Yann Ruffieux, Naomi Folb, Anna Grimsrud, Michael Hislop, Liezl Dunn, Eliane Rohner, Anne Maria Namubiru, Chido Chinogurei, Morna Cornell, Mary-Ann Davies, Matthias Egger, Gary Maartens, Andreas D. Haas
Introduction
Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing.
Methods
Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011−2013, 2014−2016, 2017−2019, 2020−2022 and overall.
Results
We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3−10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02−1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27−1.48) in 2011−2013 and 1.02 (95% CI 0.97−1.07) in 2020−2022.
Conclusions
Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.
导言在一些艾滋病护理机构中，快递配送已成为一种流行的抗逆转录病毒疗法（ART）配送方式，但有关抗逆转录病毒疗法快递配送及其与抗逆转录病毒疗法结果之间关系的数据却很少。我们研究了南非私营部门艾滋病项目中通过快递方式接受抗逆转录病毒疗法的患者与通过传统零售配药方式接受抗逆转录病毒疗法的患者在病毒抑制率方面的差异。方法2011年1月至2022年7月期间积极加入艾滋病援助项目的15岁或以上的患者符合分析条件。分析结果以病毒载量（VL）<400拷贝/毫升为标准。我们计算了抗逆转录病毒疗法配送方式与病毒抑制之间的调整后几率比（OR），比较了在 VL 检测时通过快递药店和零售药店获得补充药物的患者。我们使用了广义估计方程来考虑同一人的重复 VL 检测。模型根据年龄、性别、日历年、抗逆转录病毒疗法、精神病史和医疗保险计划进行了调整。我们计算了 2011-2013、2014-2016、2017-2019、2020-2022 历年和总体的调整后 OR。每人 VL 测量次数的中位数为 6 次（IQR 为 3-10 次）。在 398,901 次（90.1%）检测中发现了 VL 抑制，其中 185,701 次（42.0%）检测是在患者通过快递接受抗逆转录病毒疗法期间进行的。总体而言，快递送检比零售配药的病毒抑制几率高 5%（调整后 OR 1.05，95% CI 1.02-1.08）。这一关联的强度和方向因时间段而异，2011-2013 年的调整 OR 值为 1.37（95% CI 1.27-1.48），2020-2022 年为 1.02（95% CI 0.97-1.07）。需要进一步开展研究，调查在私营和公共医疗机构中通过快递递送抗逆转录病毒疗法的潜在益处和弊端。
{"title":"Courier delivery of antiretroviral therapy: a cohort study of a South African private-sector HIV programme","authors":"Yann Ruffieux, Naomi Folb, Anna Grimsrud, Michael Hislop, Liezl Dunn, Eliane Rohner, Anne Maria Namubiru, Chido Chinogurei, Morna Cornell, Mary-Ann Davies, Matthias Egger, Gary Maartens, Andreas D. Haas","doi":"10.1002/jia2.26360","DOIUrl":"10.1002/jia2.26360","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011−2013, 2014−2016, 2017−2019, 2020−2022 and overall.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3−10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02−1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27−1.48) in 2011−2013 and 1.02 (95% CI 0.97−1.07) in 2020−2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nini Tun, Cho Lwin Oo, Cho Myat Nwe, Lutgarde Lynen, Tom Decroo, Frank Smithuis, Tinne Gils
<p>People who inject drugs (PWID) are disproportionally affected by HIV acquisition [<span>1</span>]. Myanmar, a large producer of opium, has an estimated 116,000 PWID, among whom an estimated 26.4% are people living with HIV [<span>2, 3</span>]. Needle sharing contributed to one-third of the national HIV incidence in 2018 [<span>4</span>]. The national harm reduction programme includes prevention and care for HIV, viral hepatitis C (HCV), other sexually transmittable infections and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) for PWID [<span>4</span>]. Yet, nationally, only 24.0% of PWID were tested for HIV, and 47.8% of HIV-positive PWID were on antiretroviral treatment (ART) [<span>3</span>]. Even in Yangon, PWID experience barriers to access NSE and OST [<span>5</span>].</p><p>Putao is a remote sparsely populated district on the slopes of the Himalayas in the far North of Myanmar [<span>6</span>]. Sources of income include agriculture, and gold mines operated by increasing numbers of migrant workers. Opioid cultivation sites exist [<span>6</span>]. Heroin injecting is common in Putao, among miners, and in rural communities [<span>7</span>]. Access to health services for PWID is tremendously challenging. Poor road infrastructure, lack of public transport and extreme remoteness of the villages hamper physical access. OST is restricted to government hospitals. Like elsewhere, PWID are insufficiently aware about the risks of heroin use, associated blood-borne infections, and available care [<span>5</span>] and often stigmatized by community members [<span>8</span>].</p><p>Before 2012, no PWID-specific harm reduction services existed in Putao. HIV testing and ART initiation were provided at a public hospital, where only seven ART patients were registered as PWID before 2012.</p><p>Medical Action Myanmar (MAM), a medical organization, is present in Putao since 2012. In a first phase, MAM provided clinic-based primary care services, following a request by a local organization and because no other non-governmental organizations were present. Due to a lack of key population data and PWID-specific services, and a suspicion of PWID presenting with advanced HIV, MAM started clinic-based HIV testing and treatment, while referring TB patients to a local organization for treatment and care. The high incidence of malaria and TB and difficulties with linkage to care prompted MAM to set up a network of community health workers (CHWs) providing malaria, TB and primary healthcare services in remote communities in 2014. CHWs were selected by MAM and village leaders among community volunteers, trained by MAM, and incentivized per diagnosis, referral, and treated malaria or TB patient. Trained CHWs received a joint certificate from the Ministry of Health and MAM. Due to the remoteness of the Putao district, clinic-based HIV services were insufficient to reach most PWID. Between 2012 and 2017, only 144 PWID were initiat
{"title":"Improving access to integrated community-based HIV, HCV and harm reduction services for people who inject drugs in Putao district, North Myanmar","authors":"Nini Tun, Cho Lwin Oo, Cho Myat Nwe, Lutgarde Lynen, Tom Decroo, Frank Smithuis, Tinne Gils","doi":"10.1002/jia2.26355","DOIUrl":"https://doi.org/10.1002/jia2.26355","url":null,"abstract":"<p>People who inject drugs (PWID) are disproportionally affected by HIV acquisition [<span>1</span>]. Myanmar, a large producer of opium, has an estimated 116,000 PWID, among whom an estimated 26.4% are people living with HIV [<span>2, 3</span>]. Needle sharing contributed to one-third of the national HIV incidence in 2018 [<span>4</span>]. The national harm reduction programme includes prevention and care for HIV, viral hepatitis C (HCV), other sexually transmittable infections and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) for PWID [<span>4</span>]. Yet, nationally, only 24.0% of PWID were tested for HIV, and 47.8% of HIV-positive PWID were on antiretroviral treatment (ART) [<span>3</span>]. Even in Yangon, PWID experience barriers to access NSE and OST [<span>5</span>].</p><p>Putao is a remote sparsely populated district on the slopes of the Himalayas in the far North of Myanmar [<span>6</span>]. Sources of income include agriculture, and gold mines operated by increasing numbers of migrant workers. Opioid cultivation sites exist [<span>6</span>]. Heroin injecting is common in Putao, among miners, and in rural communities [<span>7</span>]. Access to health services for PWID is tremendously challenging. Poor road infrastructure, lack of public transport and extreme remoteness of the villages hamper physical access. OST is restricted to government hospitals. Like elsewhere, PWID are insufficiently aware about the risks of heroin use, associated blood-borne infections, and available care [<span>5</span>] and often stigmatized by community members [<span>8</span>].</p><p>Before 2012, no PWID-specific harm reduction services existed in Putao. HIV testing and ART initiation were provided at a public hospital, where only seven ART patients were registered as PWID before 2012.</p><p>Medical Action Myanmar (MAM), a medical organization, is present in Putao since 2012. In a first phase, MAM provided clinic-based primary care services, following a request by a local organization and because no other non-governmental organizations were present. Due to a lack of key population data and PWID-specific services, and a suspicion of PWID presenting with advanced HIV, MAM started clinic-based HIV testing and treatment, while referring TB patients to a local organization for treatment and care. The high incidence of malaria and TB and difficulties with linkage to care prompted MAM to set up a network of community health workers (CHWs) providing malaria, TB and primary healthcare services in remote communities in 2014. CHWs were selected by MAM and village leaders among community volunteers, trained by MAM, and incentivized per diagnosis, referral, and treated malaria or TB patient. Trained CHWs received a joint certificate from the Ministry of Health and MAM. Due to the remoteness of the Putao district, clinic-based HIV services were insufficient to reach most PWID. Between 2012 and 2017, only 144 PWID were initiat","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annabelle Choong, Yi Ming Lyu, Cheryl C. Johnson, Rachel Baggaley, Magdalena Barr-DiChiara, Muhammad S. Jamil, Nandi L. Siegfried, Christopher K. Fairley, Eric P. F. Chow, Virginia Macdonald, Jason J. Ong
<div> <section> <h3> Introduction</h3> <p>Social network-based testing approaches (SNAs) encourage individuals (“test promoters”) to motivate sexual partners and/or those in their social networks to test for HIV. We conducted a systematic review to examine the effectiveness, acceptability and cost-effectiveness of SNA.</p> </section> <section> <h3> Methods</h3> <p>We searched five databases from January 2010 to May 2023, and included studies that compared SNA with non-SNA. We used random-effects meta-analysis to combine effect estimates. Certainty was assessed using the GRADE approach.</p> </section> <section> <h3> Results</h3> <p>We identified 47 studies. SNA may increase uptake of HIV testing compared to non-SNA (RR 2.04, 95% CI: 1.06–3.95, Low certainty). The proportion of first-time testers was probably higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.49, 95% CI: 1.22–1.81, Moderate certainty). The proportion of people who tested positive for HIV may be higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.84, 95% CI: 1.01–3.35, Low certainty). There were no reports of any adverse events or harms associated with SNA. Based on six cost-effectiveness studies, SNA was generally cheaper per person tested and per person diagnosed compared to non-SNA. Based on 23 qualitative studies, SNA is likely to be acceptable to a variety of populations.</p> </section> <section> <h3> Discussion</h3> <p>Our review collated evidence for SNA to HIV testing covering the key populations and the general population who may benefit from HIV testing. We summarized evidence for the effectiveness, acceptability and cost-effectiveness of different models of SNA. While we did not identify an ideal model of SNA that could be immediately scaled up, for each setting and population targeted, we recommend various implementation considerations as our meta-analysis showed the effectiveness might differ due to factors which include the testing modality (i.e. use of HIV self-testing), type of test promoters, long or short duration of recruitment and use of financial incentives.</p> </section> <section> <h3> Conclusions</h3> <p>Social network-based approaches may enhance HIV testing uptake, increase the proportion of first-time testers and those testing positive for HIV. Heterogeneity among studies highlights the need for context-specific adaptations, but the overall positive impact of SNA on HIV te
导言 基于社会网络的检测方法（SNA）鼓励个人（"检测促进者"）动员性伴侣和/或其社会网络中的人进行 HIV 检测。我们对 SNA 的有效性、可接受性和成本效益进行了系统回顾。 方法 我们检索了 2010 年 1 月至 2023 年 5 月期间的五个数据库，并纳入了将 SNA 与非 SNA 进行比较的研究。我们采用随机效应荟萃分析法合并效果估计值。采用 GRADE 方法评估确定性。 结果 我们确定了 47 项研究。与非 SNA 相比，SNA 可增加 HIV 检测的接受率（RR 2.04，95% CI：1.06-3.95，低确定性）。与非 SNA 相比，使用 SNA 的检测推广者的伴侣或社会接触者中首次检测者的比例可能更高（RR 1.49，95% CI：1.22-1.81，中度确定性）。与非 SNA 相比，使用 SNA 的检测推广者的伴侣或社会接触者中 HIV 检测呈阳性的比例可能更高（RR 1.84，95% CI：1.01-3.35，低度确定性）。没有任何与 SNA 相关的不良事件或危害的报告。根据六项成本效益研究，与非 SNA 相比，SNA 的人均检测成本和人均诊断成本普遍较低。根据 23 项定性研究，SNA 有可能为各种人群所接受。 讨论 我们的综述整理了 SNA 用于 HIV 检测的证据，涵盖了可能从 HIV 检测中受益的重点人群和普通人群。我们总结了不同模式的 SNA 的有效性、可接受性和成本效益的证据。虽然我们并没有为每种环境和目标人群确定一种可以立即推广的理想 SNA 模式，但我们建议在实施过程中要考虑各种因素，因为我们的荟萃分析表明，有效性可能会因各种因素而有所不同，这些因素包括检测方式（即使用 HIV 自我检测）、检测推广者的类型、招募时间的长短以及经济激励措施的使用。 结论 基于社会网络的方法可以提高艾滋病检测的接受率，增加首次检测者和艾滋病检测呈阳性者的比例。不同研究之间的差异凸显了根据具体情况进行调整的必要性，但社会网络疗法对艾滋病检测结果的总体积极影响有助于将其纳入现有的艾滋病检测服务中。
{"title":"Social network-based approaches to HIV testing: a systematic review and meta-analysis","authors":"Annabelle Choong, Yi Ming Lyu, Cheryl C. Johnson, Rachel Baggaley, Magdalena Barr-DiChiara, Muhammad S. Jamil, Nandi L. Siegfried, Christopher K. Fairley, Eric P. F. Chow, Virginia Macdonald, Jason J. Ong","doi":"10.1002/jia2.26353","DOIUrl":"https://doi.org/10.1002/jia2.26353","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Social network-based testing approaches (SNAs) encourage individuals (“test promoters”) to motivate sexual partners and/or those in their social networks to test for HIV. We conducted a systematic review to examine the effectiveness, acceptability and cost-effectiveness of SNA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched five databases from January 2010 to May 2023, and included studies that compared SNA with non-SNA. We used random-effects meta-analysis to combine effect estimates. Certainty was assessed using the GRADE approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 47 studies. SNA may increase uptake of HIV testing compared to non-SNA (RR 2.04, 95% CI: 1.06–3.95, Low certainty). The proportion of first-time testers was probably higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.49, 95% CI: 1.22–1.81, Moderate certainty). The proportion of people who tested positive for HIV may be higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.84, 95% CI: 1.01–3.35, Low certainty). There were no reports of any adverse events or harms associated with SNA. Based on six cost-effectiveness studies, SNA was generally cheaper per person tested and per person diagnosed compared to non-SNA. Based on 23 qualitative studies, SNA is likely to be acceptable to a variety of populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our review collated evidence for SNA to HIV testing covering the key populations and the general population who may benefit from HIV testing. We summarized evidence for the effectiveness, acceptability and cost-effectiveness of different models of SNA. While we did not identify an ideal model of SNA that could be immediately scaled up, for each setting and population targeted, we recommend various implementation considerations as our meta-analysis showed the effectiveness might differ due to factors which include the testing modality (i.e. use of HIV self-testing), type of test promoters, long or short duration of recruitment and use of financial incentives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Social network-based approaches may enhance HIV testing uptake, increase the proportion of first-time testers and those testing positive for HIV. Heterogeneity among studies highlights the need for context-specific adaptations, but the overall positive impact of SNA on HIV te","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allahna L. Esber, Suze Colt, Ningbo Jian, Nicole Dear, Bonnie Slike, Valentine Sing'oei, Jonah Maswai, Michael Iroezindu, Emmanuel Bahemana, Hannah Kibuuka, Christina S. Polyak, Hendrik Streeck, Neha Shah, Trevor A. Crowell, Julie A. Ake, the AFRICOS Study Group
Introduction
People living with HIV (PLWH) have higher rates of non-infectious comorbid diseases (NCDs) than individuals without HIV. We characterized the risk of NCDs among PLWH with undetectable viral load and persistent low-level viraemia (pLLV) in the African Cohort Study (AFRICOS). We secondarily quantified the role of immune activation in the association between LLV and NCDs.
Methods
AFRICOS enrols participants in 12 clinics in Uganda, Kenya, Tanzania and Nigeria. Participants on antiretroviral therapy ≥ 6 months without an NCD at enrolment were included. PLLV was defined as at least two consecutive visits with a detectable viral load <1000 copies/ml. We examined elevated blood pressure, hypercholesterolemia, hyperglycaemia, renal insufficiency and a composite variable of any NCD. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard modelling. Among a subset of participants with biomarker data, we assessed the interaction between viral load and 13 biomarkers in the association with any NCD.
Results
From 23 January 2013 to 1 December 2022, 1755 participants met the inclusion criteria for these analyses. At the first eligible visit, the majority of participants had an undetectable viral load (n = 1375, 78.35%). Participants with pLLV had an increased rate of developing any NCD (aHR: 1.22, 95% CI: 1.02−1.47) compared to participants with an undetectable viral load. There was a statistically significant interaction between LLV and TNF-α, CCL2/MCP-1 and TNF-RII in the association with any NCD.
Conclusions
PLLV was significantly associated with NCDs and immune inflammation in this population. Aggressive management of LLV may positively impact NCDs in PLWH.
{"title":"Persistent low-level viraemia is associated with non-infectious comorbidities in an observational cohort in four African countries","authors":"Allahna L. Esber, Suze Colt, Ningbo Jian, Nicole Dear, Bonnie Slike, Valentine Sing'oei, Jonah Maswai, Michael Iroezindu, Emmanuel Bahemana, Hannah Kibuuka, Christina S. Polyak, Hendrik Streeck, Neha Shah, Trevor A. Crowell, Julie A. Ake, the AFRICOS Study Group","doi":"10.1002/jia2.26316","DOIUrl":"10.1002/jia2.26316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People living with HIV (PLWH) have higher rates of non-infectious comorbid diseases (NCDs) than individuals without HIV. We characterized the risk of NCDs among PLWH with undetectable viral load and persistent low-level viraemia (pLLV) in the African Cohort Study (AFRICOS). We secondarily quantified the role of immune activation in the association between LLV and NCDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>AFRICOS enrols participants in 12 clinics in Uganda, Kenya, Tanzania and Nigeria. Participants on antiretroviral therapy ≥ 6 months without an NCD at enrolment were included. PLLV was defined as at least two consecutive visits with a detectable viral load <1000 copies/ml. We examined elevated blood pressure, hypercholesterolemia, hyperglycaemia, renal insufficiency and a composite variable of any NCD. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard modelling. Among a subset of participants with biomarker data, we assessed the interaction between viral load and 13 biomarkers in the association with any NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 23 January 2013 to 1 December 2022, 1755 participants met the inclusion criteria for these analyses. At the first eligible visit, the majority of participants had an undetectable viral load (<i>n</i> = 1375, 78.35%). Participants with pLLV had an increased rate of developing any NCD (aHR: 1.22, 95% CI: 1.02−1.47) compared to participants with an undetectable viral load. There was a statistically significant interaction between LLV and TNF-α, CCL2/MCP-1 and TNF-RII in the association with any NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PLLV was significantly associated with NCDs and immune inflammation in this population. Aggressive management of LLV may positively impact NCDs in PLWH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Judith D. Auerbach, Siobhan Malone, Andrew D. Forsyth
<div> <section> <h3> Introduction</h3> <p>Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.</p> </section> <section> <h3> Methods</h3> <p>We conducted a scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms <i>HIV, postexposure/post-exposure prophylaxis, acceptability</i>, <i>healthcare workers</i>, and <i>values and preferences</i>. An inductive narrative review of the resulting 53 studies identified core themes.</p> </section> <section> <h3> Results</h3> <p>Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.</p> </section> <section> <h3> Discussion</h3> <p>Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use.</p> </section> <section> <h3> Conclusions</h3> <p>Lessons f
导言：暴露后预防（PEP）是一种有效的预防方法，只要在艾滋病病毒暴露后及时启动即可。然而，PEP 的使用率一直不高，即使是在制定了 PEP 政策和程序并可获得 PEP 药物的医疗机构中发生职业暴露的医护人员（HCWs）也是如此。在看似最佳的情况下，了解不均衡使用 PEP 的动态以更好地保护医护人员的健康和福祉非常重要：我们进行了一次范围界定审查，以阐明影响高危工人在职业暴露后使用 PEP 的因素。我们使用 HIV、暴露后/暴露后预防、可接受性、医护人员以及价值观和偏好等术语在 PubMed、PsychInfo 和 Google Scholar 上检索了 2014 年至 2022 年发表的同行评审英文文献。对所获得的 53 项研究进行归纳叙述式综述，确定了核心主题：几乎所有涉及各种医护人员类型和环境的研究（96%）都发生在非洲和亚洲的中低收入国家（LMICs）。确定的主题沿着 PEP 使用经验的轨迹排列：认识/了解；可接受性；可用性/可及性；接受/使用；坚持/完成。在所有研究中，人们对 PEP 用于艾滋病预防的认知度较高，对药物治疗方案和医疗机构政策的了解程度为中等至较低；对 PEP 的接受程度为中等至较高；对 PEP 可及性/可得性的认识不一致，且因地理位置和环境而异；由于不知道如何报告暴露情况以及不了解 PEP 的可用性，医务工作者对 PEP 的接受程度较低；PEP 方案的依从性/完成率为中低水平，副作用以及认为完成方案无需避免血清转换的观点阻碍了 PEP 方案的依从性/完成率。医务工作者一直对艾滋病耻辱化表示担忧：讨论：由于各研究中使用的概念不一致，以及报告暴露事件的方法不明确，研究结果受到了限制。需要采取多层次的方法来解决个人、社会和结构性障碍之间的相互作用，这些障碍削弱了医护人员使用 PEP 的积极性。加强培训、事件报告、24 小时提供无污名化的 PEP 服务以及监测坚持/完成情况对于优化医护人员使用 PEP 至关重要：结论：从低收入国家和地区的医务工作者的经验中汲取的教训可帮助我们了解在这些环境中，非职业接触者对 PEP 使用不足的情况。
{"title":"Occupational post-exposure prophylaxis among healthcare workers: a scoping review of factors affecting optimal utilization","authors":"Judith D. Auerbach, Siobhan Malone, Andrew D. Forsyth","doi":"10.1002/jia2.26341","DOIUrl":"10.1002/jia2.26341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms <i>HIV, postexposure/post-exposure prophylaxis, acceptability</i>, <i>healthcare workers</i>, and <i>values and preferences</i>. An inductive narrative review of the resulting 53 studies identified core themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lessons f","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ming Jie Lee, Miles Eason, Antonella Castagna, Galli Laura, Marie-Angelique De Scheerder, James Riley, Pablo Tebas, Jesper Gunst, Ole Søgaard, Eric Florence, Eugene Kroon, Mark De Souza, Beatriz Mothe, Marina Caskey, Sarah Fidler
<div> <section> <h3> Introduction</h3> <p>To assess the effectiveness of novel HIV curative strategies, “cure” trials require periods of closely monitored antiretroviral therapy (ART) analytical treatment interruptions (ATIs). We performed a systematic review and meta-analysis to identify the impact of ATI with or without novel therapeutics in cure-related studies on the time to viral re-suppression following ART restart.</p> </section> <section> <h3> Methods</h3> <p>Medline, Embase and Web of Science databases were searched for human studies involving ATIs from 1 January 2015 till 22 April 2024. The primary outcome was time to first viral re-suppression (plasma HIV viral load [VL] <50 copies/ml) stratified by receipt of interventional drug with ATI (IA) or ATI-only groups. Random-effects proportional meta-analysis and multivariable Cox proportional hazards analysis were performed using R.</p> </section> <section> <h3> Results</h3> <p>Of 1073 studies screened, 13 were included that met the inclusion criteria with VL data available after restarting ART (<i>n</i> = 213 participants). There was no difference between time to viral suppression in IA or ATI-only cohorts (<i>p</i> = 0.22). For 87% of participants, viral suppression within 12 weeks of ART restart was achieved, and all eventually had at least one VL <50 copies/ml during follow-up. After adjusting for covariables, while participants in the IA cohort were associated with less rapid suppression (adjusted hazard ratio [aHR] 0.61, 95% CI 0.40–0.94, <i>p</i> = 0.026), other factors include greater log VL at ART restart (aHR 0.56, 95% CI 0.46–0.68, <i>p</i><0.001), duration since HIV diagnosis (aHR 0.93, 95% CI 0.89–0.96) and longer intervals between HIV VL monitoring (aHR 0.66, 95% CI 0.59–0.74, <i>p</i><0.001). However, the use of integrase inhibitors was associated with more rapid viral suppression (aHR 1.74, 95% CI 1.16–2.59).</p> </section> <section> <h3> Discussion</h3> <p>When designing studies involving ATIs, information on time to viral re-suppression after restarting ART is important to share with participants, and should be regularly monitored and reported, to assess the impact and safety of specific trial interventions in ATI studies.</p> </section> <section> <h3> Conclusions</h3> <p>The majority of participants achieved viral suppression after restarting ART in ATI studies. ART regimens containing integrase inhibitors and frequent VL monitoring should be offered for people
导言：为了评估新型艾滋病治疗策略的有效性，"治愈 "试验需要在密切监测的抗逆转录病毒疗法（ART）分析治疗中断（ATI）期间进行。我们进行了一项系统回顾和荟萃分析，以确定在治愈相关研究中使用或不使用新型疗法的 ATI 对重新开始抗逆转录病毒疗法后病毒再抑制时间的影响：在 Medline、Embase 和 Web of Science 数据库中检索了 2015 年 1 月 1 日至 2024 年 4 月 22 日期间涉及 ATI 的人类研究。主要结果是首次病毒再抑制的时间（血浆 HIV 病毒载量 [VL] 结果：在筛选出的 1073 项研究中，有 13 项符合纳入标准，并在重新启动抗逆转录病毒疗法后提供了 VL 数据（n = 213 名参与者）。IA组和纯ATI组的病毒抑制时间没有差异（p = 0.22）。87%的参与者在抗逆转录病毒疗法重新启动后的12周内实现了病毒抑制，所有参与者最终至少有一次VL讨论：在设计涉及ATI的研究时，与参与者分享重新开始抗逆转录病毒疗法后病毒再抑制时间的信息非常重要，应定期监测和报告，以评估ATI研究中特定试验干预措施的影响和安全性：结论：在ATI研究中，大多数参与者在重新开始抗逆转录病毒疗法后实现了病毒抑制。ATI研究后重新开始抗逆转录病毒疗法的患者应接受含有整合酶抑制剂的抗逆转录病毒疗法，并经常进行VL监测，以确保快速恢复抑制。
{"title":"The impact of analytical treatment interruptions and trial interventions on time to viral re-suppression in people living with HIV restarting ART in cure-related clinical studies: a systematic review and meta-analysis","authors":"Ming Jie Lee, Miles Eason, Antonella Castagna, Galli Laura, Marie-Angelique De Scheerder, James Riley, Pablo Tebas, Jesper Gunst, Ole Søgaard, Eric Florence, Eugene Kroon, Mark De Souza, Beatriz Mothe, Marina Caskey, Sarah Fidler","doi":"10.1002/jia2.26349","DOIUrl":"10.1002/jia2.26349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To assess the effectiveness of novel HIV curative strategies, “cure” trials require periods of closely monitored antiretroviral therapy (ART) analytical treatment interruptions (ATIs). We performed a systematic review and meta-analysis to identify the impact of ATI with or without novel therapeutics in cure-related studies on the time to viral re-suppression following ART restart.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medline, Embase and Web of Science databases were searched for human studies involving ATIs from 1 January 2015 till 22 April 2024. The primary outcome was time to first viral re-suppression (plasma HIV viral load [VL] <50 copies/ml) stratified by receipt of interventional drug with ATI (IA) or ATI-only groups. Random-effects proportional meta-analysis and multivariable Cox proportional hazards analysis were performed using R.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1073 studies screened, 13 were included that met the inclusion criteria with VL data available after restarting ART (<i>n</i> = 213 participants). There was no difference between time to viral suppression in IA or ATI-only cohorts (<i>p</i> = 0.22). For 87% of participants, viral suppression within 12 weeks of ART restart was achieved, and all eventually had at least one VL <50 copies/ml during follow-up. After adjusting for covariables, while participants in the IA cohort were associated with less rapid suppression (adjusted hazard ratio [aHR] 0.61, 95% CI 0.40–0.94, <i>p</i> = 0.026), other factors include greater log VL at ART restart (aHR 0.56, 95% CI 0.46–0.68, <i>p</i><0.001), duration since HIV diagnosis (aHR 0.93, 95% CI 0.89–0.96) and longer intervals between HIV VL monitoring (aHR 0.66, 95% CI 0.59–0.74, <i>p</i><0.001). However, the use of integrase inhibitors was associated with more rapid viral suppression (aHR 1.74, 95% CI 1.16–2.59).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>When designing studies involving ATIs, information on time to viral re-suppression after restarting ART is important to share with participants, and should be regularly monitored and reported, to assess the impact and safety of specific trial interventions in ATI studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The majority of participants achieved viral suppression after restarting ART in ATI studies. ART regimens containing integrase inhibitors and frequent VL monitoring should be offered for people","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zachary Wagner, Zetianyu Wang, Chad Stecher, Yvonne Karamagi, Mary Odiit, Jessica E. Haberer, Sebastian Linnemayr
Introduction
Millions of people living with HIV (PLWH) take oral antiretroviral therapy (ART), which requires a lifetime of consistent medication adherence. The relationship between adherence and poor HIV outcomes is well documented. Newer ART regimens that include dolutegravir (DTG) could be more forgiving, but empirical evidence on the relationship between adherence and viral suppression under DTG is only emerging.
Methods
In this observational cohort study (secondary analysis of data from a randomized trial), we used data from 313 ART clients from a large HIV clinic in Kampala, Uganda. Over the 4-year study period (January 2018–January 2022), 91% switched from non-DTG regimens to DTG regimens. We measured adherence using Medication Event Monitoring Systems-caps and extracted prescription information and viral load measures from electronic health records. We estimated unadjusted linear regressions and adjusted models that included individual and time fixed-effects.
Results
Under non-DTG regimens, 96% of participants were virally suppressed (defined as viral load < 200 copies/ml) when adherence was 90% or higher in the 3 months before viral load measurement. Viral suppression was 32 percentage points lower when adherence was between 0% and 49% (95% CI −0.44, −0.20, p < 0.01), 12 percentage points lower when adherence was between 50% and 79% (95% CI −0.23, −0.02, p < 0.01), and not significantly different when adherence was between 80% and 89% (effect of 0.00, 95% CI −0.06, 0.07, p = 0.81). In contrast, for participants taking DTG, there was no statistically significant difference in viral suppression among any of the four adherence levels; more than 95% were virally suppressed at each adherence level. On average, switching to DTG increased viral suppression by 6 percentage points in our adjusted models (95% CI 0.00, 0.13, p = 0.03).
Conclusions
There was no significant association between adherence levels and viral suppression among PLWH taking DTG regimens, suggesting a high degree of forgiveness for missed doses. The use of DTG should be prioritized over older regimens, particularly for those with low adherence.
{"title":"The association between adherence to antiretroviral therapy and viral suppression under dolutegravir-based regimens: an observational cohort study from Uganda","authors":"Zachary Wagner, Zetianyu Wang, Chad Stecher, Yvonne Karamagi, Mary Odiit, Jessica E. Haberer, Sebastian Linnemayr","doi":"10.1002/jia2.26350","DOIUrl":"10.1002/jia2.26350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Millions of people living with HIV (PLWH) take oral antiretroviral therapy (ART), which requires a lifetime of consistent medication adherence. The relationship between adherence and poor HIV outcomes is well documented. Newer ART regimens that include dolutegravir (DTG) could be more forgiving, but empirical evidence on the relationship between adherence and viral suppression under DTG is only emerging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational cohort study (secondary analysis of data from a randomized trial), we used data from 313 ART clients from a large HIV clinic in Kampala, Uganda. Over the 4-year study period (January 2018–January 2022), 91% switched from non-DTG regimens to DTG regimens. We measured adherence using Medication Event Monitoring Systems-caps and extracted prescription information and viral load measures from electronic health records. We estimated unadjusted linear regressions and adjusted models that included individual and time fixed-effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Under non-DTG regimens, 96% of participants were virally suppressed (defined as viral load < 200 copies/ml) when adherence was 90% or higher in the 3 months before viral load measurement. Viral suppression was 32 percentage points lower when adherence was between 0% and 49% (95% CI −0.44, −0.20, <i>p</i> < 0.01), 12 percentage points lower when adherence was between 50% and 79% (95% CI −0.23, −0.02, <i>p</i> < 0.01), and not significantly different when adherence was between 80% and 89% (effect of 0.00, 95% CI −0.06, 0.07, <i>p</i> = 0.81). In contrast, for participants taking DTG, there was no statistically significant difference in viral suppression among any of the four adherence levels; more than 95% were virally suppressed at each adherence level. On average, switching to DTG increased viral suppression by 6 percentage points in our adjusted models (95% CI 0.00, 0.13, <i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no significant association between adherence levels and viral suppression among PLWH taking DTG regimens, suggesting a high degree of forgiveness for missed doses. The use of DTG should be prioritized over older regimens, particularly for those with low adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Number</h3>\u0000 \u0000 <p>NCT03494777.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine Verde Hashim, Emma Llewellyn, Rob Wood, Tracey Brett, Tinashe Chinyanga, Karen Webb, Kate Segal
<div> <section> <h3> Introduction</h3> <p>The Dual Prevention Pill (DPP) combines oral pre-exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self-care and technology-based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP.</p> </section> <section> <h3> Methods</h3> <p>Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage.</p> </section> <section> <h3> Results</h3> <p>Wide geographic reach, ongoing pharmacy-administered PrEP pilots in Kenya and South Africa, and over-the-counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology-based channels such as e-pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness-to-pay for all channels.</p> </section> <section> <h3> Conclusions</h3> <p>The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non-traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness-to-pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery a
{"title":"Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre-exposure prophylaxis, in an expanding HIV prevention landscape","authors":"Catherine Verde Hashim, Emma Llewellyn, Rob Wood, Tracey Brett, Tinashe Chinyanga, Karen Webb, Kate Segal","doi":"10.1002/jia2.26346","DOIUrl":"10.1002/jia2.26346","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Dual Prevention Pill (DPP) combines oral pre-exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self-care and technology-based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Wide geographic reach, ongoing pharmacy-administered PrEP pilots in Kenya and South Africa, and over-the-counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology-based channels such as e-pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness-to-pay for all channels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non-traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness-to-pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery a","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodenie A. Olete, Joseph S. Cadelina, Charmaine Faye M. Chu, Emerson A. Arriola, Inad Q. Rendon
<p>Founded in 2018, <i>Gabay sa Pulang Laso Inc</i>. (GPLI) (in English, “Guide to the Red Ribbon”) is a non-for-profit organization providing non-biomedical interventions to support people living with HIV (PLHIV) in the Philippines. As a response to a nationwide survey showing significant associations between unemployment, homelessness and mental distress among PLHIV during the COVID-19 pandemic [<span>1</span>], GPLI established the flagship programme, “Open Doors Home” (ODH). ODH is a temporary shelter programme with the main goal of addressing psychosocial and socioeconomic needs (also termed “psycho-socioeconomic” or “PsySE”) among PLHIV experiencing mental distress because of homelessness, unemployment, disrupted education, domestic violence or discrimination.</p><p>The ODH programme complements biomedical interventions by providing PsySE support (i.e. shelter, nutrition, education, individualized psychosocial counselling, career guidance and livelihood trainings) as social determinants of the HIV care cascade. Guided by the person-centred care (PCC) framework [<span>2</span>], individualized physical, mental, and socioeconomic needs assessments are done to ensure that the PsySE support is aligned with clients’ preferences and priorities. Clients, termed “housemates,” receive tailored PsySE support based on the individual needs assessment and individualized PCC plan. For example, if the intake interview shows that unemployment is the housemate's main concern, PsySE support will prioritize career path enhancement and referral to GPLI's network of entrepreneurs for hiring while also addressing other basic needs. ODH emphasizes empowerment, with healthcare providers serving only as facilitators to improve the housemates’ problem-solving capacities.</p><p>Due to limited shelter capacity, a passive intake process is used where potential clients reach out via social media (Twitter/X or Facebook) or through partner organizations (e.g. HIV & AIDS Support House, Positive Action Foundation of the Philippines Inc. and other social hygiene clinics). The requirements for ODH intake are: (a) a summative case study from their medical doctor or a referral letter from the social welfare department or a community-based organization; (b) HIV confirmatory test result; (c) a medical abstract from the last 6 months showing no concurrent opportunistic infections; and (d) copies of two valid identifications for proper coordination with their respective HIV care facilities.</p><p>Based on a previous study, SEGT demonstrated improved mental health after engagement within a mutually supportive group environment [<span>3</span>]. In ODH, SEGT was designed into four domains with 12 modules that guide housemates in expressing their emotions through focused group discussions. The modules adapted the Filipino core values of social psychology [<span>4</span>]. Conducted weekly over 3 months, these sessions incorporated activities like journal writing, catharsis trainin
{"title":"Scaling person-centred psycho-socioeconomic support for people living with HIV experiencing homelessness and unemployment in the Philippines: lessons learnt from the Open-Doors Home programme","authors":"Rodenie A. Olete, Joseph S. Cadelina, Charmaine Faye M. Chu, Emerson A. Arriola, Inad Q. Rendon","doi":"10.1002/jia2.26347","DOIUrl":"10.1002/jia2.26347","url":null,"abstract":"<p>Founded in 2018, <i>Gabay sa Pulang Laso Inc</i>. (GPLI) (in English, “Guide to the Red Ribbon”) is a non-for-profit organization providing non-biomedical interventions to support people living with HIV (PLHIV) in the Philippines. As a response to a nationwide survey showing significant associations between unemployment, homelessness and mental distress among PLHIV during the COVID-19 pandemic [<span>1</span>], GPLI established the flagship programme, “Open Doors Home” (ODH). ODH is a temporary shelter programme with the main goal of addressing psychosocial and socioeconomic needs (also termed “psycho-socioeconomic” or “PsySE”) among PLHIV experiencing mental distress because of homelessness, unemployment, disrupted education, domestic violence or discrimination.</p><p>The ODH programme complements biomedical interventions by providing PsySE support (i.e. shelter, nutrition, education, individualized psychosocial counselling, career guidance and livelihood trainings) as social determinants of the HIV care cascade. Guided by the person-centred care (PCC) framework [<span>2</span>], individualized physical, mental, and socioeconomic needs assessments are done to ensure that the PsySE support is aligned with clients’ preferences and priorities. Clients, termed “housemates,” receive tailored PsySE support based on the individual needs assessment and individualized PCC plan. For example, if the intake interview shows that unemployment is the housemate's main concern, PsySE support will prioritize career path enhancement and referral to GPLI's network of entrepreneurs for hiring while also addressing other basic needs. ODH emphasizes empowerment, with healthcare providers serving only as facilitators to improve the housemates’ problem-solving capacities.</p><p>Due to limited shelter capacity, a passive intake process is used where potential clients reach out via social media (Twitter/X or Facebook) or through partner organizations (e.g. HIV & AIDS Support House, Positive Action Foundation of the Philippines Inc. and other social hygiene clinics). The requirements for ODH intake are: (a) a summative case study from their medical doctor or a referral letter from the social welfare department or a community-based organization; (b) HIV confirmatory test result; (c) a medical abstract from the last 6 months showing no concurrent opportunistic infections; and (d) copies of two valid identifications for proper coordination with their respective HIV care facilities.</p><p>Based on a previous study, SEGT demonstrated improved mental health after engagement within a mutually supportive group environment [<span>3</span>]. In ODH, SEGT was designed into four domains with 12 modules that guide housemates in expressing their emotions through focused group discussions. The modules adapted the Filipino core values of social psychology [<span>4</span>]. Conducted weekly over 3 months, these sessions incorporated activities like journal writing, catharsis trainin","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11310265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vita W. Jongen, Ceranza Daans, Ard van Sighem, Maarten Schim van der Loeff, Kris Hage, Camiel Welling, Alex von Vaupel-Klein, Martin den Heijer, Edgar J. G. Peters, Marc van der Valk, Peter Reiss, Maria Prins, Elske Hoornenborg, the ATHENA observational HIV cohort
Introduction
Transgender women are at increased risk of acquiring HIV. Earlier studies reported lower retention in HIV care, antiretroviral therapy uptake, adherence and viral suppression. We assessed the stages of the HIV care continuum of transgender women in the Netherlands over an 11-year period. In addition, we assessed new HIV diagnoses and late presentation, as well as disengagement from care, between 2011 and 2021.
Methods
Using data from the Dutch national ATHENA cohort, we separately assessed viral suppression, as well as time to achieving viral suppression, among transgender women for each year between 2011 and 2021. We also assessed trends in new HIV diagnoses and late presentation (CD4 count of <350 cells/µl and/or AIDS at diagnosis), and disengagement from care.
Results
Between 2011 and 2021, a total of 260 transgender women attended at least one HIV clinical visit. Across all years, <90% of transgender women were virally suppressed (207/239 [87%] in 2021). The number of new HIV diagnoses fluctuated for transgender women (ptrend = 0.053) and late presentation was common (ranging between 10% and 67% of new HIV diagnoses). Of the 260 transgender women, 26 (10%) disengaged from care between 2011 and 2021 (incidence rate = 1.10 per 100 person-years, 95% confidence interval = 0.75−1.61).
Conclusions
Between 2011 and 2021, less than 90% of transgender women linked to HIV care were virally suppressed. Late presentation at the time of diagnosis and disengagement from care were common. Efforts are needed to identify barriers to early HIV diagnosis and to optimize the different steps across the care continuum for transgender women.
{"title":"Assessing the HIV care continuum among transgender women during 11 years of follow-up: results from the Netherlands’ ATHENA observational cohort","authors":"Vita W. Jongen, Ceranza Daans, Ard van Sighem, Maarten Schim van der Loeff, Kris Hage, Camiel Welling, Alex von Vaupel-Klein, Martin den Heijer, Edgar J. G. Peters, Marc van der Valk, Peter Reiss, Maria Prins, Elske Hoornenborg, the ATHENA observational HIV cohort","doi":"10.1002/jia2.26317","DOIUrl":"10.1002/jia2.26317","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Transgender women are at increased risk of acquiring HIV. Earlier studies reported lower retention in HIV care, antiretroviral therapy uptake, adherence and viral suppression. We assessed the stages of the HIV care continuum of transgender women in the Netherlands over an 11-year period. In addition, we assessed new HIV diagnoses and late presentation, as well as disengagement from care, between 2011 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the Dutch national ATHENA cohort, we separately assessed viral suppression, as well as time to achieving viral suppression, among transgender women for each year between 2011 and 2021. We also assessed trends in new HIV diagnoses and late presentation (CD4 count of <350 cells/µl and/or AIDS at diagnosis), and disengagement from care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2011 and 2021, a total of 260 transgender women attended at least one HIV clinical visit. Across all years, <90% of transgender women were virally suppressed (207/239 [87%] in 2021). The number of new HIV diagnoses fluctuated for transgender women (<i>p</i><sub>trend</sub> = 0.053) and late presentation was common (ranging between 10% and 67% of new HIV diagnoses). Of the 260 transgender women, 26 (10%) disengaged from care between 2011 and 2021 (incidence rate = 1.10 per 100 person-years, 95% confidence interval = 0.75−1.61).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Between 2011 and 2021, less than 90% of transgender women linked to HIV care were virally suppressed. Late presentation at the time of diagnosis and disengagement from care were common. Efforts are needed to identify barriers to early HIV diagnosis and to optimize the different steps across the care continuum for transgender women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11310271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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