Risk Factors for Advanced HIV Disease and Late Entry to HIV Care: National 1994–2012 HIV Surveillance Data for Wuhan, China

2015 ◽  
Vol 29 (10) ◽  
pp. 541-549 ◽  
Author(s):  
Hongbo Jiang ◽  
Nianhua Xie ◽  
Yunzhou Fan ◽  
Zhixia Zhang ◽  
Jianhua Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surveillance Data ◽  
Hiv Care ◽  
Hiv Disease ◽  
Hiv Surveillance ◽  
Late Entry ◽  
Advanced Hiv Disease

scholarly journals Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259073
Author(s):  
Nadine Mayasi Ngongo ◽  
Gilles Darcis ◽  
Hippolyte Situakibanza Nanituna ◽  
Marcel Mbula Mambimbi ◽  
Nathalie Maes ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Early Detection ◽  
Hiv Infection ◽  
Median Time ◽  
Clinical Stage ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Time To Initiation ◽  
Advanced Hiv Disease

Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

scholarly journals Use of HIV Case Surveillance System to Design and Evaluate Site-Randomized Interventions in an HIV Prevention Study: HPTN 065

2012 ◽  
Vol 6 (1) ◽  
pp. 122-130 ◽  
Author(s):  
Deborah J Donnell ◽  
H Irene Hall ◽  
Theresa Gamble ◽  
Geetha Beauchamp ◽  
Angelique B Griffin ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Surveillance System ◽  
Viral Suppression ◽  
Laboratory Data ◽  
Linkage To Care ◽  
Baseline Data ◽  
Surveillance Data ◽  
Hiv Care ◽  
Hiv Surveillance ◽  
Hiv Test

Introduction:Modeling studies suggest intensified HIV testing, linkage-to-care and antiretroviral treatment to achieve viral suppression may reduce HIV transmission and lead to control of the epidemic. To study implementation of strategy, population-level data are needed to monitor outcomes of these interventions. US HIV surveillance systems are a potential source of these data.Methods:HPTN065 (TLC-Plus) Study is evaluating the feasibility of a test, linkage-to-care, and treat strategy for HIV prevention in two intervention communities - the Bronx, NY, and Washington, DC. Routinely collected laboratory data on diagnosed HIV cases in the national HIV surveillance system were used to select and randomize sites, and will be used to assess trial outcomes.Results:To inform study randomization, baseline data on site-aggregated study outcomes was provided from HIV surveillance data by New York City and Washington D.C. Departments of Health. The median site rate of linkage-to-care for newly diagnosed cases was 69% (IQR 50%-86%) in the Bronx and 54% (IQR 33%-71%) in Washington, D.C. In participating HIV care sites, the median site percent of patients with viral suppression (<400 copies/mL) was 57% (IQR 53%-61%) in the Bronx and 64% (IQR 55%-72%) in Washington, D.C.Conclusions:In a novel use of site-aggregated surveillance data, baseline data was used to design and evaluate site randomized studies for both HIV test and HIV care sites. Surveillance data have the potential to inform and monitor sitelevel health outcomes in HIV-infected patients.

scholarly journals Advanced HIV Disease among Males and Females Initiating HIV Care in Rural Ethiopia

2019 ◽  
Vol 18 ◽  
pp. 232595821984719 ◽  
Author(s):  
Alan Raymond Lifson ◽  
Sale Workneh ◽  
Abera Hailemichael ◽  
Richard Fleming MacLehose ◽  
Keith Joseph Horvath ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Care ◽  
Stage Iii ◽  
Baseline Survey ◽  
Local Health ◽  
Hiv Disease ◽  
Rural Ethiopia ◽  
District Hospitals ◽  
Advanced Hiv Disease

Despite recommendations for rapidly initiating HIV treatment, many persons in sub-Saharan Africa present to care with advanced HIV disease. Baseline survey and clinical data were collected on 1799 adults newly enrolling at 32 district hospitals and local health HIV clinics in rural Ethiopia. Among those with complete HIV disease information, advanced HIV disease (defined as CD4 count <200 cells/mm3 or World Health Organization [WHO] HIV clinical stage III or IV disease) was present in 66% of males and 56% of females ( P < .001). Males (compared to females) had lower CD4 counts (287 cells/mm3 versus 345 cells/mm3), lower body mass index (19.3 kg/m2 versus 20.2 kg/m2), and more WHO stage III or IV disease (46% versus 37%), ( P < .001). Men reported more chronic diarrhea, fevers, cough, pain, fatigue, and weight loss ( P < .05). Most initiating care in this resource-limited setting had advanced HIV disease. Men had poorer health status, supporting the importance of earlier diagnosis, linkage to care, and initiation of antiretroviral therapy.

scholarly journals Shifting the Paradigm: Using HIV Surveillance Data as a Foundation for Improving HIV Care and Preventing HIV Infection

2013 ◽  
Vol 91 (3) ◽  
pp. 558-603 ◽  
Author(s):  
PATRICIA SWEENEY ◽  
LYTT I. GARDNER ◽  
KATE BUCHACZ ◽  
PAMELA MORSE GARLAND ◽  
MICHAEL J. MUGAVERO ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Surveillance Data ◽  
Hiv Care ◽  
Hiv Surveillance

scholarly journals New York City HIV Care Continuum Dashboards: Using Surveillance Data to Improve HIV Care Among People Living With HIV in New York City (Preprint)

2018 ◽  
Author(s):  
Sarah L Braunstein ◽  
Karen Coeytaux ◽  
Charulata J Sabharwal ◽  
Qiang Xia ◽  
Rebekkah S Robbins ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Surveillance Data ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Viral Load Suppression ◽  
Care Continuum ◽  
Hiv Surveillance

BACKGROUND HIV surveillance data can be used to improve patient outcomes. OBJECTIVE This study aimed to describe and present findings from the HIV care continuum dashboards (CCDs) initiative, which uses surveillance data to quantify and track outcomes for HIV patients at major clinical institutions in New York City. METHODS HIV surveillance data collected since 2011 were used to provide high-volume New York City clinical facilities with their performance on two key outcomes: linkage to care (LTC), among patients newly diagnosed with HIV and viral load suppression (VLS), among patients in HIV care. RESULTS The initiative included 21 facilities covering 33.78% (1135/3360) of new HIV diagnoses and 46.34% (28,405/61,298) of patients in HIV care in New York City in 2011 and was extended to a total of 47 sites covering 44.23% (1008/2279) of new diagnoses and 69.59% (43,897/63,083) of New York City patients in care in 2016. Since feedback of outcomes to providers began, aggregate LTC has improved by 1 percentage point and VLS by 16 percentage points. CONCLUSIONS Disseminating information on key facility–level HIV outcomes promotes collaboration between public health and the clinical community to end the HIV epidemic. Similar initiatives can be adopted by other jurisdictions with mature surveillance systems and supportive laws and policies.

scholarly journals Using HIV Surveillance Data to Link People to HIV Medical Care, 5 US States, 2012-2015

2018 ◽  
Vol 133 (4) ◽  
pp. 385-391 ◽  
Author(s):  
John Beltrami ◽  
Odessa Dubose ◽  
Reginald Carson ◽  
Janet C. Cleveland
Keyword(s):  
Public Health ◽  
Hiv Prevention ◽  
Linkage To Care ◽  
Surveillance Data ◽  
Hiv Care ◽  
Performance Standard ◽  
Health Staff ◽  
Health Departments ◽  
Hiv Surveillance ◽  
Prevention Activities

Introduction: From 2012 through 2015, the Centers for Disease Control and Prevention (CDC) provided funding to 5 health departments for demonstration projects using HIV surveillance data to link people with newly diagnosed HIV to care. We assessed how well these health departments established linkage to care, how the demonstration projects helped them with this work, and if they sustained these activities after CDC funding ended. Materials and Methods: We obtained quantitative and qualitative data on linkage-to-care activities from health department communications and progress reports submitted to CDC. We calculated and combined linkage-to-care results for the 5 health departments, and we compared these results with the combined linkage-to-care results for 61 health departments that received CDC funding for routine HIV prevention activities (eg, HIV testing, linkage to and reengagement in HIV care, HIV partner services) and for the same 5 health departments when they used only routine HIV prevention activities for linkage to care. Results: Of 1269 people with a new HIV diagnosis at the 5 health departments, 1124 (89%) were linked to care, a result that exceeded the 2010-2015 National HIV/AIDS Strategy goal (85%), the CDC Funding Opportunity Announcement performance standard (80%), and combined results for the 61 health departments (63%) and the same 5 health departments (66%) using routine HIV prevention activities. Benefits of the projects were improved collaboration and coordination and more accurate, up-to-date surveillance data. All health departments continued linkage-to-care activities after funding ended. Practice Implications: Using HIV surveillance data to link people with HIV to care resulted in substantial clinical and public health benefits. Our observations underscore the importance of collaboration among medical providers, public health staff members, community-based organizations, and people with HIV to ensure the best possible clinical and public health outcomes.

scholarly journals 2497

2017 ◽  
Vol 1 (S1) ◽  
pp. 81-81
Author(s):  
Rebecca Duron ◽  
Michael Mugavero ◽  
Andrew Westfall
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Medical Care ◽  
Surveillance Data ◽  
Hiv Care ◽  
Primary Care Visit ◽  
Care Visit ◽  
Retention In Hiv Care ◽  
State Surveillance ◽  
Status Of Care

OBJECTIVES/SPECIFIC AIMS: Approximately 50% of people who have been diagnosed with HIV are either not linked to a care provider or not retained in medical care. This has substantial implications for both individual and public health outcomes. On an individual level, being retained in care is necessary for continuous receipt of antiretroviral therapy and sustained viral suppression. The public health implications of poor retention in HIV care are also serious, as it is estimated that people with HIV who are not retained in medical care are responsible for a majority of HIV transmissions, even more than the number of transmissions attributable to those who are HIV infected but undiagnosed. State departments of health routinely collect surveillance data including positive HIV test results, CD4 counts and viral load measures for monitoring trends in HIV infection. A shift in the use of these surveillance measures, guided by the CDC, has brought forth the opportunity to use these data for direct patient services and, more specifically, to direct re-engagement and retention in care efforts. Although the risk factors for poor retention in HIV care have been characterized using information from individual or multiple clinics, this study seeks to incorporate state surveillance data into the retention measures. METHODS/STUDY POPULATION: This retrospective cohort study was performed at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic among patients with at least one attended HIV primary care visit during the calendar year of 2015. Retention during the calendar year of 2016 was then measured as whether or not a patient had 2 or more completed clinic visits which were separated by more than 90 days (in accordance with the Health Resources and Services Administration or HRSA guidelines, a National HIV Quality Indicator). For patients who did not have any primary care visit in 2016, the Alabama Department of Public Health will provide a status of care (out of care, in care elsewhere, died, moved out of state, and cannot locate) based on HIV laboratory results reported from all clinics and labs across the state and/or mortality information. A multinominal regression model of the status of care will be fitted to demographic, clinical, laboratory, and behavioral patient reported outcomes captured during an index visit in 2015. RESULTS/ANTICIPATED RESULTS: Data were recently obtained and is currently being analyzed on 3107 patients included in this study. We anticipate that there will be differences in the factors significantly associated with patients classified as out of care, poorly retained (patients who have only one completed clinic visit), and retained in care by the HRSA measure during calendar year 2016. DISCUSSION/SIGNIFICANCE OF IMPACT: By incorporating state surveillance data into our analysis, we expect to obtain a more precise picture of the risk factors for poor retention among HIV patients. For the first time, we will be able to determine if patients lost to our HIV clinic (~10% annually) are entirely lost to medical care or are seeking care elsewhere as indicated by HIV lab data reported to public health via surveillance. Identified risk factors will then be able to better inform the efforts to proactively improve the efficiency for HIV patient retention and re-engagement, and therefore lead to better individual outcomes for HIV patients and reduce the incidence of new HIV cases.

scholarly journals The Population Impact of Late Presentation With Advanced HIV Disease and Delayed Antiretroviral Therapy in Adults Receiving HIV Care in Latin America

2019 ◽  
Vol 189 (6) ◽  
pp. 564-572 ◽  
Author(s):  
Pablo F Belaunzarán-Zamudio ◽  
Yanink N Caro-Vega ◽  
Bryan E Shepherd ◽  
Peter F Rebeiro ◽  
Brenda E Crabtree-Ramírez ◽  
...  
Keyword(s):  
Latin America ◽  
Antiretroviral Therapy ◽  
Population Attributable Fraction ◽  
Immune Deficiency Syndrome ◽  
Late Presentation ◽  
Hiv Care ◽  
Hiv Disease ◽  
Art Initiation ◽  
Advanced Hiv Disease ◽  
The Impact

Abstract Late presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001–2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of &lt;200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America.

scholarly journals Advanced HIV Disease at Enrolment in HIV Care: Trends and Associated Factors over a Ten Year Period in Cambodia

PLoS ONE ◽  
2015 ◽  
Vol 10 (11) ◽  
pp. e0143320 ◽  
Author(s):  
Reaksmey Pe ◽  
Bopha Chim ◽  
Sopheak Thai ◽  
Lutgarde Lynen ◽  
Johan van Griensven
Keyword(s):  
Associated Factors ◽  
Hiv Care ◽  
Hiv Disease ◽  
Advanced Hiv Disease
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