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Cascade of HIV care

Genevieve Kerkerian, Mary Kestler, Allison Carter, Lu Wang, Nadine Kronfli, Paul Sereda, Eric Roth, M-J Milloy, Neora Pick, Deborah Money, Kath Webster, Robert S Hogg, Alexandra de Pokomandy, Mona Loutfy, Angela Kaida
BACKGROUND: In North America, women have lower engagement across the HIV cascade of care compared with men. Among women living with HIV (WLWH) in Canada, we measured the prevalence and correlates of attrition across cascade stages overall, and by key sub-populations. METHODS: We analyzed baseline survey data regarding six nested stages of the HIV cascade among 1,424 WLWH enrolled in the Canadian HIV Sexual and Reproductive Health Cohort Study (CHIWOS), including: linked to care, retained in care, initiated antiretroviral therapy (ART), current ART use, ART adherence (≥90%), and viral suppression (<50 copies/mL)...
June 15, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Angela M Bengtson, Brian W Pence, Matthew J Mimiaga, Bradley N Gaynes, Richard Moore, Katerina Christopoulos, Conall O'Cleirigh, David Grelotti, Sonia Napravnik, Heidi Crane, Michael Mugavero
Background: The effect of depressive symptoms over time on progression through the HIV treatment cascade is complex and poorly characterized. Methods: We included participants from the Centers for AIDS Research Network of Integrated Clinic Systems Cohort who were ART-naïve, had at least one viral load and HIV appointment measure after ART initiation, and had a depressive symptom measure within 6 months of ART initiation. Recent depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized using a validated cut-point (PHQ-9 > 10)...
June 12, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
M Eugenia Socías, Evan Wood, Thomas Kerr, Seonaid Nolan, Kanna Hayashi, Ekaterina Nosova, Julio Montaner, M-J Milloy
BACKGROUND: A cascade of care framework has been proposed to identify and address implementation gaps in addiction medicine. Using this framework, we characterized temporal trends in engagement in care for opioid use disorder (OUD) in Vancouver, Canada. METHODS: Using data from two cohorts of people who use drugs, we assessed the yearly proportion of daily opioid users achieving four sequential stages of the OUD cascade of care [linkage to addiction care; linkage to opioid agonist treatment (OAT); retention in OAT; and stability] between 2006 and 2016...
May 29, 2018: Drug and Alcohol Dependence
Aaloke Mody, Izukanji Sikazwe, Nancy L Czaicki, Mwanza Wa Mwanza, Theodora Savory, Kombatende Sikombe, Laura K Beres, Paul Somwe, Monika Roy, Jake M Pry, Nancy Padian, Carolyn Bolton-Moore, Charles B Holmes, Elvin H Geng
BACKGROUND: Although randomized trials have established the clinical efficacy of treating all persons living with HIV (PLWHs), expanding treatment eligibility in the real world may have additional behavioral effects (e.g., changes in retention) or lead to unintended consequences (e.g., crowding out sicker patients owing to increased patient volume). Using a regression discontinuity design, we sought to assess the effects of a previous change to Zambia's HIV treatment guidelines increasing the threshold for treatment eligibility from 350 to 500 cells/μL to anticipate effects of current global efforts to treat all PLWHs...
June 2018: PLoS Medicine
Carmen H Logie, Amaya Perez-Brumer, Jesse Jenkinson, Veli Madau, Winnie Nhlengethwa, Stefan Baral
Swaziland has among the highest national adult HIV prevalence globally. There is limited knowledge of HIV vulnerabilities and prevention engagement among lesbian, gay, bisexual and transgender (LGBT) persons in the context of Swaziland's criminalization of consensual same-sex practices. This study explored social processes of marginalization to assess how they could potentiate HIV vulnerabilities and limit engagement in HIV prevention services. Additionally, we assessed positive change to better understand existing strategies employed by LGBT persons to challenge these HIV prevention barriers...
May 30, 2018: AIDS Care
Mathieu Nacher, Leila Adriouch, Florence Huber, Vincent Vantilcke, Félix Djossou, Narcisse Elenga, Antoine Adenis, Pierre Couppié
BACKGROUND: In order to compute the continuum of care for French Guiana, it is necessary to estimate the total number of persons living with HIV. The main objective was to determine how many persons were infected with HIV and how many were unaware of it. METHODS: We used 2 different models to calculate the total number of persons infected with HIV: Spectrum's AIM module using CSAVR to compute incidence from case registration and vital statistics; and the ECDC model from the French Guiana HIV cohort data...
2018: PloS One
Justyna D Kowalska, Magdalena Ankiersztejn-Bartczak, Leah Shepherd, Amanda Mocroft
INTRODUCTION: Early treatment remains the most effective HIV prevention strategy; poor linkage to care after HIV diagnosis may compromise this benefit. We sought to better understand patient characteristics and their association with virological suppression (VS) following cART initiation. METHODS: The TAK project collects pre-linkage to care and clinical data on patients diagnosed with HIV in voluntary testing facilities in central Poland. Data collected for persons diagnosed in 2010-2013 were linked with HIV clinic records...
May 21, 2018: Infection
Elisa Lopez-Varela, Laura Fuente-Soro, Orvalho Joaquim Augusto, Charfudin Sacoor, Ariel Nhacolo, Esmeralda Karajeanes, Paula Vaz, Denise Naniche
INTRODUCTION: Context-specific improvements in the continuum of HIV care are needed in order to achieve the UNAIDS target of 90-90-90. This study aimed to assess the linkage to and retention in HIV care according to different testing modalities in rural southern Mozambique. METHODS: Adults newly diagnosed with HIV from voluntary counseling and testing (VCT), provider-initiated (PICT) and home-based HIV testing (HBT) services were prospectively enrolled between 2014- 2015 at the Manhiça District...
April 27, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Liem B Luong Nguyen, Yazdan Yazdanpanah, David Maman, Sitima Wanjala, Alexandra Vandenbulcke, Jianthi Price, Robert A Parker, William Hennequin, Pierre Mendiharat, Kenneth A Freedberg
Background: In southwest Kenya, the prevalence of human immunodeficiency virus (HIV) infection is about 25%. Médecins Sans Frontières has implemented a voluntary community testing (VCT) program, with linkage to care and retention interventions, to achieve the Joint United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2017. We assessed the effectiveness and cost-effectiveness of these interventions. Methods: We developed a time-discrete, dynamic microsimulation model to project HIV incidence over time in the adult population in Kenya...
May 8, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Anne F Luetkemeyer, David L Wyles
At the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), there was a major focus on hepatitis C virus (HCV) elimination and improving each component of the hepatitis C care cascade. Several countries and cohorts have demonstrated the remarkable impact that universal HCV testing and unrestricted access to hepatitis C treatment can have on markedly reducing incident HCV infections and HCV infection prevalence, including in people who inject drugs and HIV/HCV-coinfected populations. However, in many settings, substantial barriers to widespread HCV treatment remain, including undiagnosed HCV infection, particularly in populations outside the standard "baby boomer" birth cohort (ie, born 1945-1965); restricted access to hepatitis C treatment in those with known HCV infection; reinfection with HCV; and migration of HCV-infected populations...
May 2018: Topics in Antiviral Medicine
Susan Tross, Veronica Pinho, Jennifer E Lima, Megan Ghiroli, Katherine S Elkington, David H Strauss, Milton L Wainberg
HIV behavioral research has provided an invaluable knowledge base for effective approaches to behavioral challenges along the HIV care cascade. Little attention has been paid to tracking unanticipated effects of research participation, whether negative or positive. We used qualitative methods to elicit impressions of unanticipated effects of participation in behavioral research. An instrument was developed and piloted to assess positive (emotional gains, practical gains, HIV prevention knowledge and skills gains) and negative (emotional stress, discomfort with research) unanticipated effects...
April 30, 2018: AIDS and Behavior
Phillip Keen, Richard T Gray, Barbara Telfer, Rebecca Guy, Heather-Marie Schmidt, Bill Whittaker, Jo Holden, Martin Holt, Anthony Kelleher, David Wilson, Denton Callander, David A Cooper, Garrett Prestage, Christine Selvey, Andrew E Grulich
INTRODUCTION: The HIV Strategy in New South Wales (NSW) Australia aims to virtually eliminate HIV transmission by 2020. We estimated the 2016 HIV diagnosis and care cascade for the state of NSW, with a focus on introducing population-based data to improve data quality and assess progress towards the UNAIDS 90-90-90 targets. METHODS: To estimate the number of people living with diagnosed HIV (PLDHIV) we used NSW data from the Australian National HIV Registry, enhanced by surveillance among people recently diagnosed with HIV to improve migration estimates...
April 2018: Journal of the International AIDS Society
Jane Bruton, Tanvi Rai, Sophie Day, Helen Ward
OBJECTIVES: To describe the experiences of the HIV treatment cascade of diagnosis, engagement with care and initiation of treatment from the perspective of patients; we explored whether this differed according to the year of their diagnosis, for example, whether they had experienced HIV care in the pretreatment era. DESIGN: Qualitative interview study with framework analysis. SETTING: Two large HIV adult outpatient clinics in central London...
March 30, 2018: BMJ Open
Leslie A Enane, Rachel C Vreeman, Caroline Foster
PURPOSE OF REVIEW: Adolescents living with HIV are the only age group with increasing HIV mortality at a time of global scale-up of access to antiretroviral therapy (ART). As a 'treat all' strategy is implemented worldwide, it is critically important to optimize retention and adherence for this vulnerable group. RECENT FINDINGS: Adolescents and young adults living with HIV have poorer outcomes when compared with adults at each stage of the HIV care cascade, irrespective of income setting...
May 2018: Current Opinion in HIV and AIDS
David Etoori, Bernhard Kerschberger, Nelly Staderini, Mpumelelo Ndlangamandla, Bonisile Nhlabatsi, Kiran Jobanputra, Simangele Mthethwa-Hleza, Lucy Anne Parker, Sifiso Sibanda, Edwin Mabhena, Munyaradzi Pasipamire, Serge Mathurin Kabore, Barbara Rusch, Christine Jamet, Iza Ciglenecki, Roger Teck
BACKGROUND: Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland...
March 20, 2018: BMC Public Health
Elan Lazuardi, Stephen Bell, Christy E Newman
Background: The Indonesian response to HIV has been informed largely by quantitative evidence. This review examines what is known about the Indonesian HIV care cascade from published qualitative research. Methods: A 'scoping review' method was used to synthesise and interpret the findings of 17 eligible peer-reviewed publications. Results: Qualitative findings are reported in relation to two themes. Factors influencing successful engagement include a lack of HIV-related knowledge among clients, fear of stigma or lack of privacy/confidentiality at services, limited accessibility and affordability, and poor linkages between services...
March 16, 2018: Sexual Health
Raquel B De Boni, Meridith B Peratikos, Bryan E Shepherd, Beatriz Grinsztejn, Claudia Cortés, Denis Padgett, Eduardo Gotuzzo, Pablo F Belaunzarán-Zamudio, Peter F Rebeiro, Stephany N Duda, Catherine C McGowan
BACKGROUND: The HIV care cascade has improved in Latin America over the last decade. However, the influence of alcohol and noninjected drug use (NIDU) on cascade outcomes is mostly unknown. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF). METHODS: Individuals ≥18 years attending routine HIV clinic visits and completing the Rapid Screening Tool (RST; evaluating NIDU and ART adherence in 7-day recall period) during 2012-13 were followed up to 2015 in the Caribbean, Central and South America network for HIV epidemiology...
2018: PloS One
R Modi, K R Amico, A Knudson, A O Westfall, J Keruly, H M Crane, E B Quinlivan, C Golin, J Willig, A Zinski, R Moore, S Napravnik, L Bryan, M S Saag, M J Mugavero
During the initial year of HIV diagnosis, while patients are often overwhelmed adjusting to this life changing diagnosis, they must develop self-care behaviors for attending regular medical care visits and antiretroviral therapy (ART) adherence to achieve and sustain viral suppression (VS). Maintaining "HIV adherence" and integrating it into one's daily life is required to sustain VS over time. The HIV care continuum or "treatment cascade," an epidemiological snapshot of the national epidemic in the United States (US), indicates that a minority of persons living with HIV (PLWH) have achieved VS...
March 8, 2018: Contemporary Clinical Trials
Niklaus D Labhardt, Isaac Ringera, Thabo I Lejone, Thomas Klimkait, Josephine Muhairwe, Alain Amstutz, Tracy R Glass
Importance: Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). Objective: To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Design, Setting, and Participants: Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho...
March 20, 2018: JAMA: the Journal of the American Medical Association
Angela Odiachi, Salome Erekaha, Llewellyn J Cornelius, Christopher Isah, Habib O Ramadhani, Laura Rapoport, Nadia A Sam-Agudu
BACKGROUND: HIV status disclosure to male partners is important for optimal outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Depending on timing of HIV diagnosis or pregnancy status, readiness to disclose and disclosure rates may differ among HIV-positive women. We sought to determine rates, patterns, and experiences of disclosure among Nigerian women along the PMTCT cascade. METHODS: HIV-positive women in rural North-Central Nigeria were purposively recruited according to their PMTCT cascade status: pregnant-newly HIV-diagnosed, pregnant-in care, postpartum, and lost-to-follow-up (LTFU)...
March 2, 2018: Reproductive Health
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