scholarly journals The Increased Effectiveness of HIV Preventive Intervention among Men Who Have Sex with Men and of Follow-Up Care for People Living with HIV after ‘Task-Shifting’ to Community-Based Organizations: A ‘Cash on Service Delivery’ Model in China

PLoS ONE ◽  
2014 ◽  
Vol 9 (7) ◽  
pp. e103146 ◽  
Author(s):  
Hongjing Yan ◽  
Min Zhang ◽  
Jinkou Zhao ◽  
Xiping Huan ◽  
Jianping Ding ◽  
...  
Keyword(s):  
Preventive Intervention ◽  
Task Shifting ◽  
People Living With Hiv ◽  
Service Delivery Model ◽  
Community Based ◽  
Community Based Organizations ◽  
Follow Up Care ◽  
Sex With Men ◽  
Living With Hiv

scholarly journals Barriers and Facilitators of Smoking Cessation among Latinos Living with HIV: Perspectives from Key Leaders of Community-Based Organizations and Clinics

2021 ◽  
Vol 18 (7) ◽  
pp. 3437
Author(s):  
Francisco Cartujano-Barrera ◽  
Michelle Lee D’Abundo ◽  
Evelyn Arana-Chicas ◽  
Surina Chock ◽  
Pamela Valera ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Barriers And Facilitators ◽  
Mental Health Stigma ◽  
People Living With Hiv ◽  
Community Based ◽  
Care Community ◽  
Targeted Interventions ◽  
Community Based Organizations ◽  
The Individual ◽  
Living With Hiv

The purpose of this study was to identify the perspectives from key leaders of community-based organizations (CBOs) and clinics serving people living with HIV on barriers and facilitators of smoking cessation among Latino smokers living with HIV. Semi-structured interviews were conducted in English and Spanish with 10 key leaders. Using a social ecological model, qualitative theoretical analysis was used to analyze the results. Participants identified barriers at the individual (e.g., low education level, HIV, and financial stress), interpersonal (e.g., language barriers, low social support), organizational (e.g., lack of smoking cessation resources and targeted interventions), community (e.g., HIV and mental health stigma), and policy (e.g., paperwork for insurance) level. Participants identified facilitators at the individual (e.g., high participation in trials, good medication adherence), interpersonal (e.g., no smoking in social circles), organizational (e.g., bilingual staff, culturally competent care), community (e.g., providing transportation, the coronavirus disease 2019 as an opportunity for smoking cessation), and policy level (e.g., existence of funding, comprehensive insurance programs). These results provide operational strategies to address smoking disparities among Latino smokers living with HIV. Further research is needed on how to integrate these perspectives into effective smoking cessation interventions.

scholarly journals How to RESPOND to Modern Challenges for People Living with HIV: A Profile for a New Cohort Consortium

2020 ◽  
Vol 8 (8) ◽  
pp. 1164 ◽  
Author(s):  
Keyword(s):  
People Living With Hiv ◽  
Specific Data ◽  
Clinical Endpoints ◽  
Shared Data ◽  
Clinical Events ◽  
Study Population ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Living With Hiv

Background: the International Cohort Consortium of Infectious Disease (RESPOND) is a collaboration dedicated to research on HIV and other infectious diseases. Methods: RESPOND is a flexible organization, with several independent substudies operating under one shared governance. HIV-related variables, including full antiretroviral therapy (ART) history, are collected annually for all participants and merged with substudy specific data into a shared data pool. Incident clinical events are reported using standardized forms. Prospective follow-up started 1/10/17 (enrolment) with retrospective data collected back to 01/01/12. Results: Overall, 17 cohorts from Europe and Australia provided data on 26,258 people living with HIV (PLWH). The majority (43.3%) of the population were white, with men-sex-with-men accounting for 43.3% of the risk for HIV acquisition. The median age was 48 years (IQR 40–56) and 5.2% and 25.5% were known to be co-infected with hepatitis B or C. While 5.3% were ART-naïve, the median duration on ART was 10.1 years (4.8–17.6), with 89.5% having a VL <200 copies/mL and the median CD4 count being 621 cells/µL (438–830). Malignancies (n = 361) and cardiovascular disease (n = 168) were the predominant reported clinical events. Conclusion: RESPOND’s large, diverse study population and standardized clinical endpoints puts the consortium in a unique position to respond to the diverse modern challenges for PLWH.

scholarly journals Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

2020 ◽  
Author(s):  
Kelly K O'Brien ◽  
Francisco Ibáñez-Carrasco ◽  
Patricia Solomon ◽  
Richard Harding ◽  
Darren Brown ◽  
...  
Keyword(s):  
Healthy Aging ◽  
Research Priorities ◽  
People Living With Hiv ◽  
International Forum ◽  
Research Knowledge ◽  
Community Based ◽  
Community Based Organizations ◽  
Rehabilitation Research ◽  
Patient Reported ◽  
Living With Hiv

Abstract BackgroundPeople living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC’s aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. MethodsWe conducted a multi-stakeholder mixed-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. ResultsSixty-nine stakeholders from countries including Canada (n=62;90%), the United Kingdom (n=5;7%), United States (n=1;1%) and Australia (n=1;1%) attended the International Forum on HIV, Aging and Rehabilitation. Stakeholders represented community-based organizations (n=20;29%), academic institutions (n=18;26%), community or institutional healthcare organizations (n=11;16%), research or knowledge production organizations (n=10;14%), and organizations representing government or industry (n=10;14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: 1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; 2) prevalence, severity and impact of frailty; 3) community and social participation aging with HIV; 4) strategies for chronic disease management and healthy aging with HIV; 5) facilitators and barriers to access to and engagement in, rehabilitation; 6) effectiveness of rehabilitation interventions for healthy aging with HIV; and 7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. ConclusionsThese priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.

Viral Load Monitoring for People Living with HIV in the Era of Test and Treat: Progress Made and Challenges Ahead – A Systematic Review

2021 ◽  
Author(s):  
Minh D. Pham ◽  
Huy V. Nguyen ◽  
David Anderson ◽  
Suzanne Crowe ◽  
Stanley Luchters
Keyword(s):  
Systematic Review ◽  
Viral Load ◽  
Viral Suppression ◽  
Search Strategy ◽  
People Living With Hiv ◽  
Community Based ◽  
Viral Load Monitoring ◽  
Load Monitoring ◽  
Living With Hiv

Abstract Background Treatment of HIV with antiretroviral therapy (ART) can improve the health of people living with HIV (PLHIV), stop onward transmission of HIV and effectively prevent the spread of the virus. In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for PLHIV on ART in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review with key search terms relevant to HIV treatment and care, decentralization and viral load monitoring. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. More than 85% (29/34) of included studies were conducted in 11 sub-Saharan African countries (SSA) using routinely collected program data; two studies were conducted among key populations (KPs) attending research clinics. Sixty per cent (20/34) of these studies were designed to evaluate VL monitoring and/or VL cascade among PLHIV on ART, and most were published in 2019–2021. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46-82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50-84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47-85%), and pregnant women (range: 32–82%, median: 57% IQR: 43-71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82%-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48%-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions There was a marked increase in the number of studies of VL monitoring for PLHIV on ART in LMICs over the past five years. Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of SSA and in KPs. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

scholarly journals Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W Dunbar ◽  
N Sohler ◽  
Y Coppieters
Keyword(s):  
Viral Suppression ◽  
Continuum Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Care Clinic ◽  
Effective Interventions ◽  
Sex With Men ◽  
Living With Hiv

Abstract Background The HIV epidemic in Haiti continues, with an estimated 160,000 people living with HIV at the end of 2018. Although HIV prevalence in the general population is estimated to be 2.0%, certain groups are at a higher risk of HIV infection. The prevalence of HIV among men who have sex with men (MSM) is estimated to be 12.9%. As previous data have found gaps in HIV care for this population, we explored the steps in the continuum of care to determine outcomes at each step. Methods We used an observational retrospective cohort study design to follow up MSM diagnosed with HIV in the largest HIV care clinic in Port-au-Prince, Haiti. Estimates were calculated of proportions of participants reached, tested, linked to care, commencing treatment, adherent to treatment, and who achieved virologic suppression. We identified factors associated with loss to follow-up at each step using multivariable analysis. Results Data were collected between January 1, 2015, and December 31, 2018. 5009 MSM were reached for prevention services. Of those reached, 2499 (49.8%, 95% CI 48.5-51.3) were tested for HIV, 222 (8.8%, 95% CI 7.8-10.0) had a positive test result for HIV, and 172 (77,47%, 95% CI 71.4-82.8) were linked to HIV care. Among participants who started care, 54 (44.6 95% CI 24.5-38.9) were retained and 98 (78.4%, 95% CI 49.2-64.5) achieve a suppressed viral load. Fifty-nine (44.8%, 95% CI 27.2-41.9) were lost to follow-up. Participants who had been younger, with lower educational and economic level were significantly less likely to achieve retention and viral suppression (p = 0.001). Conclusions HIV cascade data among MSM in Haiti show very poor rates of retention in treatment although those retained had good virologic outcome. Characteristics associated with LTFU suggest an urgent need to develop and implement effective interventions to support patients in achieving retention and viral suppression among MSM living with HIV. Key messages Poor HIV outcomes for men who have sex with men in Haiti. Effective interventions to improve HIV outcomes for men who have sex with men in Haiti are urgently needed.

scholarly journals Acceptability of point-of-care viral load testing to facilitate differentiated care: a qualitative assessment of people living with HIV and nurses in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lindani Msimango ◽  
Andrew Gibbs ◽  
Hlengiwe Shozi ◽  
Hope Ngobese ◽  
Hilton Humphries ◽  
...  
Keyword(s):  
Point Of Care ◽  
Task Shifting ◽  
People Living With Hiv ◽  
Community Based ◽  
Community Based Art ◽  
Professional Nurses ◽  
Living With Hiv ◽  
Differentiated Care ◽  
Art Delivery ◽  
And Task

Abstract Background Providing viral load (VL) results to people living with HIV (PLHIV) on antiretroviral therapy (ART) remains a challenge in low and middle-income countries. Point-of-care (POC) VL testing could improve ART monitoring and the quality and efficiency of differentiated models of HIV care. We assessed the acceptability of POC VL testing within a differentiated care model that involved task-shifting from professional nurses to less highly-trained enrolled nurses, and an option of collecting treatment from a community-based ART delivery programme. Methods We undertook a qualitative sub-study amongst clients on ART and nurses within the STREAM study, a randomized controlled trial of POC VL testing and task-shifting in Durban, South Africa. Between March and August 2018, we conducted 33 semi-structured interviews with clients, professional and enrolled nurses and 4 focus group discussions with clients. Interviews and focus groups were audio recorded, transcribed, translated and thematically analysed. Results Amongst 55 clients on ART (median age 31, 56% women) and 8 nurses (median age 39, 75% women), POC VL testing and task-shifting to enrolled nurses was acceptable. Both clients and providers reported that POC VL testing yielded practical benefits for PLHIV by reducing the number of clinic visits, saving time, travel costs and days off work. Receiving same-day POC VL results encouraged adherence amongst clients, by enabling them to see immediately if they were ‘good’ or ‘bad’ adherers and enabled quick referrals to a community-based ART delivery programme for those with viral suppression. However, there was some concern regarding the impact of POC VL testing on clinic flows when implemented in busy public-sector clinics. Regarding task-shifting, nurses felt that, with extra training, enrolled nurses could help decongest healthcare facilities by quickly issuing ART to stable clients. Clients could not easily distinguish enrolled nurses from professional nurses, instead they highlighted the importance of friendliness, respect and good communication between clients and nurses. Conclusions POC VL testing combined with task-shifting was acceptable to clients and healthcare providers. Implementation of POC VL testing and task shifting within differentiated care models may help achieve international treatment targets. Trial registration NCT03066128, registered 22/02/2017.

scholarly journals Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

2020 ◽  
Author(s):  
Kelly K O'Brien ◽  
Francisco Ibáñez-Carrasco ◽  
Patricia Solomon ◽  
Richard Harding ◽  
Darren Brown ◽  
...  
Keyword(s):  
Healthy Aging ◽  
Research Priorities ◽  
People Living With Hiv ◽  
International Forum ◽  
Research Knowledge ◽  
Community Based ◽  
Community Based Organizations ◽  
Rehabilitation Research ◽  
Patient Reported ◽  
Living With Hiv

Abstract Background: People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC’s aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. Methods: We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. Results: Sixty-nine stakeholders from countries including Canada (n=62;90%), the United Kingdom (n=5;7%), United States (n=1;1%) and Australia (n=1;1%) attended the International Forum on HIV, Aging and Rehabilitation. Stakeholders represented community-based organizations (n=20;29%), academic institutions (n=18;26%), community or institutional healthcare organizations (n=11;16%), research or knowledge production organizations (n=10;14%), and organizations representing government or industry (n=10;14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: 1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; 2) prevalence, severity and impact of frailty; 3) community and social participation aging with HIV; 4) strategies for chronic disease management and healthy aging with HIV; 5) facilitators and barriers to access to and engagement in, rehabilitation; 6) effectiveness of rehabilitation interventions for healthy aging with HIV; and 7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. Conclusions: These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.

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