Challenges and barriers to HIV care engagement and care cascade: viewpoint

Bouabida, Khayreddine; Chaves, Breitner Gomes; Anane, Enoch

doi:10.3389/frph.2023.1201087

Cited by 17 publications

(5 citation statements)

References 25 publications

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“…As shown in Table 1 , patients with symptomatic HIV infection are different from patients with asymptomatic HIV infection, being older, more likely to be female, having fewer traditional cardiovascular risk factors, but more comorbidities such as heart failure and chronic obstructive pulmonary disease. In addition, the challenges and barriers to HIV care engagement such as access to healthcare, stigma and vulnerability and mental health issues may play a role for the outcomes dispirited between symptomatic and asymptomatic HIV infection 19 .…”

Section: Discussionmentioning

confidence: 99%

Symptomatic HIV infection and in-hospital outcomes for patients with acute myocardial infarction undergoing percutaneous coronary intervention from national inpatient sample

Cui,

Qi,

Zhang

et al. 2024

Sci Rep

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Human immunodeficiency virus (HIV) infection increases the risk of acute myocardial infarction (AMI). However, little is known about its association with in-hospital outcomes and temporal trends in patients with AMI undergoing percutaneous coronary intervention (PCI). We queried patients with AMI who underwent PCI from the National Inpatient Sample Database (2003–2015) and stratified them into three groups: symptomatic, asymptomatic, and HIV-negative. After 1:2 case–control matching (CCM), logistic regression analysis was conducted to determine how HIV infection affected in-hospital outcomes. We also evaluated their recent trends from 2003 to 2015. The total weighted national estimate of 2,191,129 AMI cases included 2,178,995 HIV/AIDS-negative, 4994 asymptomatic, and 7140 symptomatic HIV cases. Symptomatic but not asymptomatic patients with HIV suffered more than triple the in-hospital mortality (adjusted odds ratio (aOR) 3.6, 95% confidence interval (CI) 2.5–5.2), over one-fold incidence of acute kidney injury (aOR 2.6 95% CI 1.9–3.4) and cardiogenic shock risk (aOR 1.9, 95% CI 1.3–2.7), a longer length of hospital stay (beta 1.2, 95% CI 1.0–1.5), and had more procedures (beta 1.3, 95% CI 1.2–1.5). These disparities relating to symptomatic HIV infection persisted from 2003 to 2015. In patients with AMI who underwent PCI, symptomatic HIV infection was associated with higher in-hospital mortality and more severe outcomes.

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Section: Discussionmentioning

confidence: 99%

Symptomatic HIV infection and in-hospital outcomes for patients with acute myocardial infarction undergoing percutaneous coronary intervention from national inpatient sample

Cui,

Qi,

Zhang

et al. 2024

Sci Rep

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“…Promptness in having the first VL test after treatment initiation is fully justified by the clinical need for timely detection of viral failures and adherence issues[1,71]. It may also operate as an incentive to maintain adherence for those who achieve rapid VS[72,73]. Proper VL monitoring and rapid VS rate are indicators of quality of care[12].…”

Section: Discussionmentioning

confidence: 99%

Time from treatment initiation to HIV viral suppression in public care facilities in Brazil: a nationwide linked databases cohort

Nemes,

Sayuri Sato,

Reis-Santos

et al. 2024

Preprint

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ObjectivesTo analyze the time between antiretroviral therapy (ART) initiation and the first HIV viral load (VL) test <40 copies—time to suppression (TS)—in a cohort of persons aged ≥15 years, between 2015-2018 in outpatient HIV care facilities of the Brazilian Unified Health System, as well as to analyze whether individual and facility characteristics accelerate or delay TS.MethodsThis was a cohort study with data from a linkage of national HIV databases, following a previously published procedure. Two types of variables were examined: individual-level (sex, age group, race/skin color, education, baseline CD4 cell count and VL, initial ART regimen, adherence, ART regimen change and number of VL tests until suppression) and facility-level (national and metropolitan region, caseload). Multilevel parametric accelerated failure time survival models were used. Fixed and random effects were analyzed through null, sociodemographic, combined sociodemographic and clinical, and facility-related variables, adjusted for the number of VL tests until suppression. Likelihood, interquartile range, and proportion of change in variance were used for comparisons.ResultsOf 132,540 participants, 89.4% (114,696) achieved viral suppression: 20.8% within three months, and 56.4% within six months. Median TS was 161 days, varying from 31 to 1,426 days, depending on the time interval between initiation and VL testing. Among those who had VL testing within 66 days, median TS was 55 days. All individual and facility-related variables were associated with TS, explaining the 16.2% and 13.2% variability, respectively.ConclusionsThis was the first Brazilian nationwide cohort to analyze TS. It is also one of the largest operational cohorts globally to assess healthcare facility characteristics. The findings indicated that both individual and facility-related characteristics contribute to TS. Strengthening VL monitoring should be included as part of a coordinated effort to improve the quality of care provided for people living with HIV/AIDS in Brazil.

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“…There is evidence to suggest that individuals struggling with low self-perception may be less likely to engage in self-care behaviors such as medication adherence. 38 , 39 In addition, individuals who use violence against their romantic partner may not receive optimal emotional support from said partner (eg, reminders and encouragement to take medication). Indeed, there is evidence to suggest that individuals with weak emotional support networks, including lack of partner support, may struggle with medication adherence.…”

Section: Discussionmentioning

confidence: 99%

Intimate partner violence and adherence to PrEP and ART among Ugandan HIV serodifferent couples

Thomas,

Nakabugo,

Nambi

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Intimate partner violence (IPV) is associated with increased risk of HIV acquisition and reduced engagement in HIV care. There is limited understanding of the ways in which IPV exposure and other maladaptive relationship dynamics may influence adherence to antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for individuals in committed, HIV serodifferent partnerships. Methods We used binomial generalized linear mixed effect regression models to evaluate the association between IPV exposure and ART/PrEP adherence among members of serodifferent couples in Uganda. Secondarily, we assessed the association between relationship powerlessness and ART/PrEP adherence. Results: We enrolled and followed both partners in 149 heterosexual serodifferent couples. The partner living with HIV was female in 64% of couples. IPV exposure was associated with low ART adherence (15% vs. 5% in quarters with no IPV, odds ratio [OR]: 4.78, 95% confidence interval [CI] 1.48 – 15.42) but not low PrEP adherence (33% vs. 36%, p=0.69). Among HIV-negative individuals, those reporting moderate relationship powerlessness were less likely to have poor PrEP adherence compared to those with low relationship powerlessness (20% vs. 30%, OR: 0.57, 95% CI 0.36 – 0.90). We observed no association between relationship powerlessness and ART adherence. Conclusions: We found that IPV exposure was associated with low adherence to ART and that relationship powerlessness was associated with good adherence to PrEP. These findings contribute to the evidence base outlining the influence of IPV and relationship power on ART/PrEP adherence for individuals in HIV serodifferent unions.

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Challenges and barriers to HIV care engagement and care cascade: viewpoint

Cited by 17 publications

References 25 publications

Symptomatic HIV infection and in-hospital outcomes for patients with acute myocardial infarction undergoing percutaneous coronary intervention from national inpatient sample

Symptomatic HIV infection and in-hospital outcomes for patients with acute myocardial infarction undergoing percutaneous coronary intervention from national inpatient sample

Time from treatment initiation to HIV viral suppression in public care facilities in Brazil: a nationwide linked databases cohort

Intimate partner violence and adherence to PrEP and ART among Ugandan HIV serodifferent couples

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