scholarly journals Routine HIV clinic visit adherence in the African Cohort Study

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Nicole Dear ◽  
Allahna Esber ◽  
Michael Iroezindu ◽  
Emmanuel Bahemana ◽  
Hannah Kibuuka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Virologic Failure ◽  
Clinical Care ◽  
Clinic Visit ◽  
People Living With Hiv ◽  
The Past ◽  
Visit Adherence ◽  
Missed Visits ◽  
History Of ◽  
Clinic Visits

Abstract Background Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS). Methods In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits. Results Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19). Conclusions Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

scholarly journals The SPARKLE registry: protocol for an international prospective cohort study in patients with alpha-mannosidosis

2020 ◽  
Author(s):  
Julia Hennermann ◽  
Nathalie Guffon ◽  
Federica Cattaneo ◽  
Ferdinando Ceravolo ◽  
Line Borgwardt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Natural History ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Care ◽  
Clinical Manifestations ◽  
Routine Clinical Care ◽  
Safety Outcomes ◽  
History Of

Abstract Background: Alpha-mannosidosis is a lysosomal storage disorder caused by reduced enzymatic activity of alpha-mannosidase. SPARKLE is an alpha-mannosidosis registry intended to obtain long-term safety and effectiveness data on the use of velmanase alfa during routine clinical care in patients with alpha-mannosidosis. It is a post-approval commitment to European marketing authorization for Velmanase alfa (Lamzede®), the first enzyme replacement therapy for the treatment of non-neurologic manifestations in patients with mild to moderate alpha-mannosidosis. In addition, SPARKLE will expand the current understanding of alpha-mannosidosis by collecting data on the clinical manifestations, progression, and natural history of the disease in treated and untreated patients, respectively.Results: The SPARKLE registry is designed as a multicenter, multinational, noninterventional, prospective cohort study of patients with alpha-mannosidosis, starting patient enrollment in 2020. Patients will be followed for up to 15 years. Safety and effectiveness as post-authorization outcomes under routine clinical care in patients with treatment will be evaluated. The primary safety outcomes are the rate of adverse events (anti-velmanase alfa-immunoglobulin G antibody development, infusion-related reactions, and hypersensitivity). Secondary safety outcomes include the evaluation of medical events, change in vital signs, laboratory tests, physical examination, and electrocardiogram results. The primary effectiveness outcome is a global treatment response rate, evaluated as the individual aggregate of single endpoints from pharmacodynamic, functional, and quality of life effectiveness outcomes; secondary effectiveness outcomes are to characterize the population of patients with alpha-mannosidosis with regard to clinical manifestation, progression, and natural history of the disease. Any patient in the European Union with a diagnosis of alpha-mannosidosis who is willing to participate will likely be eligible for inclusion in the registry. Publications to disseminate scientific insights from the registry are planned. Conclusion: This study will provide real-world data on the long-term safety and effectiveness of velmanase alfa in patients with alpha-mannosidosis during routine clinical care and increase the understanding of the natural course, clinical manifestations, and progression of this ultra-rare disease.

scholarly journals The SPARKLE registry: protocol for an international prospective cohort study in patients with alpha-mannosidosis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Julia B. Hennermann ◽  
Nathalie Guffon ◽  
Federica Cattaneo ◽  
Ferdinando Ceravolo ◽  
Line Borgwardt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Natural History ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Care ◽  
Clinical Manifestations ◽  
Routine Clinical Care ◽  
Safety Outcomes ◽  
History Of

Abstract Background Alpha-mannosidosis is a lysosomal storage disorder caused by reduced enzymatic activity of alpha-mannosidase. SPARKLE is an alpha-mannosidosis registry intended to obtain long-term safety and effectiveness data on the use of velmanase alfa during routine clinical care in patients with alpha-mannosidosis. It is a post-approval commitment to European marketing authorization for Velmanase alfa (Lamzede®), the first enzyme replacement therapy for the treatment of non-neurologic manifestations in patients with mild to moderate alpha-mannosidosis. In addition, SPARKLE will expand the current understanding of alpha-mannosidosis by collecting data on the clinical manifestations, progression, and natural history of the disease in treated and untreated patients, respectively. Results The SPARKLE registry is designed as a multicenter, multinational, noninterventional, prospective cohort study of patients with alpha-mannosidosis, starting patient enrollment in 2020. Patients will be followed for up to 15 years. Safety and effectiveness as post-authorization outcomes under routine clinical care in patients with treatment will be evaluated. The primary safety outcomes are the rate of adverse events (anti-velmanase alfa-immunoglobulin G antibody development, infusion-related reactions, and hypersensitivity). Secondary safety outcomes include the evaluation of medical events, change in vital signs, laboratory tests, physical examination, and electrocardiogram results. The primary effectiveness outcome is a global treatment response rate, evaluated as the individual aggregate of single endpoints from pharmacodynamic, functional, and quality-of-life effectiveness outcomes; secondary effectiveness outcomes are to characterize the population of patients with alpha-mannosidosis with regard to clinical manifestation, progression, and natural history of the disease. Any patient in the European Union with a diagnosis of alpha-mannosidosis who is willing to participate will likely be eligible for inclusion in the registry. Publications to disseminate scientific insights from the registry are planned. Conclusion This study will provide real-world data on the long-term safety and effectiveness of velmanase alfa in patients with alpha-mannosidosis during routine clinical care and increase the understanding of the natural course, clinical manifestations, and progression of this ultra-rare disease.

scholarly journals The Achilles’ Heel of HIV Treatment for Prevention

2011 ◽  
Vol 10 (6) ◽  
pp. 365-372 ◽  
Author(s):  
Seth C. Kalichman ◽  
Chauncey Cherry ◽  
Denise White ◽  
Mich'l Jones ◽  
Moira Kalichman
Keyword(s):  
Sexual Behaviors ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Sexually Transmitted ◽  
The Past ◽  
Younger Age ◽  
Transgender Persons ◽  
History Of ◽  
Living With Hiv

Background: Antiretroviral therapies (ARTs) offer promising new avenues for HIV prevention. Unfortunately, people infected with HIV who have co-occurring sexually transmitted infections (STIs) are more infectious than suggested by the amount of virus in their peripheral blood. We examined the history of sexually transmitted coinfections in people living with HIV. Methods: People living with HIV/AIDS completed confidential computerized interviews that assessed history of STI, sexual behaviors, and STI knowledge. Results: Among 414 men and 156 women currently receiving ART, 53% had been diagnosed with at least 1 STI since testing HIV positive; 24% women, 19% men, and 11% transgender persons had been diagnosed with an STI in the past year. History of STI was associated with younger age, greater STI knowledge, substance use, and ART nonadherence. Conclusions: Aggressive strategies for detecting and treating STI in people receiving ART will be necessary to achieve protective benefits.

scholarly journals Monthly or Weekly Supplementation with Cholecalciferol 20,000 IU in People Living with HIV: Results from a Nested Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Sebastian Noe ◽  
Christine I. Moeckel ◽  
Christiane Schwerdtfeger ◽  
Celia Oldenbuettel ◽  
Hans Jaeger ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cohort Study ◽  
Vitamin D Deficiency ◽  
Clinical Care ◽  
Daily Intake ◽  
Vitamin D Supplementation ◽  
People Living With Hiv ◽  
Weekly Dose ◽  
Wide Range ◽  
Living With Hiv

Background. There is still considerable uncertainty in handling vitamin D deficiency in people living with HIV (PLWH), due to a lack of comparative data and the wide range of recommended daily intake. Nondaily supplementation might be preferred in many PLWH, but recommendation on dosing has not been established. We aimed to compare the efficacy of weekly versus monthly supplementation with cholecalciferol 20,000 IU in a group of PLWH with vitamin D deficiency in Western Europe. Study Design. Longitudinal, retrospective nested cohort study of PLWH from two large clinical care centers in Munich, Germany. Results. Of 307 patients with vitamin D deficiency, 124 patients received vitamin D supplementation (weekly supplementation in 84 (67.7%)). 46.4% and 22.5% of patients achieved 25(OH)D levels ≥30 ng/mL after 12 months of weekly and monthly supplementation with cholecalciferol 20,000 IU, respectively (p=0.011). Dosing interval as well as 25(OH)D baseline levels >15 ng/mL were associated with the normalization of 25(OH)D. Conclusion. A higher rate of 25(OH)D level normalization can be achieved via weekly supplementation. For several PLWH, even a weekly dose of cholecalciferol 20,000 IU might not be adequate to maintain 25(OH)D levels >30 ng/mL without an initial “loading” dose. The response to supplementation is poorly predictable at an individual level.

scholarly journals Dinesh Bhugra: a personal history of Psychiatry

2019 ◽  
Vol 2 (1) ◽  
pp. 01-08 ◽  
Author(s):  
Dinesh Bhugra
Keyword(s):  
Clinical Care ◽  
International Medical Graduate ◽  
Personal History ◽  
Medical Graduate ◽  
The Past ◽  
Home Based ◽  
Personal Histories ◽  
History Of ◽  
Personal Accounts ◽  
And Training

AbstractIn the past 40 years, the practice of psychiatry has changed dramatically from asylums to community care to personalized home-based treatments. The personal history of working in various settings and changing NHS indicates that an ability to change one’s clinical practice is a critical skill. Being a migrant and an International Medical Graduate brings with it certain specific challenges. Personal histories provide a very specific account that is inherently incomplete and perhaps biased, but personal accounts also give history a tinge that academic accounts cannot. In this account, changes in the NHS have been discussed with regards to changes in clinical care of patients with psychiatric disorders as well as research and training.

scholarly journals Adherence to Hepatitis C Therapy in a Shelter-Based Education and Treatment Model among Persons Experiencing Homelessness

2021 ◽  
Author(s):  
Jesse Powell ◽  
Margaret Ricco ◽  
Jessica Naugle ◽  
Catherine Magee ◽  
Hayat Hassan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
San Francisco ◽  
Illicit Drugs ◽  
Clinic Visit ◽  
Homeless Shelters ◽  
Prior Therapy ◽  
The Past ◽  
Hcv Therapy ◽  
Visit Adherence ◽  
Active Alcohol

Abstract Background Medication adherence is a common reason for treatment deferment in persons experiencing homelessness. We evaluated adherence to HCV therapy following HCV education in a shelter-based care model. Methods Prospective study conducted at 4 homeless shelters in Minneapolis, MN and San Francisco, CA from 11/2018–1/2021. Sixty-three patients underwent HCV education and treatment. Multivariable modeling evaluated factors associated with (1) medication and (2) overall (composite score of medication, laboratory, and clinic visit) adherence. Results Median age was 56, 73% male, 43% Black, 52% had psychiatric illness, and 81% used illicit drugs and 60% used alcohol in the past year. Following education, 52% were extremely confident in their ability to be adherent to HCV therapy. Medication adherence by patient and provider report was 88% and 48% respectively and 81% achieved HCV cure. Active alcohol use was associated with less confidence in medication adherence (43% vs. 78%, P=0.04). Older age was positively (Coef=0.3) associated with overall adherence to HCV treatment while prior therapy was associated with both medication (OR=0.08) and overall treatment (Coef=-0.87) non-adherence. Conclusions Despite imperfect adherence, SVR rates were still high. Expanding opportunities to treat persons experiencing homelessness in a structured and supportive setting is critical to HCV elimination efforts.

scholarly journals Virologic Failure Among People Living With HIV Initiating Dolutegravir-Based Versus Other Recommended Regimens in Real-World Clinical Care Settings

2019 ◽  
Vol 81 (5) ◽  
pp. 572-577 ◽  
Author(s):  
Robin M. Nance ◽  
Vani Vannappagari ◽  
Kimberly Smith ◽  
Catherine B. Johannes ◽  
Brian Calingaert ◽  
...  
Keyword(s):  
Real World ◽  
Virologic Failure ◽  
Clinical Care ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Development and Validation of a Multivariable Prediction Model for Missed HIV Healthcare Provider Visits in a Large United States Clinical Cohort

2021 ◽  
Author(s):  
April C Pettit ◽  
Aihua Bian ◽  
Cassandra O Schember ◽  
Peter F Rebeiro ◽  
Jeanne C Keruly ◽  
...  
Keyword(s):  
Prediction Models ◽  
Community Level ◽  
Research Network ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Individual Level ◽  
Visit Adherence ◽  
Level Data ◽  
Missed Visits ◽  
The Individual

Abstract Background Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual-level. Methods We developed prediction models for missed visits among people living with HIV (PLWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010-2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site-level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed using random forests with 10-fold cross-validation; candidate models with highest area under the curve (AUC) were identified. Results Data from 382,432 visits among 20,807 PLWH followed for a median of 3.8 years were included; median age was 44 years, 81% were male, 37% were Black, 15% reported injection drug use, and 57% reported male-to-male sexual contact. The highest AUC was 0.76 and strongest predictors were at the individual-level (prior visit adherence, age, CD4+ count) and community-level (proportion living in poverty, unemployed, and of Black race). A simplified model, including readily accessible variables available in a web-based calculator, had a slightly lower AUC of 0.700. Conclusions Prediction models validated using multi-level data had a similar AUC to previous models developed using only individual-level data. Strongest predictors were individual-level variables, particularly prior visit adherence, though community-level variables were also predictive. Absent additional data, PLWH with previous missed visits should be prioritized by interventions to improve visit adherence.

scholarly journals No-Show Rates in Employed Otolaryngology Practice

2019 ◽  
pp. 014556131989315 ◽  
Author(s):  
Brett T. Comer ◽  
Lauren E. Harris ◽  
Caitlin E. Fiorillo ◽  
Thomas J. Gal ◽  
Allyson Hughes
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Clinic Visit ◽  
Insurance Type ◽  
Visit Adherence ◽  
Key Factor ◽  
Potential Improvement ◽  
The Impact ◽  
Clinic Visits

Objective: To report baseline no-show rates in the hospital-employed otolaryngology practice setting and to identify factors that may affect clinic show rates that are targets for potential improvement. Study Design: Retrospective chart review. Methods: Electronic medical records from October 2012 through July 2014 of a hospital-employed otolaryngology practice were reviewed. Patients were classified by insurance type: commercial, Medicare, Medicaid, and self-pay. Clinic visits were classified as new patient, follow-up, or postoperative. No-show rates were tabulated for each type of clinic visit and compared. Factors to improve no-show rates are discussed. Results: There was an overall no-show rate of 8.3% for 5817 scheduled clinic visits. Among visit types, follow-up visits had the highest no-show rates. Among insurance types, Medicaid had the highest no-show rates. New patient Medicaid patients, follow-up Medicaid patients, and follow-up commercial insurance patients had the highest rate of no-shows among visit/insurance type combinations. Persistent reminders are a key factor in improving rate of clinic visit adherence. Conclusion: A previously unreported baseline no-show rate was established for hospital-employed otolaryngology clinics. The utilization of repeated, live-person reminders to mitigate the impact of clinic no-show rates needs to be further investigated.

scholarly journals Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study

2020 ◽  
Vol 49 (5) ◽  
pp. 1572-1581
Author(s):  
Jinqiu Yuan ◽  
Yanhong Jessika Hu ◽  
Jie Zheng ◽  
Jean Hee Kim ◽  
Tim Sumerlin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Family History ◽  
Antibiotic Use ◽  
Family History Of Diabetes ◽  
The Past ◽  
Increased Risk ◽  
History Of

Abstract Background Accumulating evidence suggested that long-term antibiotic use may alter the gut microbiome, which has, in turn, been linked to type 2 diabetes. We undertook this study to investigate whether antibiotic use was associated with increased risk of type 2 diabetes. Methods This prospective cohort study included women free of diabetes, cardiovascular disease and cancer in the Nurses’ Health Study (NHS 2008–2014) and NHS II (2009–2017). We evaluated the overall duration of antibiotics use in the past 4 years and subsequent diabetes risk with Cox proportional-hazards regression adjusting for demography, family history of diabetes and lifestyle factors. Results Pooled analyses of NHS and NHS II (2837 cases, 703 934 person-years) revealed that a longer duration of antibiotic use in the past 4 years was associated with higher risk of diabetes [Trend-coefficient = 0.09, 95% confidence interval (CI) 0.04 to 0.13]. Participants who received antibiotics treatment for a medium duration of 15 days to 2 months [hazard ratio (HR) 1.23, 95% CI 1.10 to 1.39] or long duration of &gt;2 months (HR 1.20, 95% CI 1.02 to 1.38) had higher risk of type 2 diabetes as compared with non-users. Subgroup analyses suggested that the associations were unlikely to be modified by age, family history of diabetes, obesity, smoking, alcohol drinking, physical activity and overall diet quality. Conclusions A longer duration of antibiotic use in recent years was associated with increased risk of type 2 diabetes in women. Physicians should exercise caution when prescribing antibiotics, particularly for long-term use.

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