scholarly journals Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011–2017)

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Nang Thu Thu Kyaw ◽  
Srinath Satyanarayana ◽  
Htun Nyunt Oo ◽  
Ajay M V Kumar ◽  
Anthony D Harries ◽  
...  
Keyword(s):  
Hiv Care ◽  
People Living With Hiv ◽  
Spline Regression ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Need To Evaluate ◽  
Glycemic Targets ◽  
Living With Hiv ◽  
The Relationship ◽  
Tuberculosis Disease

Abstract Background There is limited empirical evidence on the relationship between hyperglycemia, tuberculosis (TB) comorbidity, and mortality in the context of HIV. We assessed whether hyperglycemia at enrollment in HIV care was associated with increased risk of all-cause mortality and whether this relationship was different among patients with and without TB disease. Methods We conducted a retrospective analysis of adult (≥15 years) HIV-positive patients enrolled into HIV care between 2011 and 2016 who had random blood glucose (RBG) measurements at enrollment. We used hazards regression to estimate associations between RBG and rate of all-cause mortality. Results Of 25 851 patients, 43% were female, and the median age was 36 years. At registration, the median CD4 count (interquartile range [IQR]) was 162 (68–310) cell/mm3, the median RBG level (IQR) was 88 (75–106) mg/dL, and 6.2% (95% confidence interval [CI], 6.0%–6.5%) had hyperglycemia (RBG ≥140 mg/dL). Overall 29% of patients had TB disease, and 15% died during the study period. The adjusted hazard of death among patients with hyperglycemia was significantly higher (adjusted hazard ratio [aHR], 1.2; 95% CI, 1.1–1.4) than among those with normoglycemia without TB disease, but not among patients with TB disease (aHR, 1.0; 95% CI, 0.8–1.2). Using 4 categories of RBG and restricted cubic spline regression, aHRs for death were significantly increased in patients with RBG of 110–140 mg/dL (categorical model: aHR, 1.3; 95% CI, 1.2–1.4; restricted spline: aHR, 1.1; 95% CI, 1.0–1.1) compared with those with RBG <110 mg/dL. Conclusions Our findings highlight an urgent need to evaluate hyperglycemia screening and diagnostic algorithms and to ultimately establish glycemic targets for PLHIV with and without TB disease.

scholarly journals Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Juan Ignacio García ◽  
Edson Mambuque ◽  
Dinis Nguenha ◽  
Faustino Vilanculo ◽  
Charfudin Sacoor ◽  
...  
Keyword(s):  
Incidence Rates ◽  
Hiv Care ◽  
Health Concern ◽  
People Living With Hiv ◽  
All Cause Mortality ◽  
Diagnostic Work ◽  
Associated Risk Factors ◽  
Linkage To Hiv Care ◽  
Living With Hiv ◽  
Incident Cases

Abstract Tuberculosis (TB) misdiagnosis remains a public health concern, especially among people living with HIV (PLHIV), given the high mortality associated with missed TB diagnoses. The main objective of this study was to describe the all-cause mortality, TB incidence rates and their associated risk factors in a cohort of PLHIV with presumptive TB in whom TB was initially ruled out. We retrospectively followed a cohort of PLHIV with presumptive TB over a 2 year-period in a rural district in Southern Mozambique. During the study period 382 PLHIV were followed-up. Mortality rate was 6.8/100 person-years (PYs) (95% CI 5.2–9.2) and TB incidence rate was 5.4/100 PYs (95% CI 3.9–7.5). Thirty-six percent of deaths and 43% of TB incident cases occurred in the first 12 months of the follow up. Mortality and TB incidence rates in the 2-year period after TB was initially ruled out was very high. The TB diagnostic work-up and linkage to HIV care should be strengthened to decrease TB burden and all-cause mortality among PLHIV with presumptive TB.

scholarly journals Corrigendum: Hyperglycemia and Risk of All-cause Mortality Among People Living With HIV With and Without Tuberculosis Disease in Myanmar (2011–2017)

2019 ◽  
Vol 6 (4) ◽  
Author(s):  
Nang Thu Thu Kyaw ◽  
Srinath Satyanarayana ◽  
Htun Nyunt Oo ◽  
Ajay M V Kumar ◽  
Anthony D Harries ◽  
...  
Keyword(s):  
People Living With Hiv ◽  
All Cause Mortality ◽  
Living With Hiv ◽  
Tuberculosis Disease

scholarly journals “It's Almost Like a Crab-in-a-Barrel Situation”: Stigma, Social Support, and Engagement in Care Among Black Men Living With HIV

2018 ◽  
Vol 30 (2) ◽  
pp. 120-136 ◽  
Author(s):  
Katherine Quinn ◽  
Julia Dickson-Gomez ◽  
Michelle Broaddus ◽  
Jeffrey A. Kelly
Keyword(s):  
Social Support ◽  
African American ◽  
Black Men ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Engagement In Hiv Care ◽  
And Coping ◽  
Living With Hiv ◽  
Support Relationships ◽  
The Relationship

Social support is associated with improved health outcomes for people living with HIV (PLWH), including initiation and engagement in HIV care and antiretroviral therapy (ART) adherence. Yet, stigma may negatively affect the availability and utilization of social support networks, especially among African American PLWH, subsequently impacting HIV care and health out-comes. This qualitative study examines the relationship between stigma and social support relationships among African American PLWH. We conducted 23 interviews with Black men living with HIV who reported being out of care or non-adherent to ART. Thematic content analysis revealed three primary themes including variation in social support, experiences of stigma and discrimination, and coping mechanisms used to deal with stigma. Findings reveal that although social support may be protective for some men, many African American PLWH face challenges in harnessing and sustaining needed social support, partly due to stigma surrounding HIV and homo-sexuality.

scholarly journals Assessment of the tuberculosis case-finding and prevention cascade among people living with HIV in Zambia – 2018: a cross-sectional cluster survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Melgar ◽  
Ray W. Shiraishi ◽  
Clifford Tende ◽  
Sydney Mwanza ◽  
Joyce Mulenga ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Case Finding ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Tuberculosis Case ◽  
Initiation Rate ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Living With Hiv ◽  
Tuberculosis Disease

Abstract Background The Ministry of Health Zambia recommends tuberculosis preventive treatment (TPT) with 6 months daily isoniazid for all people living with human immunodeficiency virus (HIV) after ruling out active tuberculosis disease. We sought to estimate the percentage of people living with HIV who progress through each stage of the tuberculosis case-finding and prevention cascade in two provinces with the highest tuberculosis burden in Zambia. Methods In this cross-sectional survey, we used a two-stage cluster sampling method. We sampled 12 healthcare facilities with probability proportional to size. Patient volume determined facility cluster size. During October 2018, from each facility we systematically sampled medical records of adults and children living with HIV. Our primary outcome of interest was TPT initiation rate among eligible people living with HIV, weighted for complex survey design. The Rao-Scott adjusted chi-square test was used to test for differences in TPT initiation rate and other indicators from the tuberculosis prevention cascade by age group and province of residence. Additionally, we conducted semi-structured interviews with healthcare workers at each facility to assess TPT knowledge and identify challenges to its implementation. Results We sampled 482 records of people living with HIV (including 128 children living with HIV). Excluding two people diagnosed with tuberculosis disease before enrollment in HIV care, 93.4% underwent tuberculosis symptom screening. Of those, 4.7% were diagnosed with tuberculosis disease and 95.3% were TPT-eligible, of whom 24.7% initiated TPT. TPT initiation was lower among eligible children (7.7%) compared with adults (25.2%, p = 0.03) and Copperbelt residents (3.1%) compared with Lusaka residents (35.8%, p < 0.01). TPT completion rate was 38.4% among people living with HIV who initiated the 6-month course. Among interviewed healthcare workers, 58.3% (unweighted) incorrectly relayed the number of symptoms needed for a positive tuberculosis symptom screen, 83.3% (unweighted) reported insufficient isoniazid stockpile for completion at the time of TPT initiation, and only 27.3% (unweighted) reported receiving TPT-specific training. Conclusions TPT uptake among people living with HIV in Zambia is challenged by inconsistent tuberculosis screening, lack of TPT training for healthcare workers, and supply chain inefficiencies. Addressing these barriers may increase TPT initiations and improve outcomes among people living with HIV.

scholarly journals Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality—a multicentre prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christian Kraef ◽  
Adrian Bentzon ◽  
Alexander Panteleev ◽  
Alena Skrahina ◽  
Natalie Bolokadze ◽  
...  
Keyword(s):  
Weight Loss ◽  
Eastern Europe ◽  
Delayed Diagnosis ◽  
Hazard Ratio ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Risk Of Death ◽  
Increased Risk ◽  
Persons Living With Hiv ◽  
Living With Hiv

Abstract Background Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18–5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21–2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24–2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10–2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18–2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04–1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95–1.70; p = 0.103). Conclusion Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe.

Living with HIV in the Time of COVID-19

2020 ◽  
Vol 10 (1) ◽  
pp. 5-7
Author(s):  
Muhammad Naveed Noor
Keyword(s):  
Medical Care ◽  
Developing Country ◽  
People Living With Hiv ◽  
Evidence Based ◽  
Comorbid Conditions ◽  
Increased Risk ◽  
Associated Conditions ◽  
Living With Hiv

This commentary foregrounds the need to examine how the coronavirus disease 2019 (COVID-19) pandemic and associated conditions may be affecting the lives of people living with HIV (PLWH) in a developing country context like Pakistan. It raises some important questions on medical care and updated information regarding PLWH in the time of COVID-19. Since PLWH are at an increased risk of developing comorbid conditions – something that makes them more vulnerable to COVID-19 – it is critical that timely research and evidence-based actions are undertaken to protect their health.

Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajendra Bhati ◽  
Pramendra Sirohi ◽  
Bharat Sejoo ◽  
Deepak Kumar ◽  
Gopal K Bohra ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
North West ◽  
Cryptococcal Disease ◽  
Increased Risk ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

2019 ◽  
Author(s):  
Jenevieve Opoku ◽  
Rupali K Doshi ◽  
Amanda D Castel ◽  
Ian Sorensen ◽  
Michael Horberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Care ◽  
Disease Stage ◽  
People Living With Hiv ◽  
Hiv Disease ◽  
Persons Living With Hiv ◽  
Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, <i>P</i>&lt;.001) but more likely to be black (82.3% vs 69.5%, <i>P</i>&lt;.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, <i>P</i>&lt;.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, <i>P</i>&lt;.001), have a CD4 &lt;200 cells/µL in 2017 (6.2% vs 4.6%, <i>P</i>&lt;.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, <i>P</i>&lt;.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon

2021 ◽  
Author(s):  
Angela M. Parcesepe ◽  
Molly Remch ◽  
Anastase Dzudie ◽  
Rogers Ajeh ◽  
Denis Nash ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

2021 ◽  
Author(s):  
Tiago Rua ◽  
Daniela Brandão ◽  
Vanessa Nicolau ◽  
Ana Escoval
Keyword(s):  
Positive Impact ◽  
Cost Effective ◽  
Relative Magnitude ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Continuum Of Care ◽  
Clinical Conditions ◽  
Study Designs ◽  
Living With Hiv ◽  
Payment Models

AbstractThe increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system’s financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.

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