scholarly journals Operationalizing Treatment as Prevention in Los Angeles County: Antiretroviral Therapy Use and Factors Associated with Unsuppressed Viral Load in the Ryan White System of Care

2012 ◽  
Vol 26 (8) ◽  
pp. 463-470 ◽  
Author(s):  
Jennifer N. Sayles ◽  
Jacqueline Rurangirwa ◽  
Min Kim ◽  
Janni Kinsler ◽  
Rangell Oruga ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Los Angeles ◽  
Los Angeles County ◽  
System Of Care ◽  
Treatment As Prevention ◽  
Factors Associated ◽  
Ryan White

scholarly journals Implementation of Targeted Temperature Management After Out‐of‐Hospital Cardiac Arrest: Observations From the Los Angeles County Regional System

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Melody Hermel ◽  
Nichole Bosson ◽  
Andrea Fang ◽  
William J. French ◽  
James T. Niemann ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Los Angeles ◽  
Los Angeles County ◽  
The United States ◽  
System Of Care ◽  
Temperature Management ◽  
Factors Associated ◽  
Regional System ◽  
Hospital Cardiac Arrest

Background Despite the benefits of targeted temperature management (TTM) for out‐of‐hospital cardiac arrest), implementation within the United States remains low. The objective of this study was to evaluate the prevalence and factors associated with TTM use in a large, urban‐suburban regional system of care. Methods and Results This was a retrospective analysis from the Los Angeles County regional cardiac system of care serving a population of >10 million residents. All adult patients aged ≥18 years with non‐traumatic out‐of‐hospital cardiac arrest transported to a cardiac arrest center from April 2011 to August 2017 were included. Patients awake and alert in the emergency department and patients who died in the emergency department before consideration for TTM were excluded. The primary outcome measure was prevalence of TTM use. The secondary analysis were annual trends in TTM use over the study period and factors associated with TTM use. The study population included 8072 patients; 4154 patients (51.5%) received TTM and 3767 patients (46.7%) did not receive TTM. Median age was 67 years, 4780 patients (59.2%) were men, 4645 patients (57.5%) were non‐White, and the most common arrest location was personal residence in 4841 patients (60.0%). In the adjusted analysis, younger age, male sex, an initial shockable rhythm, witnessed arrest, and receiving coronary angiography were associated with receiving TTM. Conclusions Within this regional system of care, use of TTM was higher than previously reported in the literature at just over 50%. Use of integrated systems of care may be a novel method to increase TTM use within the United States.

scholarly journals Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043584 ◽  
Author(s):  
Joseph E Ebinger ◽  
Gregory J Botwin ◽  
Christine M Albert ◽  
Mona Alotaibi ◽  
Moshe Arditi ◽  
...  
Keyword(s):  
African American ◽  
Los Angeles ◽  
Delivery System ◽  
Healthcare Workers ◽  
Los Angeles County ◽  
Healthcare Delivery ◽  
Healthcare Delivery System ◽  
Hispanic Ethnicity ◽  
Factors Associated ◽  
African American Race

ObjectiveWe sought to determine the extent of SARS-CoV-2 seroprevalence and the factors associated with seroprevalence across a diverse cohort of healthcare workers.DesignObservational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionnaires.SettingsA multisite healthcare delivery system located in Los Angeles County.ParticipantsA diverse and unselected population of adults (n=6062) employed in a multisite healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions.Main outcomesUsing Bayesian and multivariate analyses, we estimated seroprevalence and factors associated with seropositivity and antibody levels, including pre-existing demographic and clinical characteristics; potential COVID-19 illness-related exposures; and symptoms consistent with COVID-19 infection.ResultsWe observed a seroprevalence rate of 4.1%, with anosmia as the most prominently associated self-reported symptom (OR 11.04, p<0.001) in addition to fever (OR 2.02, p=0.002) and myalgias (OR 1.65, p=0.035). After adjusting for potential confounders, seroprevalence was also associated with Hispanic ethnicity (OR 1.98, p=0.001) and African-American race (OR 2.02, p=0.027) as well as contact with a COVID-19-diagnosed individual in the household (OR 5.73, p<0.001) or clinical work setting (OR 1.76, p=0.002). Importantly, African-American race and Hispanic ethnicity were associated with antibody positivity even after adjusting for personal COVID-19 diagnosis status, suggesting the contribution of unmeasured structural or societal factors.Conclusion and relevanceThe demographic factors associated with SARS-CoV-2 seroprevalence among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modelling techniques, provide a vibrant picture of the demographic factors, exposures and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to COVID-19.

scholarly journals Factors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246140
Author(s):  
Sarah Nabukeera ◽  
Joseph Kagaayi ◽  
Fredrick Edward Makumbi ◽  
Henry Mugerwa ◽  
Joseph K. B. Matovu
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Side Effects ◽  
Clinical Research ◽  
Clinical Stage ◽  
Research Centre ◽  
Hiv Positive ◽  
Factors Associated ◽  
Art Initiation ◽  
Stage 4

Background While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. Method This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0–14 years) were randomly selected from existing medical records and data on children’s socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. Results The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5–9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10–14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. Conclusion Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.

scholarly journals Factors Associated with the Unsuppressed Viral Load of Children on Antiretroviral Therapy Followed Up in the Gbêkê Region (Côte d’Ivoire)

2021 ◽  
Vol 11 (04) ◽  
pp. 723-737
Author(s):  
Tanoh-Aka Aude Hélène ◽  
Siallou-Avi Christelle ◽  
Yao Kouassi Christian ◽  
Adou Leïoh Roméo ◽  
Yeboua Kossonou Roland ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Factors Associated

scholarly journals Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa

2018 ◽  
Vol 29 (6) ◽  
pp. 603-610 ◽  
Author(s):  
D Joseph Davey ◽  
Z Abrahams ◽  
M Feinberg ◽  
M Prins ◽  
C Serrao ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
A Priori ◽  
Public Healthcare ◽  
First Line ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Tb Treatment ◽  
Prior Art

Unsuppressed viral load (VL) in patients on antiretroviral therapy (ART) occurs when treatment fails to suppress a person’s VL and is associated with decreased survival and increased HIV transmission. The objective of this study was to evaluate factors associated with unsuppressed VL (VL > 400 copies/ml) in patients currently in care on first-line ART for ≥ 6 months attending South African public healthcare facilities. We analysed electronic medical records of ART patients with a VL result on record who started ART between January 2004 and April 2016 from 271 public health facilities. We present descriptive and multivariable logistic regression for unsuppressed VL at last visit using a priori variables. We included 244,370 patients (69% female) on first-line ART in April 2016 for ≥ 6 months. Median age at ART start was 33 years (7% were < 15 years old). Median duration on ART was 3.7 years. Adjusting for other variables, factors associated with having an unsuppressed VL at the most recent visit among patients in care included: (1) < 15 years old at ART start (adjusted odds ratio [aOR]=2.58; 95% CI = 2.37, 2.81) versus 15–49 years at ART start, (2) male gender (aOR = 1.29; 95% CI = 1.25, 1.35), (3) 6–12 months on ART versus longer (aOR = 1.34; 95% CI = 1.29, 1.40), (4) on tuberculosis (TB) treatment (aOR = 1.78; 95% CI = 1.48, 2.13), and (5) prior ART exposure versus none (aOR = 1.20; 95% CI = 1.08, 1.32). Approximately 85% of the ART cohort who were in care had achieved viral suppression, though men, youth/adolescents, patients with prior ART exposure, those with short duration of ART, and patients on TB treatment had increased odds of not achieving viral suppression. There is a need to develop and evaluate targeted interventions for ART patients in care who are at high risk of unsuppressed VL.

scholarly journals Determinants of Virologic Failure among Adult HIV Patients on First-Line Antiretroviral Therapy at Waghimra Zone, Northern Ethiopia: A Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Abrham Emagnu ◽  
Zenahebezu Abay ◽  
Abera Balcha Bulti ◽  
Yaregal Animut
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Drug Toxicity ◽  
Case Control Study ◽  
Virologic Failure ◽  
Case Control ◽  
Northern Ethiopia ◽  
Factors Associated ◽  
Control Study

Introduction. The primary goal of antiretroviral therapy (ART) is to reduce the viral load in HIV-infected patients to promote quality of life, as well as to reduce HIV-related morbidity and mortality. A high rate of virologic failure was reported in Waghimra Zone, Northwest Ethiopia, in viral load assessment conducted among HIV-infected patients on ART in the Amhara region. However, there is limited evidence on the determinants of virological failure in the study area. This study aimed to identify the determinants of virological failure among HIV-infected patients on antiretroviral therapy in Waghimra zone, Northern Ethiopia, 2019. Methods. An institutional-based unmatched case-control study was conducted from May 21 to June 30, 2019. Cases were people living with HIV (PLHIV) on ART who had already experienced virological failure; controls were those without virological failure. Data were extracted from 92 cases and 184 controls through chart review using a pretested and structured checklist. The data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a P value <0.05 were considered statistically significant. Results. This study revealed that poor adherence to ART (adjusted odds ratio (AOR) = 4.24, 95% confidence interval (CI): 2.17, 8.31), taking ART for longer than five years (AOR = 3.11, 95% CI: 1.17, 8.25), having drug toxicity (AOR = 3.34, 95% CI: 1.54, 7.23), age of PLHIV ≥ 35 years (AOR = 2.45, 95% CI: 1.29,4.64), and recent CD4 count <200 cells/mm³ (AOR = 3.06, 95% CI: 1.52, 6.13) were factors associated with virologic failure. Conclusion and Recommendation. This study showed that poor adherence to treatment, longer duration on ART, experiencing drug toxicity, older age, and recent CD4 <200 cell/mm³ are factors that increase the risk of virologic failure.

scholarly journals Factors Associated with Presence of Pharmacies and Pharmacies that Sell Syringes Over-the-Counter in Los Angeles County

2013 ◽  
Vol 90 (6) ◽  
pp. 1079-1090 ◽  
Author(s):  
Thomas J. Stopka ◽  
Estella M. Geraghty ◽  
Rahman Azari ◽  
Ellen B. Gold ◽  
Kathryn DeRiemer
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Over The Counter ◽  
Factors Associated
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