scholarly journals Patient Perspectives on the Implementation of Routinised Syphilis Screening With HIV Viral load Testing: Qualitative Process Evaluation of the Enhanced Syphilis Screening Among HIV-positive Men Trial

2020 ◽  
Author(s):  
Kinnon R MacKinnon ◽  
Ramandip Grewal ◽  
Darrell HS Tan ◽  
Rodney Rousseau ◽  
John Maxwell ◽  
...  
Keyword(s):  
Viral Load ◽  
Process Evaluation ◽  
Trial Registration ◽  
Hiv Care ◽  
Outpatient Clinics ◽  
Peace Of Mind ◽  
Syphilis Testing ◽  
Qualitative Process Evaluation ◽  
Syphilis Screening ◽  
Male Patients

Abstract Background: Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. Methods: Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. Results: A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. Conclusions: Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.

scholarly journals Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kinnon R MacKinnon ◽  
Ramandip Grewal ◽  
Darrell HS Tan ◽  
Rodney Rousseau ◽  
John Maxwell ◽  
...  
Keyword(s):  
Viral Load ◽  
Process Evaluation ◽  
Hiv Care ◽  
Outpatient Clinics ◽  
Patient Acceptability ◽  
Peace Of Mind ◽  
Syphilis Testing ◽  
Qualitative Process Evaluation ◽  
Syphilis Screening ◽  
Male Patients

Abstract Background Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. Methods Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. Results A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. Conclusions Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. Trial registration ClinicalTrials.gov NCT02019043; registered December 23, 2013.

scholarly journals A retrospective study of the clinical features of new syphilis infections in an HIV-positive cohort in Alberta, Canada

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e021544 ◽  
Author(s):  
Raynell Lang ◽  
Ron Read ◽  
Hartmut B Krentz ◽  
Mingkai Peng ◽  
Soheil Ramazani ◽  
...  
Keyword(s):  
Viral Load ◽  
Routine Screening ◽  
Hiv Care ◽  
Health Concern ◽  
Routine Practice ◽  
Hiv Viral Load ◽  
Syphilis Infection ◽  
Fourfold Increase ◽  
Infected Population ◽  
Syphilis Screening

ObjectivesSyphilis is a global health concern with an estimated 12 million infections occurring annually. Due to the increasing rates of new syphilis infections being reported in patients infected with HIV, and their higher risk for atypical and severe presentations, periodic screening has been recommended as a routine component of HIV care. We aimed to characterise incident syphilis presentation, serological features and treatment response in a well-defined, HIV-infected population over 11 years.MethodsSince 2006, as routine practice of both the Southern Alberta Clinic and Calgary STI programmes, syphilis screening has accompanied HIV viral load measures every 4 months. All records of patients who, while in HIV care, either converted from being syphilis seronegative to a confirmed seropositive or were reinfected as evidenced by a fourfold increase in rapid plasma reagin (RPR) after past successful treatment, were reviewed.ResultsWe identified 249 incident syphilis infections in 194 different individuals infected with HIV; 72% were initial infections whereas 28% were reinfections. Half (50.8%) of the infections were asymptomatic and identified only by routine screening. Symptomatic syphilis was more common when RPR titres were higher (p=0.03). In patients with recurrent syphilis infection, a trend was noted favouring symptomatic presentation (62%, p=0.07). All 10 patients with central nervous system (CNS) syphilis involvement presented with an RPR titre ≥1:32. Following syphilis infection, a decline of 42 cells/mm3in CD4 (p=0.004) was found, but no significant changes in viral load occurred. No association was found with the stage of syphilis or symptoms at presentation and antiretroviral therapy use, CD4 count or virological suppression.ConclusionRoutine screening of our HIV-infected population identified many asymptomatic syphilis infections. The interaction of HIV and syphilis infection appears to be bidirectional with effects noted on both HIV and syphilis clinical and serological markers.

scholarly journals Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial

2019 ◽  
Vol 34 (5) ◽  
pp. 337-345 ◽  
Author(s):  
Joanna Busza ◽  
Tarisai Chiyaka ◽  
Sithembile Musemburi ◽  
Elizabeth Fearon ◽  
Calum Davey ◽  
...  
Keyword(s):  
Viral Load ◽  
Process Evaluation ◽  
Sex Workers ◽  
Controlled Trial ◽  
Community Mobilization ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Policy Context ◽  
Significant Difference ◽  
Prevention And Treatment

Abstract Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters’ Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention’s implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe’s changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.

Factors associated with HIV care and treatment cascade in Rio Grande do Sul, Brazil, 2014–2017: A cross-sectional study

2021 ◽  
pp. 095646242097594
Author(s):  
Guilherme B Shimocomaqui ◽  
Craig S Meyer ◽  
Maria L Ikeda ◽  
Elson Romeu Farias ◽  
Tonantzin R Gonçalves ◽  
...  
Keyword(s):  
Viral Load ◽  
Rio Grande ◽  
Undetectable Viral Load ◽  
Cross Sectional Study ◽  
Hiv Care ◽  
Rio Grande Do Sul ◽  
Sectional Study ◽  
Cross Sectional ◽  
Treatment Cascade ◽  
Care And Treatment

In 2018, Rio Grande do Sul (RS) had some of the highest HIV/AIDS rates in Brazil, and we did not find any studies about the HIV care and treatment cascade (HCTC) related to this state. We aimed to estimate the indicators of HCTC of RS, Brazil, and associated factors. A cross-sectional study with all people living with HIV (PLWH) in RS between 1 January 2014 and 31 December 2017 was conducted using a national database which registers all HIV notifications, CD4 and viral load laboratory data and antiretroviral therapy (ART) usage in the public health system. We considered sex, age, education, race, year of HIV diagnosis, and health region as predictor factors, and defined linkage to care, retention to care, being on ART, and having undetectable viral load as the HCTC indicators. Descriptive analysis and multivariable logistic regression were performed using Stata 15.2. A total of 116,121 PLWH were diagnosed, 79,959 were linked to care, 72,117 retained in care, 69,219 on ART, and 54,857 had undetectable viral load from 2014 to 2017. We observed greatest attrition for younger age, non-white, and lower education in all HCTC indicators. Women are more likely to have undetectable viral load (OR = 1.04, 95% CI: 1.01–1.07), even though they are less likely to be retained to care (OR = 0.92; 95% CI: 0.89–0.96) and on ART (OR = 0.82; 95% CI: 0.78–0.86). Although all HCTC indicators have increased over the period and the “test and treat” policy indicates improvements in ART and in undetectable viral load outcomes, evidence suggests specific attrition and disparities such as those related to HIV healthcare facilities should be addressed. These findings may be used by researchers, health professionals, and policymakers in order to investigate and implement interventions to better engage PLWH across the HCTC.

scholarly journals Couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e037468
Author(s):  
Alyssa Paige Tabrisky ◽  
Lara S Coffin ◽  
David P Olem ◽  
Torsten B Neilands ◽  
Mallory O'Neill Johnson
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Virological Suppression ◽  
Hiv Care ◽  
Randomised Control Trial ◽  
Engagement In Care ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
Counselling Intervention

Introduction Advances in HIV treatment have proven to be effective in increasing virological suppression, thereby decreasing morbidity, and increasing survival. Medication adherence is an important factor in reducing viral load among people living with HIV (PLWH) and in the elimination of transmission of HIV to uninfected partners. Achieving optimal medication adherence involves individuals taking their medications every day or as prescribed by their provider. However, not all PLWH in the USA are engaged in care, and only a minority have achieved suppressed viral load (viral load that is lower than the detectable limit of the assay). Sexual and gender minorities (SGM; those who do not identify as heterosexual or those who do not identify as the sex they were assigned at birth) represent a high-risk population for poor clinical outcomes and increased risk of HIV transmission, as they face barriers that can prevent optimal engagement in HIV care. Research in dyadic support, specifically within primary romantic partnerships, offers a promising avenue to improving engagement in care and treatment outcomes among SGM couples. Dyadic interventions, especially focused on primary romantic partnerships, have the potential to have a sustained impact after the structured intervention ends. Methods and analysis This paper describes the protocol for a randomised control trial of a theory-grounded, piloted intervention (DuoPACT) that cultivates and leverages the inherent sources of support within primary romantic relationships to improve engagement in HIV care and thus clinical outcomes among persons who are living with HIV and who identify as SGM (or their partners). Eligible participants must report being in a primary romantic relationship for at least 3 months, speak English, at least one partner must identify as a sexual or gender minority and at least one partner must be HIV+ with suboptimal engagement in HIV care, defined as less than excellent medication adherence, having not seen a provider in at least the past 8 months, having a detectable or unknown viral load or not currently on antiretroviral therapy. Eligible consenting couples are allocated equally to the two study arms: a structured six-session couples counselling intervention (DuoPACT) or a three-session individually-delivered HIV adherence counselling intervention (LifeSteps). The primary aim is to evaluate the efficacy of DuoPACT on virological suppression among HIV+ members of SGM couples with suboptimal engagement in care. The DuoPACT study began its target enrolment of 150 couples (300 individuals) in August 2017, and will continue to enrol until June 2021. Ethics and dissemination All procedures are approved by the Institutional Review Board at the University of California, San Francisco. Written informed consent is obtained from all participants at enrolment, and study progress is reviewed twice yearly by an external Safety Monitoring Committee. Dissemination activities will include formal publications and report back sessions with the community. Trial registration number NCT02925949; Pre-results.

scholarly journals Time spent with HIV viral load >1500 copies/mL among patients in HIV care, 2000–2014

AIDS ◽  
2018 ◽  
pp. 1 ◽  
Author(s):  
Maria C.B. Mendoza ◽  
Lytt Gardner ◽  
Carl Armon ◽  
Charles Rose ◽  
Frank J. Palella ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Care ◽  
Hiv Viral Load

scholarly journals Process evaluation of PrEP implementation in Kenya: adaptation of practices and contextual modifications in public HIV care clinics

2021 ◽  
Vol 24 (9) ◽  
Author(s):  
Elizabeth M. Irungu ◽  
Josephine Odoyo ◽  
Elizabeth Wamoni ◽  
Elizabeth A. Bukusi ◽  
Nelly R. Mugo ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Hiv Care ◽  
Prep Implementation

scholarly journals Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study

F1000Research ◽  
2015 ◽  
Vol 3 ◽  
pp. 123 ◽  
Author(s):  
Rose McGready ◽  
Joy Kang ◽  
Isabella Watts ◽  
Mary Ellen G Tyrosvoutis ◽  
Miriam B. Torchinsky ◽  
...  
Keyword(s):  
Descriptive Study ◽  
First Year ◽  
Antenatal Screening ◽  
Testing Strategies ◽  
Syphilis Testing ◽  
Increased Risk ◽  
Syphilis Screening ◽  
Potential Impact ◽  
Low Prevalence ◽  
Positive Results

Objective: The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates.Methods: From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.Results: Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.Conclusion: As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.

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