Re-engagement in HIV Care: A Clinical and Public Health Priority

Grimes, Richard M.; Hallmark, Camden J.; Watkins, Kellie L.; Agarwal, Shradha; McNeese, Marlene

doi:10.4172/2155-6113.1000543

Cited by 17 publications

(12 citation statements)

References 30 publications

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“…Almost 10% of our participants were LFU at least once, and the vast majority (86.8%) had been late for at least one appointment. This is in concordance with other studies showing temporary disengagement from care can be very common in these cohorts (11–77%) [ 21 – 25 ]. When LFU and appointment delay are not measured continuously, but only at a given moment in time, the frequency of treatment interruptions is very likely to be underestimated [ 21 ].…”

Section: Discussionsupporting

confidence: 93%

“…With the increasing life span of the HIV cohorts, it is increasingly common for people to interrupt treatment for a short period of time or to be lost-to-follow up (LFU) and then re-engage in care. Studies report that 11–77% of patients enrolled in HIV care temporarily disengage [ 21 – 25 ]. In most HIV programmes the frequency of treatment interruptions is very likely underestimated by most HIV programmes.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

Mesic

Spina

Mar³

et al. 2021

AIDS Res Ther

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Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

Mesic

Spina

Mar³

et al. 2021

AIDS Res Ther

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“…HIV has been traditionally considered a public health priority (18), and its management safeguarded Overall, present findings suggest that 37.40% of HIV patients faced barriers to accessing HIV care in 2019. Financial and social insurance status were the main variables that impacted on access to HIV care, despite universal NHS coverage of population (22), both insured and uninsured (Law 4368/2016) (22).…”

Section: Discussionmentioning

confidence: 76%

WITHDRAWN: HIV patient access to healthcare services in post-austerity era in Greece

Tsiakalakis

Golna²,

Dedes

et al. 2020

Preprint

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Background The ten-year economic crisis and the ensuing fiscal adjustment that Greece experienced between 2009 and 2018 has had a major impact on patient access to healthcare services and resulted in an increase in unmet population health needs. The present study assesses the impact of economic crisis and ensuing austerity on HIV patient access to healthcare services. Methods A cross-sectional study was carried out between February and April 2019 to assess barriers in access to HIV care faced by people living with HIV. 329 HIV-positive individuals participated in the study. An online, self-reporting questionnaire was developed on the basis of the HOPE studies tool (2,3,9,10) and adapted to the specific clinical and societal characteristics of HIV. Results 94.2% of respondents were male and 67.80% lived in Athens. Most of them were diagnosed with HIV 1 to 10 years ago. 37,40% of respondents reported obstacles in accessing HIV care over the past year, such as shortages in antiretroviral medicine, restricted opening hours of pharmacies and delays in booking an appointment with physicians. 24,30% reported they were not tested for viral load in the last six months and received a result. Individuals, who self-evaluate their financial status as very bad or bad, were more likely to be unaware of their viral load (55.60%) compared to individuals with better financial status (33,5%) (P<0.01). Only 33.3% of uninsured participants were aware of their viral load, and this figure rose to 63.30% (P <0.01) amongst insured participants. Conclusion Our study suggests that a critical proportion of HIV patients in Greece face significant barriers to receiving optimal HIV care, according to diagnostic and clinical guidelines. Financial and social insurance status are the main variables that impact on access, despite the comprehensive and universal NHS coverage of antiretroviral treatment and HIV monitoring. Reforming and integrating NHS service provision together with addressing social barriers and discrimination are critical to ensuring care is offered as per standards to all people living with HIV in Greece.

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“…The discontinuation of antiretroviral therapy (ART) due to loss to follow-up (LTFU) is still a big challenge for ART programmes in sub-Saharan Africa and is an obstacle for attainment of the second and third targets of the UNAIDS 90-90-90 HIV treatment targets (diagnosis of 90% of HIV-infected people, provision of treatment for 90% of people diagnosed with HIV, and viral undetectability in 90% of treated people) as it affects the sustainable treatment and virological success of people living with HIV (PLHIV) on ART [1,2]. So, identifying and re-engaging PLHIV lost to follow-up is necessary [3].…”

Section: Introductionmentioning

confidence: 99%

Re-engagement in care of people living with HIV lost to follow-up after initiation of antiretroviral therapy in Mali: Who returns to care?

Baldé¹,

Lièvre²,

Maïga³

et al. 2020

PLoS ONE

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Objectives We assessed cumulative incidence rates of and factors associated with re-engagement in HIV care for PLHIV lost to follow-up in Mali. Methods HIV-1-infected individuals lost to follow-up before 31/12/2013, � 18 years old, who started ART from 2006 to 2012 at one of 16 care centres were considered. Loss to follow-up (LTFU) was defined as an interruption of � 6 months during follow-up. The re-engagement in care in PLHIV lost to follow-up before 31/12/2013 was defined as having at least one clinical visit after LTFU. The cumulative incidence rates of re-engagement in care was estimated by Kaplan-Meier and its predictive factors were assessed using Cox models. Socio-demographic characteristics, clinical and immune status, period, region, centre expertise level, and distance from home at the start of ART plus a combined variable of duration of ART until LTFU and 12-month change in CD4 count were assessed. Multiple imputation was used to deal with missing data. Results We included 3,650 PLHIV lost to follow-up before December 2013, starting ART in nine outpatient clinics and seven hospitals (5+2 in Bamako and 4+5 in other regions): 35% male, median (IQR) age 35 (29-43), and duration of ART until LTFU 11 months (5-22). Among these PLHIV, 1,975 (54%) were definitively LTFU and 1,675 (46%) subsequently returned to care. The cumulative incidence rates of re-engagement in care rose from 39.0% at one

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Re-engagement in HIV Care: A Clinical and Public Health Priority

Cited by 17 publications

References 30 publications

Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

WITHDRAWN: HIV patient access to healthcare services in post-austerity era in Greece

Re-engagement in care of people living with HIV lost to follow-up after initiation of antiretroviral therapy in Mali: Who returns to care?

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