'Seek, test and treat' slows HIV

Hayden, Erika Check

doi:10.1038/4631006a

Cited by 19 publications

(11 citation statements)

References 3 publications

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“…Together, these suggest that clinicians should not make decisions on whether to initiate eligible HIV-positive individuals in ART based solely on abstinence from drug injecting. Rather, in accordance with recently revised therapeutic guidelines from major medical and HIV policy organizations [24, 25], and in light of efforts to increase ART initiation and retention among marginalized populations such as IDU [8, 9], decisions to enroll eligible individuals on ART should be done on a case by case basis. In all cases, however, care should be taken to ensure high levels of ART regimen adherence among individuals that may be at particularly high risk of non-compliance [25].…”

Section: Discussionmentioning

confidence: 99%

“…While these strategies have demonstrated promise in reducing HIV transmission, however, limited data exist to guide optimal strategies to retain IDU on ART [8]. A key concern among clinicians is the potential that an aggressive rollout of ART among IDU populations, as suggested by UNAIDS [9], may result in suboptimal retention in treatment and a subsequent proliferation of ART resistance, especially among individuals who continue to inject drugs after enrolment in ART [10–14].…”

Section: Introductionmentioning

confidence: 99%

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Injection Drug Use and HIV Antiretroviral Therapy Discontinuation in A Canadian Setting

et al. 2012

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We investigated whether drug-related behaviors predicted antiretroviral therapy (ART) discontinuation among a cohort of injection drug users (IDU) in a Canadian setting. Cox regression analyses were used to investigate the impact of drug use patterns on rates of ART discontinuation among a sample of HIV-positive IDU in Vancouver, Canada between May 1996 and April 2008. In total, 408 HIV-positive IDU initiated ART during the study period, among whom 257 (63.0%) discontinued ART at least once. Rates of ART discontinuation were not significantly elevated among those who reported ongoing injection of heroin, cocaine, or other illicit drugs in comparison to those who reported not injecting drugs. However, public drug use was significantly predictive of ART discontinuation. Our findings may contribute to a reconsideration of the role of active drug use in determining retention in ART programs among IDU.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Injection Drug Use and HIV Antiretroviral Therapy Discontinuation in A Canadian Setting

et al. 2012

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“…In response, the HIV “Seek, Test, Treat, and Retain,” (STTR) strategy, in which infected individuals are identified through HIV testing and then engaged in ongoing treatment and counseling, has been advocated as an approach to reduce the transmission rate of HIV, slowing the spread of the epidemic (Hayden, 2010). A pillar of the strategy is employment of HIV testing among high risk, hard to reach, and often times vulnerable populations, including criminal justice-involved populations (National Institutes for Health, 2010).…”

Section: Introductionmentioning

confidence: 99%

Opt-out HIV testing in prison: informed and voluntary?

et al. 2014

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HIV testing in prison settings has been identified as an important mechanism to detect cases among high-risk, underserved populations. Several public health organizations recommend that testing across healthcare settings, including prisons, be delivered in an opt-out manner. However, implementation of opt-out testing within prisons may pose challenges in delivering testing that is informed and understood to be voluntary. In a large state prison system with a policy of voluntary opt-out HIV testing, we randomly sampled adult prisoners in each of seven intake prisons within two weeks after their opportunity to be HIV tested. We surveyed prisoners’ perception of HIV testing as voluntary or mandatory and used multivariable statistical models to identify factors associated with their perception. We also linked survey responses to lab records to determine if prisoners’ test status (tested or not) matched their desired and perceived test status. Thirty eight percent (359/936) perceived testing as voluntary. The perception that testing was mandatory was positively associated with age less than 25 years (adjusted relative risk [aRR]: 1.45, 95% CI: 1.24, 1.71) and preference that testing be mandatory (aRR: 1.81, 95% CI: 1.41, 2.31), but negatively associated with entry into one of the intake prisons (aRR: 0.41 95% CI: 0.27, 0.63). Eighty-nine percent of prisoners wanted to be tested, 85% were tested according to their wishes, and 82% correctly understood whether or not they were tested. Most prisoners wanted to be HIV tested and were aware that they had been tested, but less than 40% understood testing to be voluntary. Prisoners’ understanding of the voluntary nature of testing varied by intake prison and by a few individual-level factors. Testing procedures should ensure that opt-out testing is informed and understood to be voluntary by prisoners and other vulnerable populations.

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“…The success of ART in reducing HIV incidence in serodiscordant couples (Cohen et al, 2011) generated hope that HIV epidemics could be controlled and reversed through the use of HIV treatment as prevention (Branson, Viall, & Marum, 2013; Granich, Williams, & Montaner, 2013). This approach involves aggressive campaigns to test more people for HIV (particularly those at highest risk), link people who are HIV positive to treatment, and retain them in treatment (Check Hayden, 2010; Hull, Wu, & Montaner, 2012). High levels of ART adherence are required to achieve undetectable HIV viral loads(Kilmarx & Mutasa-Apollo, 2013) in people who are being treated.…”

Section: Introductionmentioning

confidence: 99%

Alcohol and drug use outcomes among vulnerable women living with HIV: results from the Western Cape Women's Health CoOp

et al. 2014

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Alcohol and other drug use can negatively affect adherence to and retention in antiretroviral therapy (ART) among people living with HIV. Yet, there are few brief interventions that reduce these behaviors among this population. This article presents the findings from a randomized field experiment that assessed the effects of a woman-focused intervention (the Women’s Health CoOp [WHC]) on reducing alcohol and other drug use among vulnerable women in Cape Town, South Africa. The analyses were limited to 84 women living with HIV who reported drinking alcohol at baseline. Because of the small sample size, analyses were performed using an exact logistic regression procedure. At 12-month follow-up, women in the WHC arm were more likely to be abstinent from alcohol (Odds Ratio [OR] = 3.61; 95% Confidence Intervals [CI] = 1.23, 11.70; p = 0.016) and somewhat more likely to test negative for other drugs (OR = 3.07; 95% CI = 0.83,12.31; p = 0.105), compared with women in the comparison arms. This study provides preliminary evidence of the efficacy of a brief, woman-focused intervention in reducing alcohol and other drug use among vulnerable women living with HIV and it has implications for HIV treatment.

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'Seek, test and treat' slows HIV

Cited by 19 publications

References 3 publications

Injection Drug Use and HIV Antiretroviral Therapy Discontinuation in A Canadian Setting

Injection Drug Use and HIV Antiretroviral Therapy Discontinuation in A Canadian Setting

Opt-out HIV testing in prison: informed and voluntary?

Alcohol and drug use outcomes among vulnerable women living with HIV: results from the Western Cape Women's Health CoOp

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