“Facilitating HIV status adjustment: Qualitative insights from the Tambua Mapema proof-of-concept study in Kenya”

Systematic efforts are needed to prepare persons newly diagnosed with acute or chronic HIV infection to cope. We examined how patients dealt with this news, looking at how readiness to accept an HIV diagnosis impacted treatment outcomes, prevention of transmission, and HIV status disclosure. We examined vulnerability and agency over time and considered implications for policy and practice. A qualitative sub-study was embedded in the Tambua Mapema (“Discover Early”) Plus (TMP) study (NCT03508908), conducted in coastal Kenya between 2017 and 2020, which was a stepped wedge trial to evaluate an opt-out HIV-1 nucleic acid testing intervention diagnosing acute and chronic HIV infections. Diagnosed participants were offered antiretroviral therapy (ART), viral load monitoring, HIV partner notification services, and provision of pre-exposure prophylaxis (PrEP) to their uninfected partners. Data were analyzed using thematic approaches. Participants included 24 individuals who completed interviews at four time points (2 weeks and 3, 6, and 9 months after diagnosis), including 18 patients (11 women and 7 men) and 6 partners (1 woman, 5 men, of whom 4 men started PrEP). Acceptance of HIV status was often a long, individualized, and complex process, whereby participants’ coping strategies affected day-to-day issues and health over time. Relationship status strongly impacted coping. In some instances, couples supported each other, but in others, couples separated. Four main themes impacted participants’ sense of agency: acceptance of diagnosis and commitment to ART; positive feedback after attaining viral load suppression; recognition of partner supportive role and focus on sustained healthcare support whereby religious meaning was often key to successful transition. To support patients with acute or newly diagnosed chronic HIV, healthcare and social systems must be more responsive to the needs of the individual, while also improving quality of care, strengthening continuity of care across facilities, and promoting community support.

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Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053195 ◽

2017 ◽

Vol 94 (3) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

James Blain Johnston ◽

Joss N Reimer ◽

John L Wylie ◽

Jared Bullard

Keyword(s):

Viral Load ◽

Hiv Testing ◽

Clinical Outcomes ◽

Point Of Care ◽

Age Groups ◽

Linkage To Care ◽

Hiv Positive ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

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The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain)

BMC Public Health ◽

10.1186/s12889-020-09603-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Cristina Agustí ◽

Núria Font-Casaseca ◽

Francesc Belvis ◽

Mireia Julià ◽

Núria Vives ◽

...

Keyword(s):

Spatial Distribution ◽

Hiv Infection ◽

Urban Areas ◽

Western Europe ◽

Hiv Infections ◽

National Registry ◽

Surveillance Data ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Incident Cases

Abstract Background Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. Methods Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012–2016) and associated risk factors at the small area level (ABS, acronym for “basic health area” in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. Results New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15–44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. Conclusions Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

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HIV and AIDS in Poland in 2017

Przeglad Epidemiologiczny ◽

10.32394/pe.73.17 ◽

2019 ◽

pp. 179-192

Author(s):

Katarzyna Szmulik ◽

Marta Niedźwiedzka-Stadnik ◽

Magdalena Rosińska

Keyword(s):

Hiv Testing ◽

Low Frequency ◽

Linkage To Care ◽

Hiv Infections ◽

Hiv And Aids ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Annual Survey ◽

Diagnosis Rate ◽

Epidemiological Situation

AIM. The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2017 in comparison to the changes in preceding years. MATERIALS AND METHODS. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. RESULTS. In 2017 there were 1,419 HIV cases newly diagnosed in Poland (diagnosis rate: 3.69 per 100,000), including 51 among non-Polish citizens. The frequency of newly detected HIV infections increased by nearly 8% compared to the previous year and by almost 28% compared to the median in 2011-2015 years. The total number of AIDS cases was 108 (incidence 0.28 per 100,000), and 20 people died from AIDS disease (0.05 per 100,000). New HIV diagnoses were reported mainly among people in age 20 to 39 years (69.5%) and among men (88.5%). Among cases with known transmission route, 69.5% concerned among men who had sexual contact with men (MSM). The percentage of MSM cases, similarly to heterosexual cases decrease in comparison to previous year, relatively by 5.7% and 6.4%. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by 6% percentage points in comparison with 2016 year (from 68% to 74% AIDS cases). CONCLUSION. The most HIV cases are diagnosed among MSM, so prophylactic activities are still needed in this key population. It is also need to increase the number of new cases linkage-to-care and to improve the low frequency in HIV testing rate in all population.

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COVID-19 infections post-vaccination by HIV status in the United States

10.1101/2021.12.02.21267182 ◽

2021 ◽

Author(s):

Sally B. Coburn ◽

Elizabeth Humes ◽

Raynell Lang ◽

Cameron Stewart ◽

Brenna C Hogan ◽

...

Keyword(s):

Viral Load ◽

Cumulative Incidence ◽

The United States ◽

Infection Risk ◽

Hiv Status ◽

Viral Load Suppression ◽

Hiv Viral Load ◽

Post Vaccination ◽

Increased Risk ◽

Vaccine Type

ABSTRACTImportanceRecommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines.ObjectiveEstimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US.Design, setting, and participantsThe Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals ≥18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated.ExposureHIV infectionOutcomeCOVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated.ResultsAmong 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count among PWH.Conclusions and RelevanceCOVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.

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Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes

10.1101/311597 ◽

2018 ◽

Author(s):

Denis Nash ◽

McKaylee M. Robertson ◽

Kate Penrose ◽

Stephanie Chamberlin ◽

Rebekkah S. Robbins ◽

...

Keyword(s):

New York ◽

New York City ◽

Viral Load ◽

Relative Risk ◽

York City ◽

Hiv Care ◽

Newly Diagnosed ◽

Viral Load Suppression ◽

History Of

AbstractThe New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15·3% were newly diagnosed; among the 84·7% previously diagnosed, 14·2% were consistently suppressed, 28·9% were inconsistently suppressed, and 41 ·6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59·9% of CCP and 53·9% of non-CCP participants had viral load suppression (Relative Risk=1.11, 95%CI:1.08-1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09-1.23) and 1.32 (95%CI:1.23-1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance.

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Impact of Neurocognitive Deficits on Viral Load Suppression Among Newly Diagnosed HIV-Infected Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.1714 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Lokesh Shahani ◽

Lucrecia Salazar ◽

Rodrigo Hasbun

Keyword(s):

Viral Load ◽

Newly Diagnosed ◽

Neurocognitive Deficits ◽

Viral Load Suppression

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Crushed dolutegravir/abacavir/lamivudine given via nasogastric tube in gastric outlet obstruction caused by cancer resulted in rapid viral load suppression

International Journal of STD & AIDS ◽

10.1177/0956462418797847 ◽

2018 ◽

Vol 30 (1) ◽

pp. 94-98 ◽

Cited By ~ 5

Author(s):

Aleš Chrdle ◽

Zdeňka Jerhotová ◽

Michal Vacík ◽

Marek Linka ◽

Václav Chmelík

Keyword(s):

Viral Load ◽

Gastric Outlet Obstruction ◽

Nasogastric Tube ◽

Outlet Obstruction ◽

Therapeutic Drug ◽

Viral Load Suppression ◽

Hiv Diagnosis ◽

Duodenal Ulcers ◽

Mode Of Administration ◽

Late Hiv Diagnosis

Alternative modes of antiretroviral administration are sought for people with impaired intestinal passage and/or absorption. We present a case of late HIV diagnosis (CD4+ count 160 cells/µL) with gastric outlet obstruction due to stomach adenocarcinoma. Co-morbidities included oesophageal candidiasis, Helicobacter pylori-positive duodenal ulcers and cytomegalovirus duodenitis. The gastric outlet obstruction required total parenteral nutrition and parenteral medication during four weeks of diagnostic work-up leading to pyloric resection. Crushed dolutegravir, abacavir and lamivudine were administered during this time in the evening via nasogastric tube, which was kept clamped overnight. The tube was unclamped in the morning and stomach content was drained during the daytime. This mode of administration resulted in rapid and sustained viral load suppression (from 300,000 to 115 copies per mL in 28 days, 81 copies/mL after 42 days of treatment and less than 40 copies/mL thereafter). Therapeutic drug monitoring confirmed sufficient antiretroviral plasma levels during this mode of administration. The absorption of crushed dolutegravir, abacavir and lamivudine in the stomach may be considered in people with questionable gastrointestinal passage or impaired gastric emptying to achieve viral load suppression.

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Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2926 ◽

2013 ◽

Vol 7 (08) ◽

pp. 593-599

Author(s):

María Eugenia Socías ◽

Flavio Rotryng ◽

Pablo Lapadula ◽

Maira Medrano ◽

Daniela Paz ◽

...

Keyword(s):

Viral Load ◽

Virologic Failure ◽

Laboratory Data ◽

Treatment As Prevention ◽

Viral Load Suppression ◽

Resource Limited Settings ◽

Resource Limited ◽

Third Line ◽

Over Time

Introduction: Recently, there has been increasing interest in the role of “treatment as prevention” (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting. Methodology: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs. Results: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12–15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). Conclusions: Maintaining viral load suppression over time in resource-limited-settings is feasible.

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