Delayed diagnosis of HIV infection in Victoria 1994 to 2006

Lemoh, Chris; Guy, Rebecca; Yohannes, Keflemariam; Lewis, Jennifer A.; Street, Alan; Biggs, Beverley‐Ann; Hellard, Margaret

doi:10.1071/sh08028

Cited by 23 publications

(15 citation statements)

References 19 publications

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“…Late HIV/AIDS diagnosis has been associated with heterosexual transmission in several other studies in the US, Australia, and Europe. 28,45,49,53,57,62,63 This may be due to people with high risk heterosexual activity not perceiving themselves to be at high risk of HIV.…”

Section: Discussionmentioning

confidence: 99%

“…Late diagnosis has generally been found to be more common among men and older adults in multiple studies in the US, Australia, Europe, and Asia. 13,28,[41][42][43][44][45][46][47][48][49][50][51] Health care providers may be less likely to consider HIV infection in an older adult, and older adults may perceive themselves as at lower risk than younger adults. 51 Rapid disease progression, which would appear as a late diagnosis, has been reported in older adults.…”

Section: Discussionmentioning

confidence: 99%

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Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

Trepka

Fennie

Sheehan

et al. 2014

AIDS Patient Care and STDs

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The purpose of this retrospective cohort study was to identify individual-level demographic and communitylevel socioeconomic and health care resource factors associated with late diagnosis of HIV in rural and urban areas of Florida. Multilevel modeling was conducted with linked 2007-2011 Florida HIV surveillance, American Community Survey, Area Health Resource File, and state counseling and testing data. Late diagnosis (defined as AIDS diagnosis within 3 months of HIV diagnosis) was more common in rural than urban areas (35.8% vs. 27.4%) ( p < 0.0001). This difference persisted after controlling for age, sex, race/ethnicity, HIV transmission mode, country of birth, and diagnosis year (adjusted OR 1.39; 95% CI 1.17-1.66). In rural areas, older age and male sex were associated with late HIV diagnosis; zip code-level socioeconomic and county level health care resource variables were not associated with late diagnosis in rural areas. In urban areas only, Hispanic and non-Hispanic black race/ethnicity, foreign birth, and heterosexual mode of transmission were additionally associated with late HIV diagnosis. These findings suggest that, in rural areas, enhanced efforts are needed to target older individuals and men in screening programs and that studies of psychosocial and structural barriers to HIV testing in rural and urban areas be pursued.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

Trepka

Fennie

Sheehan

et al. 2014

AIDS Patient Care and STDs

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“…Early presentation and early treatment of HIV have significant individual and public health benefits in terms of reducing morbidity and mortality and reducing HIV transmission [25,26]. Epidemiological studies have reported later presentation among African and Caribbean immigrants in Europe [27-29], among Latinos [18,30], Asian and Pacific Islanders [31], and African and Caribbean immigrants in the USA [17] and among Asian and sub-Saharan African immigrants in Australia [32-34]. It is important to note that these disparities between immigrant and locally born populations in high-income countries are mainly observed among immigrants born in developing and middle-income countries rather than immigrants born in other high-income countries [8,24,35].…”

Section: Introductionmentioning

confidence: 99%

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

McMahon

Ward

2012

Syst Rev

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BackgroundImmigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention.MethodsWe undertook a realist review to answer the research question: ‘How are HIV prevention interventions in high-income countries adapted to suit immigrants’ needs?’ A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms.ResultsThirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of ‘consonance’ mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms – ‘understanding’, ‘specificity’ and ‘embeddedness’ – which indicated that using the language of immigrants, usually the ‘mother tongue’, targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of ‘authenticity’ and ‘framing’ mechanisms and only partial evidence to support role of ‘endorsement’ mechanisms.ConclusionsThis realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.

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“…However as the number of African-born people diagnosed with HIV in Victoria is not large, this sample size represents a substantial proportion of this population. Additional complexity arises from the high proportion of late diagnoses among African-born cases of HIV living in Victoria, which suggest that testing rates may be too low to provide a solid basis for estimates of HIV prevalence in Victoria's African communities [2]. This study provides no evidence for a locally based cluster of HIV transmission among African Australians living in Victoria, although demonstrating the absence of any such cluster would require a much larger study.…”

Section: Discussionmentioning

confidence: 76%

“…African-born Australians have been recognised as a “priority population” in Australia's Sixth National HIV/AIDS Strategy, published in 2010 [1]; they are diagnosed late with HIV compared to Australian-born people living with HIV (PLHIV) and are over-represented among new diagnoses of HIV [2]–[4].…”

Section: Introductionmentioning

confidence: 99%

Acquisition of HIV by African-Born Residents of Victoria, Australia: Insights from Molecular Epidemiology

et al. 2013

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African-born Australians are a recognised “priority population” in Australia's Sixth National HIV/AIDS Strategy. We compared exposure location and route for African-born people living with HIV (PLHIV) in Victoria, Australia, with HIV-1 pol subtype from drug resistance assays and geographical origin suggested by phylogenetic analysis of env gene. Twenty adult HIV positive African-born Victorian residents were recruited via treating doctors. HIV exposure details were obtained from interviews and case notes. Viral RNA was extracted from participant stored plasma or whole blood. The env V3 region was sequenced and compared to globally representative reference HIV-1 sequences in the Los Alamos National Library HIV Database. Twelve participants reported exposure via heterosexual sex and two via iatrogenic blood exposures; four were men having sex with men (MSM); two were exposed via unknown routes. Eight participants reported exposure in their countries of birth, seven in Australia, three in other countries and two in unknown locations. Genotype results (pol) were available for ten participants. HIV env amplification was successful in eighteen cases. HIV-1 subtype was identified in all participants: eight both pol and env; ten env alone and two pol alone. Twelve were subtype C, four subtype B, three subtype A and one subtype CRF02_AG. Reported exposure location was consistent with the phylogenetic clustering of env sequences. African Australians are members of multiple transnational social and sexual networks influencing their exposure to HIV. Phylogenetic analysis may complement traditional surveillance to discern patterns of HIV exposure, providing focus for HIV prevention programs in mobile populations.

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Delayed diagnosis of HIV infection in Victoria 1994 to 2006

Cited by 23 publications

References 19 publications

Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

Acquisition of HIV by African-Born Residents of Victoria, Australia: Insights from Molecular Epidemiology

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