Adverse Health Effects for Individuals Who Move Between HIV Care Centers

Krentz, Hartmut B.; Worthington, Heather; Gill, M. John

doi:10.1097/qai.0b013e318214feee

Cited by 15 publications

(11 citation statements)

References 15 publications

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“…This finding may be largely explained by the fact that patients exposed to IPV were twice as likely to have interruptions in care with associated increases in viral load. Continuity in care is one of the most important predictors of survival and disease progression in the HAART era [37][38][39][40]. The clinical impact of IPV was further supported by a higher hospitalization rate for HIVrelated causes, probably reflecting this poor engagement in care.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, clinical associations, and impact of intimate partner violence among HIV‐infected gay and bisexual men: a population‐based study

Siemieniuk

Miller

Woodman³

et al. 2012

HIV Medicine

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Intimate partner violence (IPV) is a risk factor for HIV infection. Little is known, however, about the prevalence, clinical associations, and impact of IPV among patients living with HIV. MethodsHIV-infected gay and bisexual men in Southern Alberta, Canada were screened for IPV between May 2009 and December 2011. The associations with IPV of sociodemographic factors, psychological factors, clinical status, and HIV-related and HIV-unrelated hospitalizations, data for which were obtained from a regional database, were evaluated using Poisson regression. ResultsOf 687 gay and bisexual patients, 22.4% had experienced one or several types of IPV. Patients disclosing IPV were more likely to be Aboriginal [adjusted prevalence ratio (APR) = 2.48; 95% confidence interval (CI) 1. 18-5.20], to be younger (APR/year = 0.97; 95% CI 0.95-0.99), to be victims of childhood abuse (APR = 4.27; 95% CI 2.84-6.41), to be smokers (APR = 2.53; 95% CI 1.59-4.00), to have had depression prior to HIV diagnosis (APR = 1.87; 95% CI 1.10-3.16), to use ongoing psychiatric resources (APR = 3.53; 95% CI 2.05-6.10), to have recently participated in unprotected sex (APR = 2.29; 95% CI 1.10-4.77), and to have poor or fair vs. very good or excellent health-related quality of life (APR = 2.91; 95% CI 1.57-5.39). IPV was also associated with a higher rate of clinically relevant interruptions in care (APR = 1.95; 95% CI 1.23-3.08), a higher incidence of AIDS among patients presenting early to care (CD4 count Ն 200 cells/mL; APR = 2.06; 95% CI 1. 15-3.69), and an increased rate of HIV-related hospitalizations [relative risk (RR) = 1.55; 95% CI 0.99-2.33], especially after HIV diagnosis was established (RR = 2.46; 95% CI 1.51-3.99). ConclusionsThe prevalence of IPV is high among HIV-infected gay and bisexual men and is associated with poor social, psychiatric, and medical outcomes. IPV is an under-recognized social determinant of health in this community that may be amenable to meaningful clinical interventions. [6,7]. IPV is a subset of domestic violence (DV; also known as 'family violence') and is defined as behaviour in an intimate relationship causing physical, psychological or sexual harm [8]. Manifestations of IPV include physical, sexual, emotional and financial abuse, in addition to isolation, neglect and intimidation. Screening for IPV among women is endorsed by the US Preventative Task Force, the Institute of Medicine, and professional organizations and may reduce IPV and improve outcomes in some populations [9]. Standardized screening is important because healthcare providers often fail to identify patients at risk of IPV and to discuss IPV appropriately when risk is identified [10].Interactions between IPV and HIV infection have usually been studied within the context of violence against women [1][2][3]11]. Among women, IPV can lead to HIV infection directly through forced sexual contact (rape) and reduced ability to negotiate safe sexual practices [3] The popular feminist theory of abuse (male perpetrators and female victims) by definiti...

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Section: Discussionmentioning

confidence: 99%

Prevalence, clinical associations, and impact of intimate partner violence among HIV‐infected gay and bisexual men: a population‐based study

Siemieniuk

Miller

Woodman³

et al. 2012

HIV Medicine

View full text Add to dashboard Cite

show abstract

“…Third, most measures of engagement in-care fail to take consideration of the fact that individuals may seek care from other providers. The implications of such individuals for the overall care cascade are unclear – in Southern Alberta, patients who left the HIV care program but who returned at a later date had deterioration in both CD4 + cell counts and new AIDS events compared with those who had never left the program, in whom CD4 + cell counts increased [ 41 ]. In contrast, transfers into the care centre from outside the area had greater engagement in-care than local patients [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Association between engagement in-care and mortality in HIV-positive persons

Sabin

Howarth

José

et al. 2017

Aids

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Objective:To assess associations between engagement in-care and future mortality.Design:UK-based observational cohort study.Methods:HIV-positive participants with more than one visit after 1 January 2000 were identified. Each person-month was classified as being in or out-of-care based on the dates of the expected and observed next care visits. Cox models investigated associations between mortality and the cumulative proportion of months spent in-care (% IC, lagged by 1 year), and cumulative %IC prior to antiretroviral therapy (ART) in those attending clinic for more than 1 year, with adjustment for age, CD4+/viral load, year, sex, infection mode, ethnicity, and receipt/type of ART.Results:The 44 432 individuals (27.8% women; 50.5% homosexual, 28.9% black African; median age 36 years) were followed for a median of 5.5 years, over which time 2279 (5.1%) people died. Higher %IC was associated with lower mortality both before [relative hazard 0.91 (95% confidence interval 0.88–0.95)/10% higher, P = 0.0001] and after [0.90 (0.87–0.93), P = 0.0001] adjustment. Adjustment for future CD4+ changes revealed that the association was explained by poorer CD4+ cell counts in those with lower %IC. In total 8730 participants under follow-up for more than 1 year initiated ART of whom 237 (2.7%) died. Higher values of %IC prior to ART initiation were associated with a reduced risk of mortality before [0.29 (0.17–0.47)/10%, P = 0.0001] and after [0.36 (0.21–0.61)/10%, P = 0.0002] adjustment; the association was again explained by poorer post-ART CD4+/ viral load in those with lower pre-ART %IC.Conclusions:Higher levels of engagement in-care are associated with reduced mortality at all stages of infection, including in those who initiate ART.

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“…Retention using the HAB-MV performance measure was also associated with VL suppression at 12 months, but when HAB-MV was assessed over a 5.6 year follow-up period and dichotomized to patients who met the criterion in all years of follow-up or not, the measure was not associated with a greater likelihood of VL suppression [13]. More recently this measure was shown to have the highest optimal predictive value compared with VL outcomes [27]. Our work adds to a small but growing body of evidence supporting the usefulness of readily available electronic medical record data and the HAB-MV measure as a performance metric.…”

Section: Discussionmentioning

confidence: 99%

Patterns of HIV Service Use and HIV Viral Suppression Among Patients Treated in an Academic Infectious Diseases Clinic in North Carolina

et al. 2014

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Irregular participation in HIV medical care hinders HIV RNA suppression and impacts health among people living with HIV. Cluster analysis of clinical data from 1,748 patients attending a large academic medical center yielded three HIV service usage patterns, namely: ‘engaged in care’, ‘sporadic care’, and ‘frequent use’. Patients ‘engaged in care’ exhibited most consistent retention (on average, >88 % of each patient’s observation years had ≥2 visits 90 days apart), annualized visit use (2.9 mean visits/year) and viral suppression (>73 % HIV RNA tests <400 c/mL). Patients in ‘sporadic care’ demonstrated lower retention (46–52 %), visit use (1.7 visits/year) and viral suppression (56 % <400 c/mL). Patients with ‘frequent use’ (5.2 visits/year) had more inpatient and emergency visits. Female, out-of-state residence, low attendance during the first observation year and detectable first-observed HIV RNA were early predictors of subsequent service usage. Patients ‘engaged in care’ were more likely to have HIV RNA <400 than those receiving sporadic care. Results confirm earlier findings that under-utilization of services predicts poorer viral suppression and health out-comes and support recommendations for 2–3 visits/year.

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Adverse Health Effects for Individuals Who Move Between HIV Care Centers

Cited by 15 publications

References 15 publications

Prevalence, clinical associations, and impact of intimate partner violence among HIV‐infected gay and bisexual men: a population‐based study

Prevalence, clinical associations, and impact of intimate partner violence among HIV‐infected gay and bisexual men: a population‐based study

Association between engagement in-care and mortality in HIV-positive persons

Patterns of HIV Service Use and HIV Viral Suppression Among Patients Treated in an Academic Infectious Diseases Clinic in North Carolina

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