Access to HIV community services by vulnerable populations: evidence from an enhanced HIV/AIDS surveillance system

Madden, Hannah; Phillips-Howard, Penelope A.; Hargreaves, Suzy C.; Downing, Jennifer; Bellis, Mark A; Vivancos, Roberto; Morley, Christopher P.; Syed, Qutub; Cook, Penny A.

doi:10.1080/09540121.2010.525609

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…These characteristics have been associated with residential transience [22, 23] and are consistent with shorter term engagement with localised healthcare as well as with relatively poor adherence to ART [24–29] and higher transmission risk behaviours [27, 30–32]. This suggests that LTFU events are likely to correlate with increased risk of viral rebound and have serious implications for the HIV epidemic with higher community VL and infectiousness, and consequent ongoing HIV transmission.…”

Section: Discussionmentioning

confidence: 75%

Loss to follow-up in the Australian HIV Observational Database

McManus¹,

Petoumenos²,

Brown³

et al. 2014

Antiviral Therapy

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Background Loss to follow-up (LTFU) in HIV-positive cohorts is an important surrogate for interrupted clinical care which can potentially influence the assessment of HIV disease status and outcomes. After preliminary evaluation of LTFU rates and patient characteristics, we evaluated the risk of mortality by LTFU status in a high resource setting. Methods Rates of LTFU were measured in the Australian HIV Observational Database for a range of patient characteristics. Multivariate repeated measures regression methods were used to identify determinants of LTFU. Mortality by LTFU status was ascertained using linkage to the National Death Index. Survival following combination antiretroviral therapy initiation was investigated using the Kaplan-Meier (KM) method and Cox proportional hazards models. Results Of 3,413 patients included in this analysis, 1,632 (47.8%) had at least one episode of LTFU after enrolment. Multivariate predictors of LTFU included viral load (VL)>10,000 copies/ml (Rate ratio (RR) 1.63 (95% confidence interval (CI):1.45–1.84) (ref ≤400)), time under follow-up (per year) (RR 1.03 (95% CI: 1.02–1.04)) and prior LTFU (per episode) (RR 1.15 (95% CI: 1.06–1.24)). KM curves for survival were similar by LTFU status (p=0.484). LTFU was not associated with mortality in Cox proportional hazards models (univariate hazard ratio (HR) 0.93 (95% CI: 0.69–1.26) and multivariate HR 1.04 (95% CI: 0.77–1.43)). Conclusions Increased risk of LTFU was identified amongst patients with potentially higher infectiousness. We did not find significant mortality risk associated with LTFU. This is consistent with timely re-engagement with treatment, possibly via high levels of unreported linkage to other health care providers.

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Section: Discussionmentioning

confidence: 75%

Loss to follow-up in the Australian HIV Observational Database

McManus¹,

Petoumenos²,

Brown³

et al. 2014

Antiviral Therapy

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“…Finally, surveys of care utilization in the United Kingdom showed that migrants and asylum seekers were more likely than nonmigrants to access HIV support services, but not clinical HIV care 41,42. Bringing together the above findings, mobile populations, particularly international migrants, may be at risk for delays in HIV diagnosis or entry into HIV care 34,35.…”

Section: Geographic Mobility Access To and Maintenance In Hiv Carementioning

confidence: 95%

HIV Care for Geographically Mobile Populations

Taylor

Garduño

Reyes

et al. 2011

Mount Sinai J Medicine

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The interaction between mobility and HIV risk is well recognized, but what happens to those same individuals, once infected, as they transition to living with HIV? Does mobility affect their transition into HIV care? If so, do mobile and non-mobile populations achieve similar success with HIV treatment?The definition of mobility has changed over the centuries to encompass a complex phenotype including permanent migration, frequent travel, circular migration, and distance from HIV treatment centers. The heterogeneity of these definitions leads to discordant findings. Investigations show that mobility has an impact on HIV risk, but fewer data exist on the impact of geographic mobility on HIV care and treatment.This review will examine existing data on the impact of geographic mobility on access to and maintenance in HIV care and on adherence to antiretroviral therapy. It will also expand the concept of mobility to include data on the impact of the distance from residence to clinic on HIV care and treatment adherence.Our conclusions are that the existing literature is limited by varying definitions of mobility and the inherent oversimplification necessary to apply a "mobility measure" in a statistical analysis. The impact of mobility on HIV treatment outcomes deserves further exploration to both define the phenomenon and target interventions to these at-risk populations.

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“…HIV disproportionately affects vulnerable populations such as black and minority ethnic groups [10] [11] both nationally and in the area this study was conducted. We therefore, specifically sought to recruit clinicians who provided care to minority populations.…”

Section: Participants and Proceduresmentioning

confidence: 99%

Clinician Utilization of Best Practices for HIV Care and Status Disclosure: A Cross-Sectional Study

Ede¹,

Yancey²,

Stringer³

et al. 2014

OJPM

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Determining the baseline utilization of best practices among clinicians, with regard to HIV care and disclosure of status to at-risk partners, is critical to addressing HIV prevention issues and disease transmission. In this study, we examined clinicians' utilization of best practices for HIV/ AIDS care and the disclosure of HIV status to sexual and needle-sharing partners (HSSNSP). We conducted a cross-sectional survey of 100 clinicians to assess knowledge, attitude, and behavior towards best practices for HIV care and disclosure of HSSNSP. Multiple logistic regression analysis was used to determine factors associated with the utilization of clinical best practices for HIV care and disclosure of HSSNSP. Forty eight percent of the participants revealed poor behaviors. Fifty six percent showed less positive attitudes towards clinical best practices for HIV care and disclosure of status. Less than half (32%) of the participants had earned at least 1 HIV/AIDS CME credit in the past two years. Our study showed strong associations between the utilization of best practices for HIV care and the disclosure of status, and clinician attitudes and knowledge levels. Further research that aims to improve knowledge and attitudes on clinical best practices for providing HIV/AIDS care and the disclosure of status is needed. This improvement may lead to increase in the utilization of best practices for HIV care and disclosure of status, and contribute to decreases in disease transmission rates.

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Access to HIV community services by vulnerable populations: evidence from an enhanced HIV/AIDS surveillance system

Cited by 11 publications

References 11 publications

Loss to follow-up in the Australian HIV Observational Database

Loss to follow-up in the Australian HIV Observational Database

HIV Care for Geographically Mobile Populations

Clinician Utilization of Best Practices for HIV Care and Status Disclosure: A Cross-Sectional Study

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