smoking epidemic in US PLWH.

scholarly journals Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder

2020 ◽  
Author(s):  
Petra Jacobs ◽  
Daniel J Feaster ◽  
Yue Pan ◽  
Lauren K Gooden ◽  
Eric S Daar ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Outpatient Care ◽  
Viral Suppression ◽  
Hiv Care ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Immunodeficiency Virus ◽  
Linkage To Hiv Care ◽  
Living With Hiv

Abstract Background Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. Methods CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. Results Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P &lt; .001). Conclusions Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

Psychiatric Aspects of Care Engagement and Medication Adherence in Antiretroviral-Based HIV Treatment and Prevention

2017 ◽  
Author(s):  
Jeffrey J. Weiss ◽  
Michael J. Stirratt
Keyword(s):  
Hiv Infection ◽  
Treatment Adherence ◽  
Psychiatric Illness ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Art Adherence ◽  
Addictive Disorders ◽  
Persons Living With Hiv ◽  
Hiv Care Engagement ◽  
Living With Hiv

Care engagement and treatment adherence are directly related to HIV treatment outcomes and to mortality. Active drug use and psychiatric illness such as depressive and addictive disorders are significant barriers to care engagement and treatment adherence among persons living with HIV and those at high risk for HIV infection and eligible for pre-exposure prophylaxis (PrEP). This chapter addresses (1) psychiatric aspects of PrEP for HIV prevention, (2) the care continuum for individuals living with HIV infection, (3) psychiatric determinants of HIV care engagement, (4) behavioral interventions to improve HIV care engagement, (5) psychiatric determinants of antiretroviral (ART) adherence, (6) interventions to improve ART adherence, and (7) implications of research findings for the medical and mental health clinician working with patients with psychiatric illness who are living with HIV or at risk for infection.

scholarly journals Integrated and patient-selected care facilitates completion of isoniazid preventive therapy in Eswatini

2019 ◽  
Vol 9 (4) ◽  
pp. 153-158
Author(s):  
L. V. Adams ◽  
T. S. B. Maseko ◽  
E. A. Talbot ◽  
S. W. Grande ◽  
M. M. Mkhontfo ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Preventive Therapy ◽  
High Rate ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
Critical Factors ◽  
Cross Sectional ◽  
Persons Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Setting: Five human immunodeficiency virus (HIV) care facilities in Eswatini.Objective: To identify critical factors that enabled persons living with HIV to successfully complete a 6-month course of isoniazid preventive therapy (IPT) provided through a choice of facility-based or community-based delivery, coordinated with antiretroviral therapy (ART) refills.Design: This was a mixed methods, retrospective cross-sectional study.Results: Between June and October 2017, we interviewed 150 participants who had completed IPT in the previous year. Fourteen participants did not recall being offered a choice, and were excluded from the analysis. Of the remaining 136, 56.6% were female and 64.7% chose facility-based care; the median age was 42.5 years. Most participants reported that having a choice was important to their treatment completion (87.7%) and that linking IPT and ART refills facilitated undergoing IPT (98.5%). Participants were knowledgeable about the benefits of IPT and valued the education received from their providers. Participants also reported a high rate of IPT disclosure (95%) to friends and family members.Conclusion: Offering patients a choice of IPT delivery, linking IPT with ART refills, emphasizing patient education and engagement with healthcare workers, and supporting disclosure of IPT are critical factors to enabling IPT completion. These interventions should be incorporated throughout Eswatini and in similar high tuberculosis and HIV burden settings.

Sign in / Sign up

Export Citation Format

Share Document