Viral suppression and mortality among HIV infected adults initiated Anti-Retroviral Therapy at Temeke Regional hospital: Programmatic achievements and Opportunities for improvement

Background: Despite the fact that HIV disease has greater impact in the Sub-Saharan Africa (SSA) region, treatment outcomes are scarcely reported at implementation level. Programmatic data present real life implementation challenges of public health importance which should inform policies. This study was conducted to describe mortality, viral suppression and document challenges at secondary facility HIV clinic in Temeke, Dar es Salaam Tanzania.Methods: Hospital-based retrospective cohort study was conducted among HIV patients initiated on ART between May and November 2016 at Temeke Hospital, Dar es Salaam, Tanzania. Data was collected from HIV database between May and November 2017. Mortality was reported as proportion while viral suppression was defined as HIV-RNA below 50 copies per ml.Results: A total of 747 PLHIV were eligible and were included in the study. Out of these, forty (5.4) patients died. Good adherence to Antiretroviral therapy was seen in 70% of PLHV only. Of the 419 participants with HIV viral load measurements, viral suppression was achieved in 318 (75.9%) patients. Viral suppression is more likely for patients with CD4+ T lymphocyte count greater than 200 cells/μL. There was high attrition rate from the clinic, more than one-third 35.2% of those initiated ART were still attending the clinic at one year.Conclusion: HIV viral suppression and adherence to ART at Temeke HIV CTC are still sub-optimal. Good tracking, enhanced adherence as well as early diagnosis and treatment might improve viral suppression at one year. High attrition from the clinic may need careful examination. Keywords: Viral suppression, HIV, SSA, treatment failure, AIDS, Tanzania

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1303. Impact of Pharmacy Type on HIV Viral Suppression at a University-Based HIV Clinic in the Midwest

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1166 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S470-S470

Author(s):

Josh Havens ◽

Moses New-Aaron ◽

Yangyang Gao ◽

Qingfeng He ◽

Fadul Nada ◽

...

Keyword(s):

Clinical Characteristics ◽

Viral Suppression ◽

Binary Logistic Regression ◽

Mail Order ◽

Hiv Viral Load ◽

Regimen Adherence ◽

Chi Squared ◽

Hiv Viral Suppression ◽

Mail Order Pharmacy ◽

The Impact

Abstract Background People with HIV (PWH) utilize various pharmacy types beyond the traditional local pharmacy including mail order and specialty pharmacies. Some pharmacies often provide additional adherence services such as refill reminders, expedited delivery, and adherence packaging. Limited data are available describing the relationship between pharmacy type and HIV viral suppression (VS). We evaluated the impact of pharmacy type on VS. Methods We conducted a single-center, retrospective cohort study of PWH (≥19 years) receiving care at a Midwestern HIV clinic between January 1, 2018, and December 31, 2018, with at least 1 HIV RNA reading during the study period. We collected sociodemographic information, ART regimen, adherence (PDC—percentage of days covered), and clinical characteristics. Patients were stratified by pharmacy type: local (traditional pharmacy without adherence services), local specialty (traditional pharmacy with adherence services and same-day, couriered delivery), and mail order (mail order pharmacy with or without adherence services). Pearson Chi-squared tests and binary logistic regression were used to examine the effect of pharmacy type on VS (HIV viral load ≤50 copies/mL). Results A total of 1014 patients met study criteria; 164 (16%) utilized a local, 720 (71%) local specialty, and 130 (13%) mail order. VS rates were similar between pharmacy types: local (91%), semi-specialty local (88%), and mail order (96%). After adjusting for sociodemographic characteristics, ART regimen, ART adherence and other clinical characteristics, there was no association between pharmacy type and VS when comparing local and mail to local specialty pharmacy types (local—aOR: 0.98, 95% CI, 0.46–2.12; mail—aOR: 1.65, 95% CI, 0.46–6.0). Factors found to be negatively associated with VS were single marital status (aOR: 0.49; 95% CI, 0.24–0.95), current or historical opportunistic infection (aOR: 0.51; 95% CI, 0.26–0.99), and usage of a multiclass or dual ART regimen (aOR: 0.40; 95% CI, 0.16–0.98). Conclusion Despite additional services offered by some pharmacies, no differences were observed in HIV VS between pharmacy types. Disclosures All authors: No reported disclosures.

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Pre-Linnaean pictures of the secretarybird, Sagittarius serpentarius (J. F. )

Archives of Natural History ◽

10.3366/e0260954108000375 ◽

2008 ◽

Vol 35 (2) ◽

pp. 243-251 ◽

Cited By ~ 1

Author(s):

RAGNAR K. KINZELBACH

Keyword(s):

Nineteenth Century ◽

Sub Saharan Africa ◽

Careful Examination ◽

Nile Valley ◽

Rain Forests ◽

Roman Emperor ◽

Persian Language ◽

The Family ◽

Other Information ◽

Sub Saharan

The secretarybird, the only species of the family Sagittariidae (Falconiformes), inhabits all of sub-Saharan Africa except the rain forests. Secretarybird, its vernacular name in many languages, may be derived from the Arabic “saqr at-tair”, “falcon of the hunt”, which found its way into French during the crusades. From the same period are two drawings of a “bistarda deserti” in a codex by the Holy Roman Emperor Frederick II (1194–1250). The original sketch obviously, together with other information on birds, came from the court of Sultan al-Kâmil (1180–1238) in Cairo. Careful examination led to an interpretation as Sagittarius serpentarius. Two archaeological sources and one nineteenth century observation strengthened the idea of a former occurrence of the secretarybird in the Egyptian Nile valley. André Thevet (1502–1590), a French cleric and reliable research traveller, described and depicted in 1558 a strange bird, named “Pa” in Persian language, from what he called Madagascar. The woodcut is identified as Sagittarius serpentarius. The text reveals East Africa as the real home of this bird, associated there among others with elephants. From there raises a connection to the tales of the fabulous roc, which feeds its offspring with elephants, ending up in the vernacular name of the extinct Madagascar ostrich as elephantbird.

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Prevalence and predictors of persistent HIV viremia and viral rebound following universal test and treat: a population-based study

The Journal of Infectious Diseases ◽

10.1093/infdis/jiab021 ◽

2021 ◽

Author(s):

M Kate Grabowski ◽

Eshan U Patel ◽

Gertrude Nakigozi ◽

Victor Ssempijja ◽

Robert Ssekubugu ◽

...

Keyword(s):

Population Level ◽

Population Based ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Viral Rebound ◽

Hiv Viral Load ◽

Test And Treat ◽

Universal Test ◽

Persistent Viremia ◽

Universal Test And Treat

Abstract Background There are limited data on individual HIV viral load (VL) trajectories at the population-level following the introduction of universal test and treat (UTT) in sub-Saharan Africa. Methods HIV VLs were assessed among HIV-positive participants at three population-based surveys in four Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (two consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95%CIs of persistent viremia were estimated using multivariate Poisson regression. Results There were 1,346 HIV-positive participants (n=1,883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.7% to 13.3%. Younger age (15-29 vs. 40-49 years, adjRR=1.80 [95%CI=1.19-2.71]), male sex (adjRR=2.09 [95%CI=1.47-2.95]), never being married (vs. currently married; adjRR=1.88 [95%CI=1.34-2.62]), and recent migration to the community (vs. long-term resident; adjRR=1.91 [95%CI=1.34-2.73]) were factors associated with persistent viremia. Conclusions Despite increases in durable VL suppression during roll-out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.

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Validating a self-report measure of HIV viral suppression: an analysis of linked questionnaire and clinical data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study

BMC Research Notes ◽

10.1186/s13104-017-2453-8 ◽

2017 ◽

Vol 10 (1) ◽

Cited By ~ 17

Author(s):

Allison Carter ◽

◽

Alexandra de Pokomandy ◽

Mona Loutfy ◽

Erin Ding ◽

...

Keyword(s):

Cohort Study ◽

Reproductive Health ◽

Clinical Data ◽

Sexual And Reproductive Health ◽

Viral Suppression ◽

Self Report ◽

Hiv Viral Suppression ◽

Health Cohort Study ◽

Report Measure

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HIV viral suppression in the era of antiretroviral therapy

Postgraduate Medical Journal ◽

10.1136/pmj.79.927.36 ◽

2003 ◽

Vol 79 (927) ◽

pp. 36-42 ◽

Cited By ~ 16

Author(s):

H K Thaker

Keyword(s):

Antiretroviral Therapy ◽

Viral Suppression ◽

Hiv Viral Suppression

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1010. Effective Management of HIV in Rural Georgia Using Telemedicine

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1196 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S533-S533

Author(s):

Folake J Lawal ◽

Arni S R Srinivasa Rao ◽

Jose A Vazquez

Keyword(s):

Rural Areas ◽

Viral Suppression ◽

Retrospective Chart Review ◽

Cd4 Count ◽

Hiv Care ◽

Resistance Mutations ◽

Remote Communities ◽

Hiv Viral Load ◽

Viral Control ◽

Significant Difference

Abstract Background The increasing incidence of HIV and lack of care in rural areas contributes to the ongoing epidemic. The dearth of specialized health services within remote communities and access of this population to available services poses a challenge to HIV care. Telemedicine (TM) is a potential tool to improve HIV care in these remote communities, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care. The objective of this study is to examine the effectiveness of HIV care delivered through TM, and compare to F2F care. Methods This is a retrospective chart review of all HIV positive patients who attended either the F2F clinic (Augusta, GA) or the TM clinic (Dublin, GA) between May 2017 to April 2018. Data extracted included demographics, CD4 count, HIV PCR, co-morbidities, dates of clinic attendance, HIV resistance mutations and ART changes. Viral suppression and gain in CD4 counts were compared. T-test was conducted to test differences in characteristics and outcomes between the two groups. Results 385 cases were included in the study (52.5% black, 82% females, F2F=200, TM=185). Mean CD4 count in the TM group was statistically higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p< 0.001). There was no statistically significant difference in mean HIV viral load (F2F= 416.8 cp/ml, TM=713.4 cp/ml, p=0.3) and rates of year-round viral control (F2F= 73% vs TM = 77% p= 0.54). 38 patients achieved viral suppression during the study period (F2F= 24, TM =14) with a mean change of -3.34 x 104 vs -1.24 x 104, respectively. The difference in mean change was not statistically significant by Snedacor’s W Statistics. This indicates there was no significant difference between the two populations in terms of mean viral suppression among patients who were otherwise not suppressed before the study period. Conclusion To achieve an HIV cure, HIV care is required to extend to rural areas of the country and the world. Through delivery of care using TM, trained specialists can target communities with little or no health care. Moreover, use of TM achieves target outcome measures comparable to F2F clinics. Increase in the use of TM will improve the access to specialty HIV care and help achieve control of HIV in rural communities. Disclosures All Authors: No reported disclosures

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The Effect of Partnership Presence and Support on HIV Viral Suppression Among Serodiscordant Partnered and Single Heterosexual HIV-Positive Individuals in Brazil

AIDS and Behavior ◽

10.1007/s10461-020-03124-5 ◽

2021 ◽

Author(s):

Zoë Baker ◽

Pamina Gorbach ◽

Marineide Gonçalves de Melo ◽

Ivana Varela ◽

Eduardo Sprinz ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Positive ◽

Hiv Viral Suppression

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1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1174 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S473-S473

Author(s):

Christina Rizk ◽

Alice Zhao ◽

Janet Miceli ◽

Portia Shea ◽

Merceditas Villanueva ◽

...

Keyword(s):

Viral Suppression ◽

Linkage To Care ◽

Hiv Care ◽

Hiv Care Continuum ◽

Newly Diagnosed ◽

New Haven ◽

Care Continuum ◽

Art Initiation ◽

Ryan White ◽

Hiv Viral Suppression

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

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