How health systems can adapt to a population ageing with HIV and comorbid disease

Kiplagat, Jepchirchir; Tran, Dan N.; Barber, Tristan; Njuguna, Benson; Vedanthan, Rajesh; Triant, Virginia A.; Pastakia, Sonak D.

doi:10.1016/s2352-3018(22)00009-1

Cited by 37 publications

(32 citation statements)

References 78 publications

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“…The rates of sexual transmission were significantly higher in the older group, which is similar to the findings from other countries where the prevalence of HIV infections increased fastest among people aged 50–80 years ( 24 ). Opposite to the common assumption that the older population has rare or no need for sexual activity, as people live longer, older individuals continue to enjoy sexual activity with multiple reasons for showing risky sexual behavior ( 25 ). Although marital status does not have a significant influence on the rates of sexual transmission, gender does.…”

Section: Discussionmentioning

confidence: 99%

Ways of HIV transmission in China: The effect of age, period, and cohort

Wang

et al. 2022

Front. Public Health

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BackgroundAcquired immunodeficiency syndrome (AIDS) is a global pandemic caused by human immunodeficiency virus (HIV), which is transmitted through human behaviors, such as sexual intercourse, intravenous drug injection, and blood transfusion. Rare studies have focused on the evaluation of the effects of culture, society, and HIV-related policies in adjusting people's HIV-related behaviors, i.e., ways of HIV transmission.MethodsBy taking the new HIV infections in Hubei Province each year from 1995 to 2020 as the sample, our study used the Hierarchical Age-Period-Cohort (HAPC) model to analyze the effects of age, period, and cohort on the trends of ways of HIV transmission.ResultsFrom 1995 to 2020, the number of new HIV infections in Hubei presented a general upward trend. A total of 34,636 HIV infections were reported during this period. According to the statistics of the new HIV infections in Hubei Province between 1995 and 2020, there is a negative correlation between age (−0.099, p < 0.001), squared age (−0.002, p < 0.001), and the rate of blood transmission. While there is a positive correlation between age (0.143, p < 0.001), squared age (0.002, p < 0.001), and the rate of HIV infection through sexual transmission. The significant period and cohort effects on ways of HIV transmission were also observed in the Chinese population.ConclusionSexual and blood transmission are the two main ways of HIV infection in China and Hubei. The trend of blood transmission is in accordance with the wave of blood trade in the early 1990s in China. The trend of sexual transmission indicates an increasing need to promote safer sexual behavior among the older population and later generations and design more tailored, innovative, and diverse HIV prevention strategies, especially for the high-risk groups.

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Section: Discussionmentioning

confidence: 99%

Ways of HIV transmission in China: The effect of age, period, and cohort

Wang

et al. 2022

Front. Public Health

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“…People living with HIV experience the requirements of early HIV diagnosis, linkage to care, and lifetime commitment to ART differently depending on their age, gender, sexual identity, and health status, with each step in the HIV care cascade complicated by their personal, professional, and social circumstances (16)(17)(18)(19)(20)(21). Traditionally, HIV care and treatment has been top-down and required patient compliance rather than ownership of life-long antiretroviral therapy (ART) (11,22).…”

Section: Introductionmentioning

confidence: 99%

“…In other instances, health providers may change patient care practices due to resource constraints, for example, substituting ART regimens due to low or quickly expiring supplies, which may inadvertently increase the burden of treatment for the patient (28). Additionally, standardized treatment protocols may not account for differential needs of women, adolescents, men, the differently abled, and the aged, putting them under undue stress as they navigate their social dependencies and roles to meet stringent health service requirements and multiple, required appointments at varied locations (16)(17)(18)(19)(20)(21). Thus, health providers may exert their discretionary power using their best judgement under the prevailing circumstances, but nonetheless deliver sub-optimal services and leave patients dissatisfied with their HIV care (25).…”

Section: Introductionmentioning

confidence: 99%

“Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia”

et al. 2022

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IntroductionTraditional patient-provider relationships privilege the providers, as they possess the formal authority and clinical knowledge applied to address illness, but providers also have discretion over how they exercise their power to influence patients' services, benefits, and sanctions. In this study, we assessed providers' exercise of discretionary power in implementing patient-centered care (PCC) practices in Lusaka, Zambia.MethodsHIV clinical encounters between patients on antiretroviral therapy (ART) and providers across 24 public health facilities in Lusaka Province were audio recorded and transcribed verbatim. Using qualitative content analysis, we identified practices of discretionary power (DP) employed in the implementation of PCC and instances of withholding DP. A codebook of DP practices was inductively and iteratively developed. We compared outcomes across provider cadres and within sites over time.ResultsWe captured 194 patient-provider interactions at 24 study sites involving 11 Medical Officers, 58 Clinical Officers and 10 Nurses between August 2019 to May 2021. Median interaction length was 7.5 min. In a hierarchy where providers dominate patients and interactions are rapid, some providers invited patients to ask questions and responded at length with information that could increase patient understanding and agency. Others used inclusive language, welcomed patients, conducted introductions, and apologized for delayed services, narrowing the hierarchical distance between patient and provider, and facilitating recognition of the patient as a partner in care. Although less common, providers shared their decision-making powers, allowing patients to choose appointment dates and influence regimens. They also facilitated resource access, including access to services and providers outside of scheduled appointment times. Application of DP was not universal and missed opportunities were identified.ConclusionSupporting providers to recognize their power and intentionally share it is both inherent to the practice of PCC (e.g., making a patient a partner), and a way to implement improved patient support. More research is needed to understand the application of DP practices in improving the patient-centeredness of care in non-ART settings.

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“…Health systems are increasingly focusing on the question of how to meet the health needs of large numbers of PLHIV who are stable on ART [ 5 ]. Viral suppression has conventionally been regarded as a key marker of the success of HIV care, but as more people live with controlled HIV for many years, there is recognition that health-related quality of life (HRQoL) warrants greater consideration [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool

Safreed-Harmon

Fuster‐RuizdeApodaca

Cal

et al. 2022

Health Qual Life Outcomes

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Background In settings with high antiretroviral therapy coverage, numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). As part of a larger study to develop and validate a new patient-reported outcome measure for use in HIV clinical care in Spain, we sought to identify the most burdensome health-related issues experienced by PLHIV in order to determine which issues should be addressed in the new instrument. Methods We conducted a literature review and a qualitative study based on four focus group discussions (FGDs) with key informants in Spain. Participants were selected via purposive sampling. Two FGDs convened 16 expert HIV service providers, and two convened 15 PLHIV with diverse epidemiological profiles. FGDs followed semi-structured interview scripts and incorporated an exercise to prioritise the most critical health-related issues among those named in the discussions. Content analysis was conducted using MAXQDA 12. Results The analysis of FGD data identified several broad categories of issues that were perceived to negatively affect PLHIV. The most frequently named issues fell within the categories of social problems; physical symptoms; psychological problems; and sexuality-related problems. Regarding social problems, stigma/discrimination was by far the issue raised the most frequently. In the prioritisation exercise, stigma/discrimination was also ranked as the most burdensome issue by both service providers and PLHIV. Within the physical symptoms category, the issues named most frequently were sleep-related problems, fatigue, physical pain and body fat changes. Regarding psychological problems, FGD participants most commonly spoke of emotional distress in general terms, and also called attention to depression and anxiety. In the prioritisation exercise, both service providers and PLHIV ranked psychological well-being as the second-most important issue following stigma. Sexuality-related problems that were reported included sexually transmitted infections, hormonal problems, lack of libido, and general sexual dissatisfaction. Conclusions PLHIV are negatively affected by a wide range of health-related issues. HIV-related stigma and psychological well-being remain major challenges. Identifying and addressing these and other issues in routine clinical care supports healthy aging and may ultimately contribute to better health and HRQoL outcomes in this population.

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How health systems can adapt to a population ageing with HIV and comorbid disease

Cited by 37 publications

References 78 publications

Ways of HIV transmission in China: The effect of age, period, and cohort

Ways of HIV transmission in China: The effect of age, period, and cohort

“Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia”

Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool

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