scholarly journals Unsafe Injection Is Associated with Higher HIV Testing after Bayesian Adjustment for Unmeasured Confounding

2020 ◽  
Vol 23 (12) ◽  
pp. 848-855
Author(s):  
Soodabeh Navadeh ◽  
Ali Mirzazadeh ◽  
Willi McFarland ◽  
Phillip Coffin ◽  
Mohammad Chehrazi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
San Francisco ◽  
Expert Opinion ◽  
Bias Analysis ◽  
Hiv Knowledge ◽  
Persons Who Inject Drugs ◽  
Adjusted Risk ◽  
Unmeasured Confounder ◽  
Unsafe Injection ◽  
Insufficient Knowledge

Background: To apply a novel method to adjust for HIV knowledge as an unmeasured confounder for the effect of unsafe injection on future HIV testing. Methods: The data were collected from 601 HIV-negative persons who inject drugs (PWID) from a cohort in San Francisco. The panel-data generalized estimating equations (GEE) technique was used to estimate the adjusted risk ratio (RR) for the effect of unsafe injection on not being tested (NBT) for HIV. Expert opinion quantified the bias parameters to adjust for insufficient knowledge about HIV transmission as an unmeasured confounder using Bayesian bias analysis. Results: Expert opinion estimated that 2.5%–40.0% of PWID with unsafe injection had insufficient HIV knowledge; whereas 1.0%–20.0% who practiced safe injection had insufficient knowledge. Experts also estimated the RR for the association between insufficient knowledge and NBT for HIV as 1.1-5.0. The RR estimate for the association between unsafe injection and NBT for HIV, adjusted for measured confounders, was 0.96 (95% confidence interval: 0.89,1.03). However, the RR estimate decreased to 0.82 (95% credible interval: 0.64, 0.99) after adjusting for insufficient knowledge as an unmeasured confounder. Conclusion: Our Bayesian approach that uses expert opinion to adjust for unmeasured confounders revealed that PWID who practice unsafe injection are more likely to be tested for HIV – an association that was not seen by conventional analysis.

scholarly journals Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa

2021 ◽  
Author(s):  
Dorina Onoya ◽  
Tembeka Sineke ◽  
Idah Mokhele ◽  
Jacob Bor ◽  
Matthew P. Fox ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Testing ◽  
Self Report ◽  
Hiv Diagnosis ◽  
Adjusted Risk ◽  
Art Initiation ◽  
Art Policy ◽  
Universal Test And Treat ◽  
Post Test ◽  
Treat All

AbstractWe aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30–39.9 vs 18–29.9 years, 95% confidence intervals (CI): 1.0–2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4–3.6) and HIV testing history (aRR 1.7 for  > 12 months vs < 12 months/no prior test, 95% CI: 1.0–2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4–3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2–18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2–0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2–3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.

scholarly journals Low HIV testing among persons who inject drugs—National HIV Behavioral Surveillance, 20 U.S. cities, 2012

2016 ◽  
Vol 165 ◽  
pp. 270-274 ◽  
Author(s):  
Laura A. Cooley ◽  
Cyprian Wejnert ◽  
Michael W. Spiller ◽  
Dita Broz ◽  
Gabriela Paz-Bailey
Keyword(s):  
Hiv Testing ◽  
Persons Who Inject Drugs ◽  
Behavioral Surveillance ◽  
National Hiv Behavioral Surveillance

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

scholarly journals Study on Influencing Factors to HIV Health Services Among Men Who Have Sex with Men (MSM) from 2013 to 2021

2021 ◽  
Author(s):  
Bing Lin ◽  
Jiaxiu Liu ◽  
Hong Pan ◽  
Yingjie Ma ◽  
Xiaoni Zhong
Keyword(s):  
Health Services ◽  
Condom Use ◽  
Hiv Testing ◽  
Influencing Factors ◽  
Behavioral Model ◽  
Consistent Condom ◽  
Hiv Knowledge ◽  
Consistent Condom Use ◽  
Predisposing Factor ◽  
Hiv Counseling

Abstract Background We assessed the utilization of HIV health services and its influencing factors on consistent condom use, HIV testing and HIV counseling among men who have sex with men (MSM) based on Andersen Behavioral Model, so as to provide a theoretical basis for future infectious disease prevention and control strategies and health services policy formulation.method This is a cross-sectional study from 2013 to 2021. A sample survey was conducted in southwest China including Chongqing, Sichuan, Xinjiang and Guangxi, and an anonymous self-administered questionnaire survey was conducted among MSM who met the requirements and were recruited. Based on Anderson Behavioral Model, the questionnaire divided the influencing factors into predisposing factor, enabling factor and need factor. There were 2908 valid questionnaires. Multivariate logistic regression analysis was used to explore the factors influencing the utilization of health services.Results In the survey of HIV health services, 36.49% of respondents consistently used condoms, 82.81% had HIV testing, and 65.61% had HIV counseling. It can be obtained that among the predisposing factor, older age is a factor that promotes HIV testing but is a hindrance to consistent condom use. Condom use was higher among MSM who were Ethnic Han and had an education level of "junior high or below". Among the enabling factor, not finding a sexual partner through the Internet, not having commercial sex were associated with consistent condom use. Urban and high income were enablers of HIV testing and HIV counseling. Among the need factor, improved HIV knowledge could promote HIV testing and HIV counseling among MSM.Conclusions For these groups, MSM with high-risk characteristics should be identified as a priority in the future public health services. HIV knowledge should be promoted in health education, and mental health diagnosis and treatment also should be strengthened.

scholarly journals Predictors to HIV testing among youth women in Ethiopia: 2016 Ethiopian Demographic and Health Survey

2019 ◽  
Author(s):  
Gedefaw Diress ◽  
Mohammed Ahmed ◽  
Seteamlak Adane ◽  
Melese Linger ◽  
Birhan Aleminew
Keyword(s):  
Logistic Regression ◽  
Hiv Testing ◽  
Health Survey ◽  
Multivariate Logistic Regression Analysis ◽  
Demographic And Health Survey ◽  
Outcome Variable ◽  
Hiv Knowledge ◽  
Cross Sectional ◽  
Infected People ◽  
Treatment Cascade

Abstract Background HIV testing is the critical first step in identifying and linking HIV infected people to the treatment cascade and it also provides an important opportunity to reinforce HIV prevention among the negatives. The aim of this study was examine factors associated with HIV testing among youth women. Methods A community-based cross-sectional study design was used and a nationally representative secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey(EDHS). A total of 6401 youth women were eligible in the study. The data were analyzed by SPSS version 20. Frequencies and weighted percentage of the variables were calculated. Chi-square tests and logistic regression models were used to assess predictors of HIV testing. Multivariate logistic regression analysis was conducted to control confounders and to identify the independent contribution of each variable to the outcome variable. Result A total of 6401 youth women aged 15 to 24 years of age were included. Only 37.7% (95% CI:(33.6-39.1%)) of participants were ever tested for HIV in their life. In the final multivariable model age, marital status, level of educational, media access, number of sexual partner, STIs in Past 12 months and comprehensive knowledge to HIV, were significantly associated with ever been tested for HIV. Youth women who were in the age group between 20 to 24 (AOR=2.18; 95CI:(1.800-2.652), who were married (AOR=4.70; 95% CI:(3.674-6.008)), were divorced (AOR=6.16; 95% CI (3.976-9.541)), who had no access to media (AOR = 0.69; 95 CI %: (0.540-0.870)), who had no comprehensive HIV knowledge (AOR = 0.68; 65% CI: (0.530-0.861)) and having one or more sexual partners (AOR=2.48; 95% CI:(1.350-4.551)) were significantly associated with ever been tested for HIV.

OP208 Did Health Technology Assessments Make the Wrong Call? Quantitative Bias Analysis: Alectinib versus Ceritinib in Non-Small Cell Lung Cancer

2021 ◽  
Vol 37 (S1) ◽  
pp. 6-6
Author(s):  
Samantha Wilkinson ◽  
Alind Gupta ◽  
Eric Mackay ◽  
Paul Arora ◽  
Kristian Thorlund ◽  
...  
Keyword(s):  
Real World ◽  
Performance Status ◽  
Missing At Random ◽  
Health Technology ◽  
Bias Analysis ◽  
Ecog Performance Status ◽  
Unmeasured Confounding ◽  
Unmeasured Confounder ◽  
Innovative Therapies ◽  
Quantitative Bias Analysis

IntroductionThe German health technology assessment (HTA) rejected additional benefit of alectinib for second line (2L) ALK+ NSCLC, citing possible biases from missing ECOG performance status data and unmeasured confounding in real-world evidence (RWE) for 2L ceritinib that was submitted as a comparator to the single arm alectinib trial. Alectinib was approved in the US and therefore US post-launch RWE can be used to evaluate this HTA decision.MethodsWe compared the real-world effectiveness of alectinib with ceritinib in 2L post-crizotinib ALK+ NSCLC using the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Using quantitative bias analysis (QBA), we estimated the strength of (i) unmeasured confounding and (ii) deviation from missing-at-random (MAR) assumptions needed to nullify any overall survival (OS) benefit.ResultsAlectinib had significantly longer median OS than ceritinib in complete case analysis. The estimated effect size (Hazard Ratio: 0.55) was robust to risk ratios of unmeasured confounder-outcome and confounder-exposure associations of <2.4.Based on tipping point analysis, missing baseline ECOG performance status for ceritinib-treated patients (49% missing) would need to be more than 3.4-times worse than expected under MAR to nullify the OS benefit observed for alectinib.ConclusionsOnly implausible levels of bias reversed our conclusions. These methods could provide a framework to explore uncertainty and aid decision-making for HTAs to enable patient access to innovative therapies.

Factors Associated With HIV Testing in Teenage Men Who Have Sex With Men

2021 ◽  
pp. 31-39
Author(s):  
Brian Mustanski ◽  
David A. Moskowitz ◽  
Kevirj O. Moran ◽  
H. Jonathon Rendina ◽  
Michael E. Newcomb ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hiv Testing ◽  
Sexual Behaviors ◽  
Odds Ratio ◽  
Hiv Knowledge ◽  
Hiv Prevention Intervention ◽  
Hiv Test ◽  
Sexual Health Communication ◽  
Sex With Men ◽  
Regular Doctor

BACKGROUND Adolescent men who have sex with men (AMSM) have a high rate of HIV diagnoses. An estimated 14.5% of HIV infections in the United States are undiagnosed; but among 13- to 24-year-olds, the rate is 51.4%. We describe HIV testing rates and identifies salient individual, family, school, and health care influences among AMSM. METHODS Data were collected as part of SMART, an ongoing pragmatic trial of an online HIV prevention intervention for AMSM (N = 699). Measures included lifetime HIV testing, demographics, sexual behaviors, condom use, HIV education from school and family, sexual health communication with doctors, HIV knowledge, and risk attitudes. RESULTS Only 23.2% of participants had ever had an HIV test. Rates of testing increased with age (5.6% in 13- to 14-year-olds; 15.8% in 15- to 16-year-olds; 37.8% in 17- to 18-year-olds), and sexual experience was a strong predictor of testing (odds ratio: 6.54; 95% confidence interval: 3.95–11.49; P &lt; .001). Most participants had a regular doctor (67.5%), but few had conversations about same-sex sexual behaviors (21.3%), HIV testing (19.2%), or sexual orientation (29.2%). Speaking to a doctor about HIV testing had a large effect (odds ratio: 25.29; confidence interval: 15.91–41.16; P &lt; .001), with 75.4% who had such conversations having been tested, compared to only 10.8% of those who had not had such conversations. CONCLUSIONS Despite higher risk, few participants reported ever having received an HIV test. Data indicate pediatricians are an important, but largely untapped, source of testing and could be integral to achieving testing rates needed to end the epidemic.

HIV Testing Patterns and Unrecognized HIV Infection Among Young Asian and Pacific Islander Men Who Have Sex With Men in San Francisco

2005 ◽  
Vol 17 (6) ◽  
pp. 540-554 ◽  
Author(s):  
Tri D. Do ◽  
Sanny Chen ◽  
Willi McFarland ◽  
Gina M. Secura ◽  
Stephanie K. Behel ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
San Francisco ◽  
Pacific Islander ◽  
Asian And Pacific Islander ◽  
Sex With Men ◽  
Testing Patterns

scholarly journals Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use–Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak—Cincinnati/Northern Kentucky, 2017–2018

2020 ◽  
Author(s):  
Nathan W Furukawa ◽  
Erin F Blau ◽  
Zach Reau ◽  
David Carlson ◽  
Zachary D Raney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Hiv Testing ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Diagnosis ◽  
Persons Who Inject Drugs ◽  
Missed Opportunities ◽  
Immunodeficiency Virus

Abstract Background Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. Methods PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017–September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. Results Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70–4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10–2.82). Conclusions PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.

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