المؤلفون: Drain, Paul K., Losina, Elena, Coleman, Sharon M., Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Freedberg, Kenneth A., Bassett, Ingrid V.

المصدر: Open Forum Infectious Diseases; Summer2017, Vol. 4 Issue 3, p1-9, 9p

مصطلحات موضوعية: LIPOARABINOMANNANS, HIV antibodies, PUBLIC health

مصطلحات جغرافية: SOUTH Africa

مستخلص: Background. Urinary lipoarabinomannan (LAM) has limited sensitivity for diagnosing active human immunodeficiency virus (HIV)-associated tuberculosis (TB) disease, but LAM screening at HIV diagnosis might identify adults with more severe clinical disease or greater risk of mortality. Methods. We enrolled antiretroviral therapy-naive HIV-infected adults from 4 clinics in Durban. Nurses performed urine LAM testing using a rapid assay (Determine TB LAM) graded from low (1+) to high (≥3+) intensity. Urine LAM results were not used to guide anti-TB therapy. We assessed TB-related symptoms and obtained sputum for mycobacterial smear and culture. Participants were observed for 12 months, and we used multivariable Cox proportional hazard models to determine hazard ratios for all-cause mortality. Results. Among 726 HIV-infected adults with median CD4 of 205 cells/mm³ (interquartile range, 79–350 cells/mm³), 93 (13%) were LAM positive and 89 (12%) participants died during the follow-up period. In multivariable analyses, urine LAM-positive participants had a mortality hazard ratio (MHR) of 3.58 (95% confidence interval [CI], 2.20–5.81) for all-cause mortality. Among participants with mycobacterial-confirmed TB, urine LAM-positivity had a 2.91 (95% CI, 1.26–6.73) MHR for all participants and a 4.55 (95% CI, 1.71–12.1) MHR for participants with CD4 ≤100 cell/mm³. Participants with LAM-positive TB had significantly more clinical signs and symptoms of disease, compared with participants with LAM-negative TB disease. Conclusions. Among HIV-infected adults, urinary LAM-positive patients had more clinical disease severity and a 3-fold increase in 12-month mortality compared with those who were LAM negative. [ABSTRACT FROM AUTHOR]

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المؤلفون: Drain, Paul K., Losina, Elena, Coleman, Sharon M., Bogart, Laura, Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Bassett, Ingrid V.

المصدر: AIDS Care; Oct2015, Vol. 27 Issue 10, p1231-1240, 10p, 3 Charts, 2 Graphs

مصطلحات موضوعية: DIAGNOSIS of HIV infections, CONFIDENCE intervals, COUNSELING, LONGITUDINAL method, MEDICAL screening, MENTAL health, MULTIVARIATE analysis, REGRESSION analysis, RESEARCH funding, SELF-perception, STATISTICS, SOCIAL support, RANDOMIZED controlled trials, CROSS-sectional method, DATA analysis software, DESCRIPTIVE statistics, ODDS ratio

مصطلحات جغرافية: SOUTH Africa

مستخلص: Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study’s Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18;p< 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bogart, Laura M., Chetty, Senica, Giddy, Janet, Sypek, Alexis, Sticklor, Laurel, Walensky, Rochelle P., Losina, Elena, Katz, Jeffrey N., Bassett, Ingrid V.

المصدر: AIDS Care; Jul2013, Vol. 25 Issue 7, p843-853, 11p

مصطلحات موضوعية: FOCUS groups, HIV-positive persons, INTERVIEWING, RESEARCH methodology, MEDICAL care, PATIENT satisfaction, PATIENTS, PHYSICIAN-patient relations, RESEARCH funding, JUDGMENT sampling, THEMATIC analysis, INTER-observer reliability, DATA analysis software, PATIENTS' attitudes, PHYSICIANS' attitudes, DESCRIPTIVE statistics

مصطلحات جغرافية: SOUTH Africa

مستخلص: We collected qualitative data (semi-structured interviews with 11 healthcare providers and 10 patients; 8 focus groups with 41 patients) to identify barriers to linkage to care among people living with HIV in South Africa who were not yet taking antiretroviral treatment. Patients and providers identified HIV stigma as a sizable barrier. Patients felt that stigma-related issues were largely beyond their control, fearing discrimination if they disclosed to employers or were seen visiting clinics in their community. Providers believed that patients should take responsibility for overcoming internal stigma and disclosing serostatus. Patients had considerable concerns about inconvenient clinic hours, long queues, difficulty in appointment scheduling, and disrespect from staff. Providers seemed to minimize the effects of such barriers and not recognize the extent of patient dissatisfaction. Better communication and understanding between patients and providers are needed to facilitate greater patient satisfaction and retention in HIV care. [ABSTRACT FROM AUTHOR]

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المؤلفون: Regan, Susan, Losina, Elena, Chetty, Senica, Giddy, Janet, Walensky, Rochelle P., Ross, Douglas, Holst, Helga, Katz, Jeffrey N., Freedberg, Kenneth A., Bassett, Ingrid V.

المصدر: PLoS ONE; Apr2013, Vol. 8 Issue 4, p1-7, 7p

مصطلحات موضوعية: HIV infections, THERAPEUTICS, DISEASE prevalence, MEDICAL statistics, COMMUNICABLE diseases, CLINICAL epidemiology, VIRUS diseases

مصطلحات جغرافية: DURBAN (South Africa), SOUTH Africa

مستخلص: Background: Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country. Methods: We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model. Results: Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45). Conclusions: In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis. [ABSTRACT FROM AUTHOR]

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المؤلفون: Drain, Paul K., Losina, Elena, Parker, Gary, Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Coleman, Sharon M., Bogart, Laura M., Freedberg, Kenneth A., Walensky, Rochelle P., Bassett, Ingrid V.

المصدر: PLoS ONE; Jan2013, Vol. 8 Issue 1, Special section p1-9, 9p

مصطلحات موضوعية: HIV, HIV-positive persons, MEDICAL care, MENTAL health, MULTIVARIATE analysis

مصطلحات جغرافية: SOUTH Africa

مستخلص: Background: After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults. Methods: We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm³. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing ("competing needs to healthcare") on presentation with late-stage HIV disease. Results: Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% Cl 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% Cl 1.2-2.4), were male (AOR 1.7, 95% Cl 1.2-2.3), worked outside the home (AOR 1.5, 95% Cl 1.1-2.1), perceived health service delivery barriers (AOR 1.5, 95% Cl 1.1-2.1), and/or had poor emotional health (AOR 1.4, 95% Cl 1.0-1.9) had higher odds of late-stage HIV disease presentation. Conclusions: Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease. [ABSTRACT FROM AUTHOR]

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المؤلفون: Losina, Elena, Bassett, Ingrid V., Giddy, Janet, Chetty, Senica, Regan, Susan, Walensky, Rochelle P., Ross, Douglas, Scott, Callie A., Uhler, Lauren M., Katz, Jeffrey N., Holst, Helga, Freedberg, Kenneth A.

المصدر: PLoS ONE; 2010, Vol. 5 Issue 3, p1-8, 8p

مصطلحات موضوعية: HIGHLY active antiretroviral therapy, HIV infections, TEST interpretation, PUBLIC health, DISEASE risk factors, TUBERCULOSIS, CHEST diseases

مصطلحات جغرافية: DURBAN (South Africa), SOUTH Africa

مستخلص: Background: Although loss to follow-up after antiretroviral therapy (ART) initiation is increasingly recognized, little is known about pre-treatment losses to care (PTLC) after an initial positive HIV test. Our objective was to determine PTLC in newly identified HIV-infected individuals in South Africa. Methodology/Principal Findings: We assembled the South African Test, Identify and Link (STIAL) Cohort of persons presenting for HIV testing at two sites offering HIV and CD4 count testing and HIV care in Durban, South Africa. We defined PTLC as failure to have a CD4 count within 8 weeks of HIV diagnosis. We performed multivariate analysis to identify factors associated with PTLC. From November 2006 to May 2007, of 712 persons who underwent HIV testing and received their test result, 454 (64%) were HIV-positive. Of those, 206 (45%) had PTLC. Infected patients were significantly more likely to have PTLC if they lived ≥10 kilometers from the testing center (RR = 1.37; 95% CI: 1.11-1.71), had a history of tuberculosis treatment (RR = 1.26; 95% CI: 1.00-1.58), or were referred for testing by a health care provider rather than self-referred (RR = 1.61; 95% CI: 1.22-2.13). Patients with one, two or three of these risks for PTLC were 1.88, 2.50 and 3.84 times more likely to have PTLC compared to those with no risk factors. Conclusions/Significance: Nearly half of HIV-infected persons at two high prevalence sites in Durban, South Africa, failed to have CD4 counts following HIV diagnosis. These high rates of pre-treatment loss to care highlight the urgent need to improve rates of linkage to HIV care after an initial positive HIV test. [ABSTRACT FROM AUTHOR]

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المؤلفون: Cloete, Christie, Regan, Susan, Giddy, Janet, Govender, Tessa, Erlwanger, Alison, Gaynes, Melanie R., Freedberg, Kenneth A., Katz, Jeffrey N., Walensky, Rochelle P., Losina, Elena, Bassett, Ingrid V.

المصدر: Open Forum Infectious Diseases; Sep2014, Vol. 1 Issue 2, p1-1, 1p

مصطلحات موضوعية: HIV, HTLV, AIDS, CLINICS

مصطلحات جغرافية: SOUTH Africa

مستخلص: The rapid transfer of nearly 4000 HIV-infected patients from a hospital-based clinic to community-based clinics had an estimated success of 82%. Close collaboration between transferring and receiving clinics is necessary to ensure that the health gains from PEPFAR funding are maintained.Background. President's Emergency Plan for AIDS Relief (PEPFAR) funding changes have resulted in human immunodeficiency virus (HIV) clinic closures. We evaluated linkage to care following a large-scale patient transfer from a PEPFAR-funded, hospital-based HIV clinic to government-funded, community-based clinics in Durban.Methods. All adults were transferred between March and June 2012. Subjects were surveyed 5–10 months post-transfer to assess self-reported linkage to the target clinic. We validated self-reports by auditing records at 8 clinics. Overall success of transfer was estimated using linkage to care data for both reached and unreached subjects, adjusted for validation results.Results. Of the 3913 transferred patients, 756 (19%) were assigned to validation clinics; 659 (87%) of those patients were reached. Among those reached, 468 (71%) had a validated clinic record visit. Of the 46 who self-reported attending a different validation clinic than originally assigned, 39 (85%) had a validated visit. Of the 97 patients not reached, 59 (61%) had a validated visit at their assigned clinic. Based on the validation rates for reached and unreached patients, the estimated success of transfer for the cohort overall was 82%.Conclusions. Most patients reported successful transfer to a community-based clinic, though a quarter attended a different clinic than assigned. Validation of attendance highlights that nearly 20% of patients may not have linked to care and may have experienced a treatment interruption. Optimizing transfers of HIV care to community sites requires collaboration with receiving clinics to ensure successful linkage to care. [ABSTRACT FROM PUBLISHER]

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