HIV Care Providers’ Communication with Patients About Safer Conception for People Living with HIV in Tanzania

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

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Childhood Adversities and Physical and Mental Health Outcomes in Adults Living with HIV: Findings from the Ontario HIV Treatment Network Cohort Study

AIDS Research and Treatment ◽

10.1155/2018/2187232 ◽

2018 ◽

Vol 2018 ◽

pp. 1-17 ◽

Cited By ~ 3

Author(s):

Tsegaye Bekele ◽

Evan J. Collins ◽

Robert G. Maunder ◽

Sandra Gardner ◽

Sergio Rueda ◽

...

Keyword(s):

Health Outcomes ◽

Childhood Adversity ◽

Hiv Treatment ◽

Hiv Care ◽

People Living With Hiv ◽

Care Providers ◽

Physical And Mental Health ◽

Childhood Adversities ◽

African Caribbean ◽

Living With Hiv

We sought to estimate the prevalence of childhood adversity and examine its relationship with health outcomes among people living with HIV. Study participants included 1409 adults living with HIV and receiving care in Toronto, Canada. Data on childhood adversity, health behaviors, HIV outcome measures, depression, and health-related quality of life (HRQOL) were collected through face-to-face interviews and medical records. Statistical analyses included multivariable linear and logistic regression modeling. The prevalence of any childhood adversity was 71% (individual types ranged from 11% to 44%) and higher prevalence was associated with younger age, Indigenous or African/Caribbean/Black ethnicity, lower socioeconomic status, and higher rates of cigarette smoking and nonmedicinal drug use. Greater number of childhood adversities was associated with greater odds of depression and decreasing mental HRQOL. HIV care providers need to screen for childhood adversities and address childhood trauma within the context of HIV care.

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1305. Use of a Clinical Pharmacist to Reduce Inpatient ART (Antiretroviral Therapy) Errors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1168 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S470-S471

Author(s):

DeMaurian Mitchner ◽

Lauren E Richey

Keyword(s):

Antiretroviral Therapy ◽

Clinical Pharmacist ◽

Medical Center ◽

Medication Administration ◽

Transitions Of Care ◽

Hiv Care ◽

Inpatient Setting ◽

People Living With Hiv ◽

Care Providers ◽

Living With Hiv

Abstract Background Continuous antiretroviral therapy (ART) that results in viral suppression is the goal of therapy for people living with HIV (PLWH). This results in improved clinical outcomes and prevents transmission to partners. University Medical Center is an urban charity hospital that provides the majority of inpatient care to PLWH in the city of New Orleans. HIV care providers noticed many ART errors during transitions of care, particularly during inpatient admissions. Impartial regimens and interactions can occur when non-HIV providers manage patients in the hospital leading to resistance and viral failure. Methods A clinical pharmacist was hired to improve the quality of HIV care, both in the inpatient and outpatient setting. An electronic medical records alert was created for any patient with HIV who was admitted to the hospital. The clinical pharmacist then reviewed the ART orders Monday through Friday and provided recommendations to the inpatient teams. Data on the frequency and types of errors on the medication administration record (MAR) were recorded. Data were collected for 6 months, from October 2018 to March 2019. Three-month data from October 2018 to December 2018 was compared with three-month data from January 2019 to March 2019 for quality improvement purposes. Results One hundred forty-eight people living with HIV were admitted to the hospital during the specified time period. A minority of the patients (25%) had a consult to an HIV Specialist. Eight (5%) were omission of ART (no regimen or partial regimen), 19 (13%) had food or drug interactions, and 14 (10%) had the incorrect ART regimen ordered. The clinical pharmacist was able to contact the inpatient team and have these errors corrected. There was a 20% decrease in the patients with errors in their inpatient ART order on the MAR during the review period, due to physicians and pharmacists proactively contacting the pharmacist prior to orders being placed and processed. Conclusion Errors in ART in the inpatient setting are common. A clinical pharmacist intervention can successfully decrease ART errors as patients’ transition between inpatient and outpatient care. Disclosures All authors: No reported disclosures.

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Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study

Sexual Health ◽

10.1071/sh19011 ◽

2019 ◽

Vol 16 (4) ◽

pp. 367 ◽

Cited By ~ 4

Author(s):

Ashley Lacombe-Duncan ◽

Peter A. Newman ◽

Greta R. Bauer ◽

Carmen H. Logie ◽

Yasmeen Persad ◽

...

Keyword(s):

Mixed Methods ◽

Mixed Methods Study ◽

Hiv Care ◽

People Living With Hiv ◽

Care Providers ◽

Structural Barriers ◽

Women Living With Hiv ◽

Related Stigma ◽

Trans Women ◽

Living With Hiv

Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. Methods: This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. Results: Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5–67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3–29.2%). Factors significantly associated with not having begun one’s medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. Conclusions: HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.

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The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes

JMIR mhealth and uhealth ◽

10.2196/14557 ◽

2020 ◽

Vol 8 (1) ◽

pp. e14557 ◽

Cited By ~ 1

Author(s):

César Escobar-Viera ◽

Zhi Zhou ◽

Jamie P Morano ◽

Robert Lucero ◽

Spencer Lieb ◽

...

Keyword(s):

Clinical Outcomes ◽

Mobile Health ◽

Clinical Care ◽

Hiv Care ◽

People Living With Hiv ◽

Art Adherence ◽

Care Providers ◽

Cell Counts ◽

Living With Hiv

Background For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. Although research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with the usage of a commercially available, regularly updated mobile health (mHealth) app for improving ART adherence among PLWH. Objective This study aimed to assess the feasibility, acceptability, and clinical outcomes of Care4Today, an existing, free, biprogrammatic mHealth app for improving ART adherence among PLWH. Methods The Florida mHealth Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in 3 public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% (44/132) declined, 31.1% (41/132) agreed but never used the app, and 35.6% (47/132) used the app. All were asked to complete follow-up surveys at 30 days and 90 days after enrollment. Usage data were used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) versus those who did not (nonusers). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis. Results Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and nonusers, respectively. Among users, a Kaplan-Meier plot showed that 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3%) of those who used the mHealth app reported ≥95% ART adherence, compared with 17 (58.6%) nonusers (P=.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants’ favorite features were medication reminders, ability to create custom reminders, and adherence reports. Conclusions This longitudinal study found that a commercially available medication adherence mHealth app was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across 3 public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than nonusers, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage.

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“What if They Are Pre-conception? What Should We Do?”: Knowledge, Practices, and Preferences for Safer Conception Among Women Living With HIV and Healthcare Providers in Gaborone, Botswana

Frontiers in Global Women's Health ◽

10.3389/fgwh.2020.582463 ◽

2020 ◽

Vol 1 ◽

Author(s):

Sarah A. Gutin ◽

Gary W. Harper ◽

Neo Moshashane ◽

Christina Bitsang ◽

Jane Harries ◽

...

Keyword(s):

Healthcare Providers ◽

Sub Saharan Africa ◽

Hiv Care ◽

People Living With Hiv ◽

Safer Conception ◽

Knowledge Practices ◽

Women Living With Hiv ◽

Universal Test And Treat ◽

Living With Hiv ◽

And Training

Safer conception interventions that address HIV care, treatment, and prevention for HIV-affected couples are increasingly available in sub-Saharan Africa. Botswana, an HIV endemic country, is yet to offer formal safer conception services although universal test-and-treat approaches mean that increasing numbers of young, sexually active people living with HIV will start treatment and likely desire childbearing. In order to advance the safer conception discussion in Botswana, it is necessary to understand the current safer conception knowledge, practices, and preferences of healthcare providers and women living with HIV (WLHIV). We conducted qualitative in-depth interviews with 10 HIV healthcare providers and 10 WLHIV in Gaborone. Interviews were analyzed using a phenomenological approach. Safer conception knowledge was limited and safer conception discussions were rare. Healthcare provider and WLHIV preferences were at odds, with providers preferring WLHIV to initiate safer conception discussions, and WLHIV desiring providers to initiate safer conception discussions. Quotes from women and providers highlight deeper issues about power dynamics, concerns about stigma among women, and provider fears about promoting pregnancy. Providers emphasized the need for guidelines and training in order to improve the provision of safer conception counseling. These findings point to areas where safer conception in Botswana can be improved. Both WLHIV and providers would benefit from having information about a range of safer conception methods and approaches. In addition, since WLHIV felt hesitant about initiating safer conception conversations and feared stigma, and because putting the onus for starting safer conception discussions on women is a reversal of normal roles and power structures, providers must take the lead and routinely initiate fertility desire and safer conception discussions. Assisting healthcare providers with clear safer conception guidelines and training would improve the provision of accurate safer conception counseling and facilitate reproductive choice.

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The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes (Preprint)

10.2196/preprints.14557 ◽

2019 ◽

Author(s):

César Escobar-Viera ◽

Zhi Zhou ◽

Jamie P Morano ◽

Robert Lucero ◽

Spencer Lieb ◽

...

Keyword(s):

Clinical Outcomes ◽

Mobile Health ◽

Clinical Care ◽

Hiv Care ◽

People Living With Hiv ◽

Art Adherence ◽

Care Providers ◽

Cell Counts ◽

Living With Hiv

BACKGROUND For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. Although research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with the usage of a commercially available, regularly updated mobile health (mHealth) app for improving ART adherence among PLWH. OBJECTIVE This study aimed to assess the feasibility, acceptability, and clinical outcomes of Care4Today, an existing, free, biprogrammatic mHealth app for improving ART adherence among PLWH. METHODS The Florida mHealth Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in 3 public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% (44/132) declined, 31.1% (41/132) agreed but never used the app, and 35.6% (47/132) used the app. All were asked to complete follow-up surveys at 30 days and 90 days after enrollment. Usage data were used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) versus those who did not (nonusers). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis. RESULTS Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and nonusers, respectively. Among users, a Kaplan-Meier plot showed that 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3%) of those who used the mHealth app reported ≥95% ART adherence, compared with 17 (58.6%) nonusers (<italic>P</italic>=.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants’ favorite features were medication reminders, ability to create custom reminders, and adherence reports. CONCLUSIONS This longitudinal study found that a commercially available medication adherence mHealth app was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across 3 public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than nonusers, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage.

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A Microfinance Program Targeting People Living with HIV in Uganda: Client Characteristics and Program Impact

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957416667485 ◽

2016 ◽

Vol 16 (3) ◽

pp. 254-260 ◽

Cited By ~ 3

Author(s):

Sebastian Linnemayr ◽

Lydia Buzaalirwa ◽

James Balya ◽

Glenn Wagner

Keyword(s):

Unmet Need ◽

Hiv Care ◽

People Living With Hiv ◽

Microfinance Institutions ◽

Care Providers ◽

Client Characteristics ◽

Business Training ◽

Economic Support ◽

Living With Hiv

HIV has disproportionately affected economically vulnerable populations. HIV medical care, including antiretroviral therapy, successfully restores physical health but can be insufficient to achieve social and economic health. It may therefore be necessary to offer innovative economic support programs such as providing business training and microcredit tailored to people living with HIV/AIDS. However, microfinance institutions have shown reluctance to reach out to HIV-infected individuals, resulting in nongovernment and HIV care organizations providing these services. The authors investigate the baseline characteristics of a sample of medically stable clients in HIV care who are eligible for microcredit loans and evaluate their business and financial needs; the authors also analyze their repayment pattern and how their socioeconomic status changes after receipt of the program. The authors find that there is a significant unmet need for business capital for the sample under investigation, pointing toward the potentially beneficial role of providing microfinance and business training for clients in HIV care. HIV clients participating in the loans show high rates of repayment, and significant increases in (disposable) income, as well as profits and savings. The authors therefore encourage other HIV care providers to consider providing their clients with such loans.

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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