Strengthening the HIV Care Continuum in the Dominican Republic: Application of a Triadic Implementation Framework to Meet the UNAIDS 90-90-90 Treatment Goal

Bowman, Alex S.; Mehta, Mili; Nadal, Leonel Lerebours; Halpern, Mimi; Nicholas, Stephen W.; Amesty, Silvia

doi:10.1089/apc.2017.0118

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…24 Similarly, a recent study conducted in the Dominican Republic showed how an enhanced program that included adherence counseling in addition to an outreach program can result in improvements in viral suppression. 25 Future studies should address if these same interventions are feasible and efficient in other settings.…”

Section: Figmentioning

confidence: 99%

Early Retention in Care Neither Mediates Nor Modifies the Effect of Sex and Sexual Mode of HIV Acquisition on HIV Survival in the Americas

Coelho

Rebeiro

Castilho

et al. 2018

AIDS Patient Care and STDs

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Early retention in care, sex, and sexual mode of HIV acquisition has been associated with mortality risk among persons living with HIV (PLWH). We assessed whether early retention in care mediates or modifies the association between mortality and sex and sexual mode of HIV acquisition among PLWH on antiretroviral therapy (ART) in the Americas. ART-naïve, adult PLWH (≥18 years) enrolling at Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and Vanderbilt Comprehensive Care Clinic sites 2000-2015, starting ART, and with ≥1 visit after ART-start were included. Early retention in care was defined as ≥2 HIV care visits/labs ≥90 days apart in the first year of ART. Cox models assessed the association between early retention in care, sex, and sexual mode of HIV acquisition [i.e., women, heterosexual men and men who have sex with men (MSM)], and mortality. Associations were estimated separately by site and pooled. Among 11,721 included PLWH (median follow-up, 4.3 years; interquartile range, 2.0-7.6), 647 died (rate = 10.9/1000 person-years) and 1985 were lost to follow-up (rate = 33.6/1000 person-years). After adjustment for confounders, early retention in care was associated with lower mortality during subsequent years (pooled hazard ratio = 0.47; 95% confidence interval = 0.39-0.57). MSM had lower and heterosexual men had comparable mortality risk to women; risks were similar when adjusting for early retention in care. Additionally, no evidence of an interaction between early retention in care and sex and sexual mode of HIV acquisition on mortality was observed (p > 0.05). Early retention in care substantially reduced mortality but does not mediate or modify the association between sex and sexual mode of HIV acquisition and mortality in our population.

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Section: Figmentioning

confidence: 99%

Early Retention in Care Neither Mediates Nor Modifies the Effect of Sex and Sexual Mode of HIV Acquisition on HIV Survival in the Americas

Coelho

Rebeiro

Castilho

et al. 2018

AIDS Patient Care and STDs

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“…Of 310 patients diagnosed with HIV during 2013, 73% enrolled in care, 28% were retained in care, and 16% achieved viral load suppression. 6 Though these numbers are better than the 4% viral suppression observed in 2011, the numbers remain concerning. Understanding why those who are diagnosed and linked to care but do not achieve viral suppression is key to ending the HIV epidemic in this setting.…”

Section: Introductionmentioning

confidence: 94%

Barriers to HIV treatment adherence among adults living with HIV in the eastern Dominican Republic

Bast

Stonbraker²,

Halpern³

et al. 2021

Int J STD AIDS

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Despite access to nationally supplied antiretroviral treatment, viral load suppression rates remain suboptimal in the Dominican Republic. Counseling and support services are available but mainly targeted to those identified as having the most need. At Clínica de Familia La Romana (CFLR) in La Romana, all patients undergo a structured baseline interview including exploration of expected barriers to care. We conducted a retrospective cohort study of a random sample of patients at CFLR with treatment initiation between 1 January 2015 and 1 December 2017 to determine if self-identified barriers to HIV care predict viral load suppression. Viral load suppression occurred in 63% of the 203 patients evaluated. Lack of food ( n = 19) was significantly associated with lack of viral suppression (OR 3.0, 95% CI 1.14–7.87). Nondisclosure of HIV status ( n = 24) showed evidence for a protective effect (OR 0.33; 95% CI 0.11–1.0). Further steps should be taken to address food insecurity as well as to understand associated barriers to care among individuals with food insecurity.

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“…In addition to the large-scale clinical trials of TasP described above, there have been an increasing number of studies examining the process of implementation of the 90-90-90 goals. 58-62 Such studies are an anchor of HIV implementation science efforts and we highlight three of the larger such studies—MaxART 63 in Swaziland, Project Shikamana 64 in Tanzania, and the SAPPH-IRe intervention in Zimbabwe. 65…”

Section: -90-90 Implementation Studiesmentioning

confidence: 99%

Treatment as Prevention: Concepts and Challenges for Reducing HIV Incidence

Brault

Spiegelman

Hargreaves

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Four of the largest HIV prevention trials have been conducted in sub-Saharan Africa, enrolling hundreds of thousands of participants in catchment areas of millions of people. The trials have focused on community-level interventions to increase diagnosis and initiation of antiretroviral therapy (ART) in order to improve health and reduce HIV transmission. Universal test-and-treat strategies are deployed to achieve viral suppression thereby reducing risk to uninfected persons, known as treatment-as-prevention (TasP). Purpose: We review the work that found HIV plasma load to correlate with transmission risk, demonstrated that ART could reduce genital tract viral expression, and showed early treatment to be beneficial for persons living with HIV and that HIV-uninfected sexual partners were protected from infection. We review the seemingly inconsistent findings of the major TasP trials: The TasP (ANRS 12249) study in South Africa, the SEARCH trial in Kenya and Uganda, the Botswana Combination Prevention Project (BCPP) Ya Tsie study, and the HIV Prevention Trials Network (HPTN) 071 (PopART) trial in Zambia and South Africa. Findings: All the trials reinforce the critical need to identify approaches to optimize programs and incentivize uptake and engagement in HIV testing and ART-based care in ways that consistently reduce HIV transmission. That other chronic conditions can be screened for and treated in the same infrastructures suggests added value of HIV investments. Conclusion: Implementation challenges are a principal frontier in the global struggle to reduce HIV transmission and mortality using TasP, complementing efforts to find a cure for HIV and an effective, deployable vaccine.

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Strengthening the HIV Care Continuum in the Dominican Republic: Application of a Triadic Implementation Framework to Meet the UNAIDS 90-90-90 Treatment Goal

Cited by 6 publications

References 22 publications

Early Retention in Care Neither Mediates Nor Modifies the Effect of Sex and Sexual Mode of HIV Acquisition on HIV Survival in the Americas

Early Retention in Care Neither Mediates Nor Modifies the Effect of Sex and Sexual Mode of HIV Acquisition on HIV Survival in the Americas

Barriers to HIV treatment adherence among adults living with HIV in the eastern Dominican Republic

Treatment as Prevention: Concepts and Challenges for Reducing HIV Incidence

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