Toward an Endgame: Finding and Engaging People Unaware of Their HIV-1 Infection in Treatment and Prevention

Burns, David; DeGruttola, Victor; Pilcher, Christopher D.; Kretzschmar, Mirjam; Gordon, Christopher M.; Flanagan, Elizabeth H.; Duncombe, Christopher; Cohen, Myron S.

doi:10.1089/aid.2013.0274

Cited by 33 publications

(22 citation statements)

References 78 publications

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“…This may in part explain the lower rates of successful contact, as this may be a particularly “hard-to-reach” population. Given the estimated 20–30% of HIV-positive individuals that are unaware of their infection(25), finding a high prevalence previously unreachable groups is a priority. However, from these data it is not clear that most at risk populations are being reached.…”

Section: Discussionmentioning

confidence: 99%

Next-Generation Methods for HIV Partner Services

Hochberg¹,

Berringer²,

Schneider³

2015

Sexually Transmitted Diseases

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Partner notification is a widely accepted method whose intent is to limit onwards HIV transmission. With acceleration in the use of new technologies such as text-messaging, e-mail and social network sites, there has been growing interest in utilizing these techniques for “next-generation” HIV partner services (PS). We conducted a systematic review to assess the utilization and effectiveness of these technologies in HIV PS. Our literature search resulted in 1,343 citations, and 8 met our inclusion criteria. We found efforts focused in 3 domains: 1) patient-led anonymous referral online (n=3); 2) provider-led efforts to augment traditional partner notification techniques at public health departments (n=4); 3) a hybrid approach utilizing a website for e-notification available to those with confirmed STI through an STI clinic (n=1). For the provider-led efforts a modest increase in HIV case-finding was noted despite a generally lower rate of successful notification in comparison to traditional PS. The public websites had a high total number of e-notifications sent, but less than 10% of cards were sent for HIV. Furthermore, low awareness of these services was found in surveys amongat-risk target populations. When given a choice, the majority of clients chose to send an e-notification via text versus e-mail. Although successful notification may be lower overall, use of next-generation services provides an avenue to contact those that would previously have been untraceable. Additional research is needed to determine to what extent technology enhanced partner services improves identification of newly infected persons as well as initiating new prevention for HIV negative clients within high-risk networks.

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Section: Discussionmentioning

confidence: 99%

Next-Generation Methods for HIV Partner Services

Hochberg¹,

Berringer²,

Schneider³

2015

Sexually Transmitted Diseases

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“…Considering specific STDs, any-stage syphilis had a crude IR of 3.95/1000 PYFU (95% CI 3.59-4.35/1000 PYFU), HPV infection 1.96 (95% CI 1.71-2.24), acute viral hepatitis 1.72 (95% CI 1.49-1.99) [HAV 0.19 (95% CI 0.09-0.36), HBV 6.54 (95% CI 5.83-7.32), and HCV 3.74 (95% CI 3.21-4.34)], HSV infection 0.81 (95% CI 0.65-0.99), gonococcal uretritis 0.46 (95% CI 0.35-0.61), nongonococcal uretritis 0.47 (95% CI 0.36-0.62) and other genital ulcers 0.11 (95% CI 0.06-0.19). As shown in Table 1, a higher IR of STDs was observed in men compared with women [24.1/1000 PYFU (95% CI 22.4-25.8/1000 PYFU) versus 14.6/1000 PYFU (95% CI 12.7-16.8/1000 PYFU), respectively] and in people aged 18-30 years compared with the other age strata [45.4/1000 Crude incidence of sexually transmitted diseases (STDs) in the whole population (n = 9168)PYFU (95% CI 39.0-52.5/1000 PYFU) versus2) for[31][32][33][34][35][36][37][38][39][40]2) for 41-50 years,2) for 51-70 years and for > 70 years].…”

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confidence: 99%

Incidence and factors associated with the risk of sexually transmitted diseases in HIV‐infected people seen for care in Italy: data from the Icona Foundation cohort

et al. 2015

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ObjectivesThe aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis.MethodsAll HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors.ResultsData for 9168 participants were analysed [median age 37.3 (range 18–81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0–22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52–3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42–1.97 for 2008–2012 versus 1998–2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19–1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69–5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77–0.89) and being currently on ART (RR 0.38; 95% CI 0.33–0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs.ConclusionsAn increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.

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“…Comparison of our alternative model parameterisations (appendix pp 49, 50) shows how patterns of health-care seeking behaviour can modify the effect of interventions on population health, which has not been readily apparent from empirical observation 30 . Health-care seeking behaviours have an important effect on the value of outreach interventions.…”

Section: Discussionmentioning

confidence: 99%

Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study

et al. 2016

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SummaryBackgroundWith expanded access to antiretroviral therapy (ART) in sub-Saharan Africa, HIV mortality has decreased, yet life-years are still lost to AIDS. Strengthening of treatment programmes is a priority. We examined the state of an HIV care programme in Kenya and assessed interventions to improve the impact of ART programmes on population health.MethodsWe created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among adults infected with HIV in Kenya. We calibrated the model to a longitudinal dataset from the Academic Model Providing Access To Healthcare (known as AMPATH) programme describing the routes into care, losses from care, and clinical outcomes. We simulated the cost and effect of interventions at different stages of HIV care, including improvements to diagnosis, linkage to care, retention and adherence of ART, immediate ART eligibility, and a universal test-and-treat strategy.FindingsWe estimate that, of people dying from AIDS between 2010 and 2030, most will have initiated treatment (61%), but many will never have been diagnosed (25%) or will have been diagnosed but never started ART (14%). Many interventions targeting a single stage of the health-care cascade were likely to be cost-effective, but any individual intervention averted only a small percentage of deaths because the effect is attenuated by other weaknesses in care. However, a combination of five interventions (including improved linkage, point-of-care CD4 testing, voluntary counselling and testing with point-of-care CD4, and outreach to improve retention in pre-ART care and on-ART) would have a much larger impact, averting 1·10 million disability-adjusted life-years (DALYs) and 25% of expected new infections and would probably be cost-effective (US$571 per DALY averted). This strategy would improve health more efficiently than a universal test-and-treat intervention if there were no accompanying improvements to care ($1760 per DALY averted).InterpretationWhen resources are limited, combinations of interventions to improve care should be prioritised over high-cost strategies such as universal test-and-treat strategy, especially if this is not accompanied by improvements to the care cascade. International guidance on ART should reflect alternative routes to programme strengthening and encourage country programmes to evaluate the costs and population-health impact in addition to the clinical benefits of immediate initiation.FundingBill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.

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Toward an Endgame: Finding and Engaging People Unaware of Their HIV-1 Infection in Treatment and Prevention

Cited by 33 publications

References 78 publications

Next-Generation Methods for HIV Partner Services

Next-Generation Methods for HIV Partner Services

Incidence and factors associated with the risk of sexually transmitted diseases in HIV‐infected people seen for care in Italy: data from the Icona Foundation cohort

Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study

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