Analysis of the Consequences of the COVID-19 Pandemic on the Continuum of the Care in a Cohort of HIV-Positive Patients Followed in a Single Center of Northern Italy.

Abstract Background: During the COVID-19 pandemic, hospitals faced increasing pressure, where HIV patients risked to either acquire SARS-Cov-2 and to interrupt the HIV continuum of care.Methods: retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of HIV patients followed by the Spedali Civili of Brescia, between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019.Results: We observed a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020, a raise of missed visits from 5% to 8%, a drop in ART dispensation especially for not-protease inhibitors and an increase of hospitalized HIV patients due to COVID-19.Conclusions: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.

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Consequences of the COVID-19 pandemic on the continuum of the care in a cohort of people living with HIV followed in a single center of Northern Italy

10.21203/rs.3.rs-38253/v2 ◽

2020 ◽

Author(s):

Eugenia Quiros-Roldan ◽

Paola Magro ◽

Canio Carriero ◽

Annacarla Chiesa ◽

Issa El Hamad ◽

...

Keyword(s):

Antiretroviral Drugs ◽

Hiv Care ◽

Categorical Variables ◽

People Living With Hiv ◽

Continuous Variables ◽

Hiv Diagnosis ◽

Missed Visits ◽

Hiv Continuum Of Care ◽

Living With Hiv ◽

The Continuum

Abstract Introduction: During the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care.Methods: this is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student’s t-tests and the Mann-Whitney test. Proportions for categorical variables were compared using the χ2 test.Results: As of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51,4 ±13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n=3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5% to 8% (p<0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p=0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16,6% vs 21,6%, p<0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known. Conclusions: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.

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Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy

AIDS Research and Therapy ◽

10.1186/s12981-020-00314-y ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Eugenia Quiros-Roldan ◽

Paola Magro ◽

Canio Carriero ◽

Annacarla Chiesa ◽

Issa El Hamad ◽

...

Keyword(s):

Continuum Of Care ◽

Antiretroviral Drugs ◽

Hiv Care ◽

Categorical Variables ◽

People Living With Hiv ◽

Continuous Variables ◽

Hiv Diagnosis ◽

Missed Visits ◽

Living With Hiv ◽

The Continuum

Abstract Introduction During the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care. Methods This is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October–November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student’s t-tests and the Mann–Whitney test. Proportions for categorical variables were compared using the χ2 test. Results As of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51.4 ± 13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n = 3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5 to 8% (p < 0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p = 0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16.6 vs 21.6%, p < 0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known. Conclusions Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.

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Impact of COVID-19 pandemic on HIV viremia: a single-center cohort study in northern Italy

AIDS Research and Therapy ◽

10.1186/s12981-021-00355-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Ilaria Izzo ◽

Canio Carriero ◽

Giulia Gardini ◽

Benedetta Fumarola ◽

Erika Chiari ◽

...

Keyword(s):

Time Window ◽

Time Windows ◽

Continuum Of Care ◽

Northern Italy ◽

Hiv Diagnosis ◽

Hiv Patients ◽

Before And After ◽

Missed Visits ◽

Hiv Continuum Of Care ◽

The Impact

Abstract Background Brescia Province, northern Italy, was one of the worst epicenters of the COVID-19 pandemic. The division of infectious diseases of ASST (Azienda Socio Sanitaria Territoriale) Spedali Civili Hospital of Brescia had to face a great number of inpatients with severe COVID-19 infection and to ensure the continuum of care for almost 4000 outpatients with HIV infection actively followed by us. In a recent manuscript we described the impact of the pandemic on continuum of care in our HIV cohort expressed as number of missed visits, number of new HIV diagnosis, drop in ART (antiretroviral therapy) dispensation and number of hospitalized HIV patients due to SARS-CoV-2 infection. In this short communication, we completed the previous article with data of HIV plasmatic viremia of the same cohort before and during pandemic. Methods We considered all HIV-patients in stable ART for at least 6 months and with at least 1 available HIV viremia in the time window March 01–November 30, 2019, and another group of HIV patients with the same two requisites but in different time windows of the COVID-19 period (March 01–May 31, 2020, and June 01–November 30, 2020). For patients with positive viremia (PV) during COVID-19 period, we reported also the values of viral load (VL) just before and after PV. Results: the percentage of patients with PV during COVID-19 period was lower than the previous year (2.8% vs 7%). Only 1% of our outpatients surely suffered from pandemic in term of loss of previous viral suppression. Conclusions Our efforts to limit the impact of pandemic on our HIV outpatients were effective to ensure HIV continuum of care.

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Sexual health care of HIV-positive patients: an audit of a local service

International Journal of STD & AIDS ◽

10.1258/095646203322025821 ◽

2003 ◽

Vol 14 (7) ◽

pp. 493-496 ◽

Cited By ~ 6

Author(s):

Jane Hutchinson ◽

Penny Goold ◽

Hugh Wilson ◽

Kevin Jones ◽

Claudia Estcourt

Keyword(s):

Health Care ◽

Sexual Health ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Diagnosis ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Sexual Health Care ◽

Patient Appointment ◽

Health Screen

The sexual health care of 175 HIV-positive patients attending the two HIV clinics at Barts and the London NHS Trust was audited for the first time. The audit standard was that 100% of patients should be in receipt of a sexual health screen within six months of their first HIV out-patient appointment. Overall, 44.5% of patients had a sexual health screen, of which 46 (60.5%) were diagnosed with a sexually transmitted infection. Those screened were younger than those who were not. Five factors were identified which were significantly associated with not having a genitourinary screen performed; site of HIV care, setting of HIV diagnosis, stage of HIV disease, specialty of HIV physician and whether a screen was recommended by the HIV physician. A number of recommendations have been implemented to improve the uptake of sexual health screening amongst HIV-positive patients.

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Retaining HIV-positive patients in HIV care: a personalised approach for those at risk of loss to follow-up at an inner city sexual health service

Sexual Health ◽

10.1071/sh17036 ◽

2018 ◽

Vol 15 (1) ◽

pp. 91

Author(s):

Loretta Healey ◽

Catherine C. O'Connor

Keyword(s):

Health Service ◽

Sexual Health ◽

Text Messages ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Patients ◽

Loss To Follow Up ◽

Sexual Health Service ◽

Lost To Follow Up

In 2013 a personalised approach to follow-up of HIV patients who had withdrawn from HIV care was taken at RPA Sexual Health, a Sydney metropolitan sexual health service. HIV patients were telephoned, sent text messages, emailed and sent letters multiple times where applicable. With this intervention 20 of 23 people who had withdrawn from HIV care re-engaged. Since that time, active follow-up of all people diagnosed with HIV has resulted in only 2% of HIV patients at RPA Sexual Health being lost to follow-up.

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Smell assessment in a HIV positive population: An observational study

10.14293/s2199-1006.1.sor-.ppc7m7n.v1 ◽

2020 ◽

Author(s):

Usama Fawzy Kamel ◽

Ushan Andrady ◽

Rafik Salama

Keyword(s):

Observational Study ◽

Health And Safety ◽

Hiv Positive ◽

Hiv Diagnosis ◽

Hiv Patients ◽

Cross Sectional ◽

System Effect ◽

Human Immuno Deficiency Virus ◽

Normal Score ◽

Test Kit

HIV (Human Immuno-deficiency Virus) infection has a multi system effect. some publications claimed deterioration of smell perception in HIV. In this study, we present our smell assessment in a group of HIV patients using market available tests. Methods: Cross sectional observational study of 19 patients recruited from a North Wales genito-urinary medicine (GUM) clinic. Inclusion and exclusion criteria were applied to HIV diagnosed patients. Patients who gave consent for the study were invited to an ENT clinic where smell and nasal assessment took place. Patients had anterior rhinoscoy. Smell Threshold test kit was used to assess smell sensation. Normal score smell threshold was considered if score was 5.5 or above. Results: 16 males and 3 females, age range 22-75 (mean 46 years old). 2 African and 17 Caucasian origin subjects. 14/19 (74%) had HIV diagnosis for less than five years. 11/19 (58%) had hyposmia (mean 4.40 while normal score is 5.50) when tested. 16/19 (84%) complained of no hyposmia prior to testing. 12/19 (63%) had highly active anti-retroviral therapy (HAART) treatment. 6/19 (32%) used recreational drugs (Cannabis). None of the patients had cognitive impairment. Conclusions: HIV patients had hyposmia although patients did not report it as a compalaint. Smell threshold is affected in HIV positive patients. This is important for patients health and safety. We recommend assessment of smell in HIV positive patients so they become aware of their reduced sense and its implication.

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‘There are no more secrets’: acceptability of a family-centered model of care for HIV positive children in Eswatini

BMC Health Services Research ◽

10.1186/s12913-020-05810-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Philisiwe N. Khumalo ◽

Leila Katirayi ◽

Kim Ashburn ◽

Caspian Chouraya ◽

Lydia Mpango ◽

...

Keyword(s):

Waiting Times ◽

Family Members ◽

Standard Of Care ◽

Antiretroviral Drugs ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Status ◽

Retention In Hiv Care ◽

Family Centered ◽

Clinic Visits

Abstract Background HIV-positive children have lagged adults on retention in HIV care and viral suppression. To address this gap, Eswatini’s Ministry of Health started a pilot family-centered HIV care model (FCCM) targeting HIV-positive children under 20 years old and their families. Methods We conducted semi-structured in-depth interviews with 25 caregivers and 17 healthcare workers (HCWs) to assess acceptability of FCCM in four pilot FCCM health facilities in Hhohho region of Eswatini. Thematic analysis with inductive and deductive codes was used to identify salient themes. Results Caregivers and HCWs reported FCCM benefits including strengthening the family bond, encouragement for family members to disclose their HIV status and supporting each other in taking antiretroviral drugs. Caregivers reported that they spent fewer days in clinic, experienced shorter waiting times, and received better counseling services in FCCM compared to the standard-of-care services. FCCM implementation challenges included difficulty for families to attend clinic visits together (e.g., due to scheduling conflicts with weekend Teen Support Club meetings and weekday FCCM appointments). Both HCWs and caregivers mentioned difficulty in sharing sensitive health information in the presence of other family members. HCWs also had challenges with supporting caregivers to disclose HIV status to children and managing the larger group during clinic visits. Conclusions FCCM for HIV-positive children was acceptable to both caregivers and HCWs, and they supported scaling-up FCCM implementation nationally. However, special considerations should be made to address the challenges experienced by participants in attending clinic visits together as a family in order to achieve the full benefits of FCCM for HIV positive children.

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Human immunodeficiency virus in institutionalized elderly people

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2016.0034150516 ◽

2016 ◽

Vol 134 (6) ◽

pp. 528-533

Author(s):

Milton Luiz Gorzoni ◽

Sueli Luciano Pires ◽

Lilian de Fátima Costa Faria ◽

Márcia Regina Valadares Aguado ◽

Miriam Carmen Santana

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis B ◽

Lymphocyte Count ◽

Antiretroviral Drugs ◽

Total Lymphocyte Count ◽

Hiv Positive ◽

Hiv Diagnosis ◽

Total Lymphocyte ◽

Hospital Infection Control ◽

Immunodeficiency Virus

ABSTRACT CONTEXT AND OBJECTIVE: A search in the SciELO and PubMed databases showed few studies on human immunodeficiency virus (HIV) positive individuals in long-term care institutions (LTCIs), thus prompting the present study. The aim of this study was to ascertain whether there were any HIV-positive individuals in LTCIs for the elderly. DESIGN AND SETTING: Cross-sectional study in which the Hospital Infection Control Committee (HICC) of a 405-bed LTCI was consulted. METHODS: The medical records of 405 individuals interned in the LTCI who had been tested for HIV infection were requested for analysis of the following variables: [1] age and gender; [2] length of stay at LTCI (months); [3] causes and diagnoses on admission to LTCI according to International Classification of Diseases, 10th edition; [4] date of HIV diagnosis; [5] seropositivity for syphilis and hepatitis B and C viruses; [6] medications used at last prescription in medical file; and [7] mean CD4 lymphocyte count based on: total lymphocyte count/6 and total lymphocyte count x 0.8 x 0.2 or 0.3. RESULTS: Four men were HIV-positive, with mean age 71.2 ± 8.6 years, LTCI stay 74.2 ± 38.1 months and length of HIV diagnosis 24.5 ± 17 months (confirmed by HICC standard screening). Three had stroke sequelae; one, dementia syndrome; two, seropositivity for syphilis; two, hepatitis B and one, hepatitis C. The main drugs used were lamivudine, zidovudine, lopinavir, ritonavir, levothyroxine, omeprazole, ranitidine, lactulose and risperidone. The estimated CD4 count was 341 ± 237/mm3. CONCLUSIONS: HIV-positive individuals are present in LTCIs, diagnosable through serological screening and treatable with antiretroviral drugs.

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HIV Diagnosis, Linkage to HIV Care, and HIV Risk Behaviors Among Newly Diagnosed HIV-Positive Female Sex Workers in Kigali, Rwanda

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182170fd3 ◽

2011 ◽

Vol 57 (4) ◽

pp. e70-e76 ◽

Cited By ~ 21

Author(s):

Sarah L Braunstein ◽

Marie-Michèle Umulisa ◽

Nienke J Veldhuijzen ◽

Evelyne Kestelyn ◽

Chantal M Ingabire ◽

...

Keyword(s):

Risk Behaviors ◽

Hiv Risk ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Risk Behaviors ◽

Hiv Care ◽

Hiv Positive ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Linkage To Hiv Care

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

Violence Against Women ◽

10.1177/1077801218802640 ◽

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.

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