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Cascade of HIV care

Collins C Iwuji, Nuala McGrath, Tulio de Oliveira, Kholoud Porter, Deenan Pillay, Martin Fisher, Melanie Newport, Marie-Louise Newell
INTRODUCTION: Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges. DISCUSSION: In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another...
November 30, 2015: Journal of AIDS & Clinical Research
Jack J Olney, Paula Braitstein, Jeffrey W Eaton, Edwin Sang, Monicah Nyambura, Sylvester Kimaiyo, Ellen McRobie, Joseph W Hogan, Timothy B Hallett
BACKGROUND: With expanded access to antiretroviral therapy (ART) in sub-Saharan Africa, HIV mortality has decreased, yet life-years are still lost to AIDS. Strengthening of treatment programmes is a priority. We examined the state of an HIV care programme in Kenya and assessed interventions to improve the impact of ART programmes on population health. METHODS: We created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among adults infected with HIV in Kenya...
October 19, 2016: Lancet HIV
Emily C Williams, Judith A Hahn, Richard Saitz, Kendall Bryant, Marlene C Lira, Jeffrey H Samet
Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV...
October 2016: Alcoholism, Clinical and Experimental Research
S K Sah, S K Sahu, B Lamichhane, G K Bhatta, K B Bhandari, P Owiti, S S Majumdar
Setting: The three government tertiary care hospitals providing care for people living with the human immunodeficiency virus (PLHIV) in Kathmandu, Nepal. Objectives: To assess 1) the screening cascades for intensified case finding for tuberculosis (TB), 2) isoniazid preventive therapy (IPT), including demographic and clinical factors associated with treatment interruption, and 3) TB infection control (IC) in the health facilities. Design: A cross-sectional study of new PLHIV enrolled from January 2012 to December 2014...
September 2016: Public Health Action
Barbara Castelnuovo, Rachel Musomba, Joseph Musaazi, Agnes N Kiragga
In resource-limited settings, a number of patients do not receive continuous HIV care. In this analysis, we compared outcomes in patients who entered care by different modality of entry. This was a retrospective analysis of all patients started on antiretroviral treatment (ART) at a large urban center in Uganda from 2005 to 2012. Patients were categorized into three groups (1) Front door: started on ART without interruption during follow-up; (2) drop-out side door: restarted on ART after having an interruption >6 months and (3) transfer-in side door: transferred-in after being started on ART somewhere else...
August 15, 2016: AIDS Care
Daudi Simba, Deodatus Kakoko, Innocent Semali, Anna Kessy, Martha Embrey
INTRODUCTION: Private sector drug shops are an important source of medicines in Tanzania. In 2003, the government introduced the accredited drug dispensing outlet (ADDO) program to improve access to good-quality medicines in rural and peri-urban areas that have frequent drug shortages in public health facilities and few or no registered pharmacies. However, increasing access may also contribute to antimicrobial resistance (AMR) due to the potential overuse and misuse of drugs. METHODS: We conducted a cross-sectional household survey in four regions in mainland Tanzaniato characterize consumer care-seeking habits and medicines use and to determine the extent to which members of the community are knowledgeable about antimicrobials and AMR...
2016: PloS One
Anjuli D Wagner, Cyrus M Wachira, Irene N Njuguna, Elizabeth Maleche-Obimbo, Kenneth Sherr, Irene W Inwani, James P Hughes, Dalton C Wamalwa, Grace C John-Stewart, Jennifer A Slyker
OBJECTIVES: Few routine systems exist to test older, asymptomatic children for HIV. Testing all children in the population has high uptake but is inefficient, while testing only symptomatic children increases efficiency but misses opportunities to optimize outcomes. Testing children of HIV-infected adults in care may efficiently identify previously undiagnosed HIV-infected children before symptomatic disease. METHODS: HIV-infected parents in HIV care in Nairobi, Kenya were systematically asked about their children's HIV status and testing history...
September 19, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Nikoloz Chkhartishvili, Otar Chokoshvili, Natia Dvali, Akaki Abutidze, Lali Sharvadze, Tengiz Tsertsvadze
The objective of this report was to assess Georgia's progress toward Joint United Nations Programme on HIV/AIDS 90-90-90 targets over the period between 2011 and 2015. The number of HIV-positive persons was estimated using Spectrum software. Number of persons diagnosed, on antiretroviral therapy (ART) and virally suppressed were quantified using data from the national AIDS health information system. By the end of 2015, out of the estimated 7100 persons living with HIV, 62% were diagnosed, 38% were on ART, and 32% were virally suppressed...
September 14, 2016: Journal of the International Association of Providers of AIDS Care
Keshet Ronen, Christine J McGrath, Agnes C Langat, John Kinuthia, Danvers Omolo, Benson Singa, Abraham K Katana, Lucy W NgʼAngʼA, Grace John-Stewart
BACKGROUND: Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS: We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability-proportionate-to-size-sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics...
September 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Naveed Z Janjua, Margot Kuo, Amanda Yu, Maria Alvarez, Stanley Wong, Darrel Cook, Jason Wong, Jason Grebely, Zahid A Butt, Hasina Samji, Alnoor Ramji, Mark Tyndall, Mel Krajden
BACKGROUND: Population-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage. METHODS: The BC Hepatitis Testers Cohort (BC-HTC) includes 1.5million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data...
August 25, 2016: EBioMedicine
Katharine Ea Darling, Anna Hachfeld, Matthias Cavassini, Ole Kirk, Hansjakob Furrer, Gilles Wandeler
In 2014, there were 36.9 million people worldwide living with human immunodeficiency virus (PLWH), of whom 17.1 million did not know they were infected. Whilst the number of new human immunodeficiency virus (HIV) infections has declined globally since 2000, there are still regions where new infection rates are rising, and diagnosing HIV early in the course of infection remains a challenge. Late presentation to care in HIV refers to individuals newly presenting for HIV care with a CD4 count below 350 cells/µl or with an acquired immune deficiency syndrome (AIDS)-defining event...
2016: Swiss Medical Weekly
T Kompala, A P Moll, N Mtungwa, R P Brooks, G H Friedland, S V Shenoi
BACKGROUND: HIV testing, diagnosis and treatment programs have expanded globally, particularly in resource-limited settings. Diagnosis must be followed by determination of treatment eligibility and referral to care prior to initiation of antiretroviral treatment (ART). However, barriers and delays along these early steps in the treatment cascade may impede successful ART initiation. New strategies are needed to facilitate the treatment cascade. We evaluated the role of on site CD4+ T cell count phlebotomy services by nurses in facilitating pre-ART care in a community-based voluntary counseling and testing program (CBVCT) in rural South Africa...
2016: BMC Health Services Research
Angela M Bengtson, Brian W Pence, Heidi M Crane, Katerina Christopoulos, Rob J Fredericksen, Bradley N Gaynes, Amy Heine, W Christopher Mathews, Richard Moore, Sonia Napravnik, Steven Safren, Michael J Mugavero
OBJECTIVE: To describe disparities along the depression treatment cascade, from indication for antidepressant treatment to effective treatment, in HIV-infected individuals by gender and race/ethnicity. METHODS: The Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort includes 31,000 HIV-infected adults in routine clinical care at 8 sites. Individuals were included in the analysis if they had a depressive symptoms measure within one month of establishing HIV care at a CNICS site...
2016: PloS One
S Adam Granato, Stephen Gloyd, Julia Robinson, Serge A Dali, Irma Ahoba, David Aka, Seydou Kouyaté, Doroux A Billy, Samuel Kalibala, Ahoua Koné
INTRODUCTION: Loss-to-follow-up (LTFU) in the prevention of mother-to-child HIV transmission (PMTCT) programmes can occur at multiple stages of antenatal and follow-up care. This paper presents findings from a national assessment aimed at identifying major bottlenecks in Côte d'Ivoire's PMTCT cascade, and to distinguish characteristics of high- and low-performing health facilities. METHODS: This cross-sectional study, based on a nationally representative sample of 30 health facilities in Côte d'Ivoire used multiple data sources (registries, patient charts, patient booklets, interviews) to determine the magnitude of LTFU in PMTCT services...
2016: Journal of the International AIDS Society
Godfrey B Woelk, Dieudonne Ndatimana, Sally Behan, Martha Mukaminega, Epiphanie Nyirabahizi, Heather J Hoffman, Placidie Mugwaneza, Muhayimpundu Ribakare, Anouk Amzel, B Ryan Phelps
OBJECTIVES: Investigate levels of retention at specified time periods along the prevention of mother-to-child transmission (PMTCT) cascade among mother-infant pairs as well as individual- and facility-level factors associated with retention. METHODS: A retrospective cohort of HIV-positive pregnant women and their infants attending five health centres from November 2010 to February 2012 in the Option B programme in Rwanda was established. Data were collected from several health registers and patient follow-up files...
2016: Journal of the International AIDS Society
Lindsey K Reif, Rachel Bertrand, Charles Benedict, Matthew R Lamb, Vanessa Rouzier, Rose Verdier, Warren D Johnson, Jean W Pape, Daniel W Fitzgerald, Louise Kuhn, Margaret L McNairy
INTRODUCTION: Adolescents account for over 40% of new HIV infections in Haiti. This analysis compares outcomes among HIV-positive adolescents before and after implementation of an adolescent HIV clinic in Port-au-Prince, Haiti. METHODS: We conducted a cohort study using programmatic data among HIV-positive adolescents aged 13 to 19. Data from 41,218 adolescents who were HIV tested from January 2003 to December 2012 were included. Outcomes across the HIV care cascade were assessed before and after implementation of an adolescent clinic (2009), including HIV testing, enrolment in care, assessment for antiretroviral therapy (ART) eligibility, ART initiation and 12-month retention...
2016: Journal of the International AIDS Society
Naoko Miyazaki, Wataru Sugiura, Hiroyuki Gatanaga, Dai Watanabe, Yasuyuki Yamamoto, Yoshiyuki Yokomaku, Kazuhisa Yoshimura, Shuzo Matsushita
To understand the effectiveness of Japan's health care system for HIV/AIDS, including prevention, diagnosis, access to antiretroviral treatment, and treatment outcomes, clinical information on HIV/AIDS cases was collected through questioners sent to 377 registered HIV/AIDS clinics in Japan. The data were collected in 2009 and 2014, and 9,040 and 14,569 cases were obtained, respectively. Prevalence of on-treatment cases linked to care were 69.6% and 87.8% in 2009 and 2014, respectively, demonstrating improvement in treatment coverage over the recent 5 years...
June 30, 2016: Japanese Journal of Infectious Diseases
Nigel Raymond, Kelly Bargh, Kyi Lai Lai Aung, James Rice
AIM: Antiretroviral therapy (ART) is highly effective in providing better outcomes for people living with HIV infection (PLHIV) and reducing the risk of transmission to others. The 'cascade of care' describes steps in delivering care: diagnosis, linkage and retention in care, and the provision and success of ART. METHODS: The cascade of care for PLHIV in the Wellington region was reviewed during 2015. An estimate of 20% undiagnosed HIV infection was used from past New Zealand research...
2016: New Zealand Medical Journal
Ruby N Fayorsey, Duncan Chege, Chunhui Wang, William Reidy, Zachary Peters, Masila Syengo, Chrisostim Barasa, Samuel O Owino, Martin Sirengo, Mark P Hawken, Elaine J Abrams
BACKGROUND: Effective retention of HIV-infected mothers and their infants is fraught with multiple challenges, resulting in loss across the continuum of prevention of mother-to-child HIV transmission (PMTCT) care and missed opportunities to offer life-saving HIV prevention and treatment. METHODS: The Mother Infant Retention for Health study is an individual-randomized study evaluating the effectiveness of active patient follow-up compared with standard of care on the combined outcome of attrition of HIV-infected women and their infants at 6 months postpartum...
August 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Marcel Yotebieng, Harsha Thirumurthy, Kathryn E Moracco, Andrew Edmonds, Martine Tabala, Bienvenu Kawende, Landry K Wenzi, Emile W Okitolonda, Frieda Behets
BACKGROUND: Novel strategies are needed to increase retention in prevention of mother-to-child HIV transmission (PMTCT) services. We have recently shown that small, incremental cash transfers conditional on attending clinic resulted in increased retention along the PMTCT cascade. However, whether women who receive incentives to attend clinic visits are as adherent to antiretrovirals (ARV) as those who do not was unknown. OBJECTIVE: To determine whether HIV-infected women who received incentives to remain in care were as adherent to antiretroviral treatment and achieved the same level of viral suppression at 6 weeks postpartum as those who did not receive incentives but also remained in care...
August 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
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