What Shapes Late HIV Diagnosis in Vietnam? A Qualitative Investigation of Multilevel Factors

2021 ◽  
Vol 33 (5) ◽  
pp. 450-463
Author(s):  
Thu Trang Nguyen ◽  
Anh Ngoc Luong ◽  
Thi Dieu Thuy Dao ◽  
Nicolas Nagot ◽  
Didier Laureillard ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Hiv Treatment ◽  
Public Health Issue ◽  
Structural Level ◽  
Key Populations ◽  
Global Public Health ◽  
Hiv Diagnosis ◽  
Cd4 Counts ◽  
Late Hiv Diagnosis ◽  
Increased Risk

Late HIV treatment remains a global public health issue despite significant efforts. To better understand what shapes this issue, we interviewed 36 Vietnamese ART-naive patients who came to HIV treatment in 2017. Half of them had intake CD4 counts fewer than 100 cells/mm3, the others had intake CD4 counts of 350 cells/mm3 and above. Late diagnosis was the reason of late treatment in our sample. Most late presenters were not members of the key populations at increased risk of HIV (e.g., people who inject drugs, commercial sex workers, and men who have sex with men). Individual-level factors included low risk appraisal, habit of self-medication, and fear of stigma. Network and structural-level factors included challenges to access quality health care, normalization of HIV testing in key populations and inconsistent provider-initiated HIV testing practices. Structural interventions coupled with existing key population-targeted strategies would improve the issue of late HIV diagnosis.

scholarly journals Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state

2020 ◽  
pp. 095646242094756
Author(s):  
Sabina O Nduaguba ◽  
Kentya H Ford ◽  
James P Wilson ◽  
Kenneth A Lawson ◽  
Robert L Cook
Keyword(s):  
At Risk ◽  
Older Individuals ◽  
Hiv Diagnosis ◽  
Interaction Terms ◽  
Late Hiv Diagnosis ◽  
Increased Risk ◽  
At Risk Populations ◽  
Sex With Men ◽  
Aids Diagnosis ◽  
Racial Ethnic

We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.

scholarly journals CD4 Cell Counts at HIV Diagnosis among HIV Outpatient Study Participants, 2000–2009

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Kate Buchacz ◽  
Carl Armon ◽  
Frank J. Palella ◽  
Rose K. Baker ◽  
Ellen Tedaldi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Population Level ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Cell Counts ◽  
Late Hiv Diagnosis ◽  
Cd4 Cell Counts ◽  
The Usa ◽  
Study Participants ◽  
Cd4 Cell

Background. It is unclear if CD4 cell counts at HIV diagnosis have improved over a 10-year period of expanded HIV testing in the USA.Methods. We studied HOPS participants diagnosed with HIV infection ≤6 months prior to entry into care during 2000–2009. We assessed the correlates of CD4 count <200 cells/mm3at HIV diagnosis (late HIV diagnosis) by logistic regression.Results. Of 1,203 eligible patients, 936 (78%) had a CD4 count within 3 months after HIV diagnosis. Median CD4 count at HIV diagnosis was 299 cells/mm3and did not significantly improve over time (P=0.13). Comparing periods 2000-2001 versus 2008-2009, respectively, 39% and 35% of patients had a late HIV diagnosis (P=0.34). Independent correlates of late HIV diagnosis were having an HIV risk other than being MSM, age ≥35 years at diagnosis, and being of nonwhite race/ethnicity.Conclusions. There is need for routine universal HIV testing to reduce the frequency of late HIV diagnosis and increase opportunity for patient- and potentially population-level benefits associated with early antiretroviral treatment.

scholarly journals Infrequent HIV Testing and Late HIV Diagnosis Are Common Among a Cohort of Black Men Who Have Sex With Men in 6 US Cities

2014 ◽  
Vol 67 (4) ◽  
pp. 438-445 ◽  
Author(s):  
Sharon B. Mannheimer ◽  
Lei Wang ◽  
Leo Wilton ◽  
Hong Van Tieu ◽  
Carlos del Rio ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Black Men ◽  
Hiv Diagnosis ◽  
Late Hiv Diagnosis ◽  
Sex With Men ◽  
Us Cities

Tailoring HIV testing in a setting of late HIV diagnosis: is the tide turning?

2015 ◽  
Vol 76 (10) ◽  
pp. 592-595 ◽  
Author(s):  
Monica Lascar ◽  
Joseph Freer ◽  
Elias Phiri
Keyword(s):  
Hiv Testing ◽  
Hiv Diagnosis ◽  
Late Hiv Diagnosis

Adolescent suicide as a global public health issue

2017 ◽  
Vol 31 (4) ◽  
Author(s):  
Zebib K. Abraham ◽  
Leo Sher
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Access To Care ◽  
Homeless Youth ◽  
Global Mental Health ◽  
Public Health Issue ◽  
Global Public Health ◽  
Youth Suicide ◽  
Increased Risk ◽  
Global Strategies

AbstractYouth suicide is a major global mental health problem. This review looks at the epidemiology, risk and protective factors associated with youth suicide, and global strategies to address this important issue. To better understand factors contributing to youth suicide, global gender differences in suicide were examined. Global rates of suicide amongst young men are higher than young women. However, there are anomalously higher rates of female youth suicide in India and China, and possible causes of this are examined further. It is likely that underestimation of youth suicide is a major factor affecting the accuracy of suicide epidemiology. Risk factors for youth suicide are varied. Psychiatric factors include various psychiatric illnesses, substance use (particularly amongst refugee and homeless youth). Psychosocial risk factors include family conflict, physical and sexual childhood abuse, isolation, socioeconomic disadvantage, discrimination and acculturation. Vulnerable populations are at increased risk, including refugee/immigrant/indigenous youth, those in foster care and homeless youth. Protective factors can include family cohesion and strong interpersonal relationships, as well as increased access to care. Global strategies to prevent youth suicide include reducing lethal means to suicide and reducing harmful media reporting. Various psychosocial interventions may be helpful, including individual support, and family, school and community based interventions. Strategies can also increase evaluation of psychiatric disorders and access to care, as well as promote psycho-education and reduce stigma against mental illness.

scholarly journals Factors associated with offering HIV testing to people aged ≥ 50 years: A qualitative study

2021 ◽  
pp. 095646242110593
Author(s):  
Elaney Youssef ◽  
Juliet Wright ◽  
Kevin A Davies ◽  
Valerie Delpech ◽  
Alison Brown ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Thematic Analysis ◽  
Older Patients ◽  
Older Patient ◽  
Hiv Diagnosis ◽  
Related Factors ◽  
Factors Associated ◽  
Late Hiv Diagnosis ◽  
Symptom Attribution ◽  
Risk Symptom

Background Individuals aged ≥ 50 years continue to be disproportionately affected by late HIV diagnosis, which is associated with poorer health outcomes and onward transmission. Despite HIV testing guidelines and high acceptability of HIV testing among all patients, clinicians are less likely to offer a test to an older individual. The aim of this study was to identify clinician-related factors associated with offering HIV testing to patients aged ≥ 50 years. Methods Twenty clinicians who had been involved in the care of an older patient diagnosed late with HIV were interviewed. Results Thematic analysis identified seven factors associated with offering HIV testing to older people: knowledge, stigma, stereotyping and perception of risk, symptom attribution, discussing HIV with patients, consent procedures and practical issues. Conclusions Although some factors are not unique to older patients, some are unique to this group. Many clinicians lack up-to-date HIV-related knowledge, feel anxious discussing HIV with older patients and perceive asexuality in older age. In order to increase the offer of HIV testing to this group, we identified clinician-related barriers to test offer that need to be addressed.

scholarly journals HIV – lessons from a late diagnosis

2016 ◽  
Vol 15 (2) ◽  
pp. 84-87
Author(s):  
Xin Hui S. Chan ◽  
◽  
Barbara L. Onen ◽  
Mansoor M. Raza ◽  
Dushyant Mital ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Hiv Diagnosis ◽  
Septic Complications ◽  
Routine Testing ◽  
Late Hiv Diagnosis ◽  
Hiv Test ◽  
High Prevalence ◽  
Wide Experience ◽  
Routine Hiv Testing ◽  
The Uk

Late HIV diagnosis is the most important predictor of HIV-related morbidity and mortality in the UK and often results from missed testing opportunities during earlier contact with health services. The HPA now recommends routine HIV testing be commissioned as a priority for all general medical admissions in high prevalence areas, such as Milton Keynes. We present the case of a patient admitted to our Medical Admissions Unit (MAU) managed initially for presumed septic complications of metastatic disease who was later found to have terminal HIV disease. In keeping with UK-wide experience which we review, a local audit following this case found MAU HIV test coverage increased after routine testing but not after staff education alone, and resulted in implementation of routine HIV testing in our MAU.

scholarly journals “If He’s Abusing You . . . the Baby Is Going to Be Affected”: HIV-Positive Pregnant Women’s Experiences of Intimate Partner Violence

2018 ◽  
Vol 25 (7) ◽  
pp. 839-861
Author(s):  
Adele Marais ◽  
Caroline C. Kuo ◽  
Robin Julies ◽  
Dan J. Stein ◽  
John A. Joska ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Qualitative Interviews ◽  
Intimate Partner ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Increased Risk ◽  
Engagement In Hiv Care

Pregnancy represents a time of increased risk for intimate partner violence (IPV), and an HIV diagnosis further increases the vulnerability of this at-risk group. This study explores experiences of recent IPV using qualitative interviews with N = 12 HIV-positive pregnant women recruited from a clinical setting in South Africa, a location with a high global prevalence of IPV and HIV. Partner dynamics around IPV resulted in HIV shame and stigma and adversely affected engagement in HIV care and HIV treatment behaviors. The results highlight the challenges women face in navigating disclosure of both IPV and HIV, accessing necessary support, and engaging in both HIV-related and pregnancy-related care in the context of an abusive relationship.

Barriers to HIV testing among Australian gay men

Sexual Health ◽  
2012 ◽  
Vol 9 (5) ◽  
pp. 453 ◽  
Author(s):  
Garrett Prestage ◽  
Graham Brown ◽  
Phillip Keen
Keyword(s):  
Hiv Testing ◽  
Gay Men ◽  
Online Survey ◽  
Point Of Care ◽  
Anal Intercourse ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Increased Risk ◽  
To Receive ◽  
Hiv Positive Men

Objective To investigate the barriers to HIV testing among Australian gay men. Methods: An online survey was conducted to explore reasons for avoiding and delaying testing for HIV; 519 non-HIV-positive men completed the online survey. Results: Most non-HIV-positive men (92.9%) had been tested for HIV, with 75.4% indicating they had been tested in the previous year. The most common reasons for avoiding or delaying testing were a belief that they had not done anything risky (41.2%) and the need to return for a second clinic visit to receive results (40.3%). Among men who engaged in unprotected anal intercourse with casual partners (UAIC), those who had not been recently tested were more likely to cite the lack of any symptoms as reasons for not having tested (adjusted odds ratio: 2.34; 95% confidence interval: 1.03–5.31; P = 0.041). Conclusions: For men who do not engage in risky sex, the decision not to test is probably reasonable, but those who engage in noncondom-based risk reduction may be at some increased risk and should be encouraged to test relatively often. Changes to Australia’s national HIV testing policy may ameliorate some of the need to return for second clinic visits to receive results, but the policy still requires full implementation, including the introduction of rapid point-of-care HIV testing to Australia. Among men who engage in UAIC, there appears to be a particular need for information about the benefits of early treatment after HIV diagnosis and about the relative likelihood of experiencing HIV seroconversion illness.

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