scholarly journals Childhood Adversities and Physical and Mental Health Outcomes in Adults Living with HIV: Findings from the Ontario HIV Treatment Network Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-17 ◽  
Author(s):  
Tsegaye Bekele ◽  
Evan J. Collins ◽  
Robert G. Maunder ◽  
Sandra Gardner ◽  
Sergio Rueda ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Childhood Adversity ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Childhood Adversities ◽  
African Caribbean ◽  
Living With Hiv

We sought to estimate the prevalence of childhood adversity and examine its relationship with health outcomes among people living with HIV. Study participants included 1409 adults living with HIV and receiving care in Toronto, Canada. Data on childhood adversity, health behaviors, HIV outcome measures, depression, and health-related quality of life (HRQOL) were collected through face-to-face interviews and medical records. Statistical analyses included multivariable linear and logistic regression modeling. The prevalence of any childhood adversity was 71% (individual types ranged from 11% to 44%) and higher prevalence was associated with younger age, Indigenous or African/Caribbean/Black ethnicity, lower socioeconomic status, and higher rates of cigarette smoking and nonmedicinal drug use. Greater number of childhood adversities was associated with greater odds of depression and decreasing mental HRQOL. HIV care providers need to screen for childhood adversities and address childhood trauma within the context of HIV care.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

2019 ◽  
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, <i>P</i>&lt;.001) but more likely to be black (82.3% vs 69.5%, <i>P</i>&lt;.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, <i>P</i>&lt;.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, <i>P</i>&lt;.001), have a CD4 &lt;200 cells/µL in 2017 (6.2% vs 4.6%, <i>P</i>&lt;.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, <i>P</i>&lt;.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

scholarly journals Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Vasiliki Papageorgiou ◽  
Bethan Davies ◽  
Emily Cooper ◽  
Ariana Singer ◽  
Helen Ward
Keyword(s):  
Systematic Review ◽  
Social Determinants ◽  
Meta Analysis ◽  
Hiv Treatment ◽  
Material Deprivation ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

scholarly journals Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986821
Author(s):  
Claire E. Kendall ◽  
Janessa E. Porter ◽  
Esther S. Shoemaker ◽  
Rachel Seoyeon Kang ◽  
Michael Fitzgerald ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Care Providers ◽  
Question Type ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Local Health ◽  
Care Providers ◽  
Patients At Risk ◽  
Survey Responses ◽  
Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

‘What will it take’: addressing alcohol use among people living with HIV in South Africa

2019 ◽  
Vol 30 (11) ◽  
pp. 1049-1054 ◽  
Author(s):  
K Sorsdahl ◽  
NK Morojele ◽  
CD Parry ◽  
CT Kekwaletswe ◽  
N Kitleli ◽  
...  
Keyword(s):  
South Africa ◽  
Alcohol Use ◽  
Brief Intervention ◽  
Hiv Treatment ◽  
Hiv And Aids ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Screening And Brief Intervention ◽  
Treatment Services ◽  
Living With Hiv

Given that hazardous and harmful alcohol use has been identified as a significant barrier to adherence to antiretroviral therapy (ART) in South Africa, alcohol reduction interventions delivered within HIV treatment services are being investigated. Prior to designing and implementing an alcohol-focused screening and brief intervention (SBI), we explored patients’ perceptions of alcohol as a barrier to HIV treatment, the acceptability of providing SBIs for alcohol use within the context of HIV services and identifying potential barriers to patient uptake of this SBI. Four focus groups were conducted with 23 participants recruited from three HIV treatment sites in Tshwane, South Africa. Specific themes that emerged included: (1) barriers to ART adherence, (2) available services to address problematic alcohol use and (3) barriers and facilitators to delivering a brief intervention to address alcohol use within HIV care. Although all participants in the present study unanimously agreed that there was a great need for SBIs to address alcohol use among people living with HIV and AIDS, our study identified several areas that should be considered prior to implementing such a programme.

scholarly journals People living with HIV in Estonia: engagement in HIV care in 2013

2016 ◽  
Vol 21 (43) ◽  
Author(s):  
Kaja-Triin Laisaar ◽  
Mait Raag ◽  
Irja Lutsar ◽  
Anneli Uusküla
Keyword(s):  
Medical Care ◽  
Universal Access ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Administrative Databases ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
The European Union ◽  
Treatment Cascade ◽  
Living With Hiv

Estonia had the highest rate of newly diagnosed human immunodeficiency virus (HIV) cases in the European Union (24.6/100,000) and an estimated adult HIV prevalence of 1.3% in 2013. HIV medical care, including antiretroviral therapy (ART), is free of charge for people living with HIV (PLHIV). To maximise the health benefits of HIV treatment, universal access should be achieved. Using data from surveillance and administrative databases and the treatment cascade model, we assessed the number of people infected with HIV, diagnosed with HIV, linked to HIV care, retained in HIV care, on ART, and with suppressed viral load (HIV-RNA: < 200 copies/mL). We identified that about one quarter of the 8,628 HIV-positive people estimated to live in Estonia in 2013 had not been diagnosed with HIV, and another quarter, although aware of their HIV-positive serostatus, had not accessed HIV medical care. Although altogether only 12–15% of all PLHIV in Estonia had achieved viral suppression, the main gap in HIV care in Estonia were the 58% of PLHIV who had accessed HIV medical care at least once after diagnosis but were not retained in care in 2013.

scholarly journals 727. Predictors of Depressive Symptoms in Pregnant Partners in Seroconcordant Couples Living with HIV in Zambézia Province, Mozambique

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S462-S463
Author(s):  
Daniel Sack ◽  
Ariano Matino ◽  
Graves Erin ◽  
Almiro Emilio ◽  
Bryan Shepherd ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Male Partner ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Relationship Status ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Living With Hiv ◽  
Seroconcordant Couples

Abstract Background Depression contributes to HIV treatment outcomes in sub-Saharan Africa, where approximately 15% of people living with HIV have comorbid depression. HoPS+, a cluster randomized trial among seroconcordant couples living with HIV, assesses male partner involvement during antenatal HIV care and HIV outcomes. We describe predictors of depressive symptoms among pregnant partners living with HIV in Zambézia Province, Mozambique. Methods This baseline cross-sectional analysis includes 1079 female HoPS+ participants. We show demographic (age, enrollment date, relationship status, education, and occupation) and clinical (WHO HIV stage, body mass index [BMI], and antiretroviral therapy [ART] use history) factors. We model females’ depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) using proportional odds models with continuous covariates as restricted cubic splines (enrollment date, age, BMI, partner’s PHQ-9 score), categorical covariates (district, relationship status, education, occupation, WHO stage), and ART use history. Missing covariates were imputed 20 times. Results Participants’ median age was 23 (interquartile range [IQR] 20-28). Most women reported no or &lt; 7 years of education (84.1%), were farmers (61.3%), and were WHO stage I (81.9%). They had a median PHQ-9 score of 3 (IQR 0-5) and 47 (43.6%) had moderately severe or severe depressive symptoms, with 19.6% missing PHQ-9 scores. Among 867 pregnant partners with PHQ-9s, demographic and clinical covariates were not meaningful predictors of PHQ-9 score. Male partner’s PHQ-9 score, however, was associated with (covariate-adjusted Spearman’s rho 0.58, 95% Confidence Interval [CI]: 0.51-0.65) and strongly predictive of a pregnant partner’s score (Figure). An increase in a male partner’s PHQ-9 score from 9 to 10 was associated with 1.47 times increased odds (95% CI: 1.37-1.58) of a ≥1-point increase in a woman’s PHQ-9 score Figure: Female Partner's Depressive Symptoms Conclusion Depressive symptoms are highly correlated among pregnant people and their partners, which may have implications for pregnancy care. Interventions aimed to reduce depressive symptoms and improve HIV-related outcomes during pregnancy may have greater success when focused on addressing both partners’ depressive symptoms. Disclosures All Authors: No reported disclosures

Motivational Interviewing and the Continuum of HIV Care in Practice

2019 ◽  
pp. 29-34
Author(s):  
Shriya Kaneriya ◽  
K. Rivet Amico ◽  
Antoine Douaihy
Keyword(s):  
Motivational Interviewing ◽  
Medical Condition ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Positive Health ◽  
Hiv Management ◽  
Living With Hiv ◽  
Positive Health Outcomes

Advances in HIV treatment have transformed a nearly universally fatal disease into a manageable long-term medical condition. Treatment, however, requires long-term, active engagement and self-directed adherence to HIV medications, which can be challenging to manage. Factors influencing HIV management are multilevel and best understood from an interdisciplinary framework. This chapter reviews the interdisciplinary care model for HIV management, discusses barriers interfering with positive health outcomes in people living with HIV (PLWH), and positions motivational interviewing (MI) as particularly well suited to optimizing outcomes in an interdisciplinary context. This chapter advocates for the integration of MI into the care of PLWH throughout the HIV care continuum.

scholarly journals Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study

10.2196/16061 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e16061
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

Background HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). Methods Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). Conclusions These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

scholarly journals Rehabilitation: A crucial component in the future of HIV care and support

2011 ◽  
Vol 12 (2) ◽  
pp. 12 ◽  
Author(s):  
Stephanie Nixon ◽  
Lisa Forman ◽  
Jill Hanass-Hancock ◽  
Muriel Mac-Seing ◽  
Norbert Munyanukato ◽  
...  
Keyword(s):  
Human Rights ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Persons With Disabilities ◽  
Care And Support ◽  
Crucial Component ◽  
United Nations Convention ◽  
Living With Hiv ◽  
Art Delivery

Provision of antiretroviral therapy (ART) is not an end in itself but a means to achieving improved wellness for people living with HIV. Rehabilitation, broadly defined, is another key contributor to wellness within this context. Understanding the potential for rehabilitation requires that one is able to consider HIV not only within a biomedical model that focuses on body systems, diagnoses and symptoms, but also within a rehabilitation framework that focuses on how these diagnoses and symptoms affect people’s lives more broadly. Furthermore, rehabilitation is a human rights imperative, which deserves the energetic attention enjoyed by other aspects of HIV treatment and care. In particular, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is shining a long-overdue spotlight on the human rights imperatives associated with disability. For South Africa and other countries, proactively and meaningfully engaging rehabilitation in the HIV response will require major shifts on several fronts, including practice, education, policy and research. We argue that in settings where ART delivery is now widespread, HIV should be understood not only as a medical issue, but as a rehabilitation and disability concern. Whereas medicine adds years to life, it is rehabilitation that aims to add life to years.

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