Viral Suppression Rates Research Articles

Moderating effects of social support on the relationship between substance use disorders and HIV viral load and medication adherence among Black women living with HIV in the United States

ABSTRACT Substance use may predict lower rates of antiretroviral therapy (ART) adherence and viral suppression among Black Women Living with HIV (BWLWH). We assessed how perceived social support (PSS) moderates the relationship between substance use disorder (SUD) and viral load (VL) and ART adherence. 119 BWLWH provided information on PSS, SUD, alcohol use disorder (AUD) and adherence (via Wisepill). Higher PSS from friends (β = −.263, p = .008) and significant others (β = −.219, p = .025) predicted lower VL. SUD predicted low Wisepill adherence (a) in the past week (β = −.273, p = .035) and past two weeks (β = −.273, p = .033) only for women low in PSS from friends, and (b) in the past two weeks only for women low in total PSS (β = −.294, p = .024). Ironically, for women high in total PSS, SUD predicted higher adherence in the past four weeks (β = .360, p = .006). Adherence and VL may be bolstered by understanding the role of various forms of PSS and SUDs.

Prevention and control of HIV/AIDS in China: lessons from the past three decades.

In the past 37 years, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has undergone various major transmission routes in China, with the world most complex co-circulating HIV-1 subtypes, even the prevalence is still low. In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection, China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing, which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection. China has been providing free antiretroviral therapy (ART) since 2003, which covered >80% of the identified patients and achieved a viral suppression rate of 91%. To bend the curve of increasing the disease burden of HIV and finally end the epidemic, China should consider constraining HIV spread through sexual transmission, narrowing the gaps in identifying HIV cases, and the long-term effectiveness and safety of ART in the future.

Structural Syndemics and Antiretroviral Medication Adherence Among Black Sexual Minority Men Living With HIV.

Background:Although HIV antiretroviral treatment (ART) access and uptake have increased among racial/ethnic minority individuals, lower rates of ART adherence and viral suppression persist, especially among Black men who have sex with men (BMSM) compared with their White counterparts.Setting:Black men who have sex with men living with HIV (BMSM+) residing in Los Angeles County (N = 124) were recruited in-person (eg, clinic) and online (eg, social networking apps).Methods:Participants completed a cross-sectional survey measuring demographic characteristics, structural syndemics (poverty, criminal justice involvement, and housing instability), and psychosocial syndemics (mental health and substance use). A text message survey assessed missed doses of ART over the past week. Zero-inflated Poisson regression models were used to evaluate variables associated with the number of missed doses of ART.Results:On average, participants missed 1.30 doses of ART (SD = 2.09) and reported structural syndemics: poverty (56.1%), criminal justice involvement (36.6%), housing instability (26.3%), and psychosocial syndemics: childhood sexual abuse (51.8%), intimate partner violence (16.9%), depression (39%), and problem alcohol use (15.5%). After controlling for employment, age, education, and psychosocial syndemics, participants with a one-point increase in structural syndemic indicators were found to be 1.63 times more likely to have missed a dose of ART.Conclusions:Structural syndemic were associated with ART nonadherence among BMSM+ after adjusting for demographic and psychosocial factors. HIV treatment interventions that incorporate financial incentives, legal support, and housing may help improve ART adherence among BMSM+. Findings suggest that key priorities to ending the HIV epidemic must include structural interventions that alleviate poverty, eliminate disproportionate policing and criminalization, and end homelessness.

Outcomes After Switching to BIC/FTC/TAF in Patients with Virological Failure to Protease Inhibitors or Non-Nucleoside Reverse Transcriptase Inhibitors: A Real-World Cohort Study.

PurposeThis study evaluated the real-world tolerability and treatment effectiveness of BIC/FTC/TAF in treatment-experienced patients living with HIV-1 in Taiwan, especially in those with viremia at switch.Patients and MethodsThis was a retrospective cohort study of adult patients in Taiwan with HIV-1 who received BIC/FTC/TAF from between November 2019 and November 2020. The primary endpoint was the rate of viral suppression (plasma HIV RNA load <50 copies/mL) while on BIC/FTC/TAF. The secondary endpoints included durability of treatment, incidence of and reasons for discontinuation of BIC/FTC/TAF, and changes in weight and lipid profiles.ResultsA total of 175 patients were switched to BIC/FTC/TAF. Among them, 74 patients (42%) were using INSTI based regimen, 34 patients (19%) NNRTI based regimen and 65 patients (37%) with PI based regimen before switching. Before starting BIC/FTC/TAF, 84.6% of the patients were virologically suppressed, of whom 97.3% maintained suppression while on BIC/FTC/TAF. Overall, 15.4% of the patients (n=27) had a detectable viral load before BIC/FTC/TAF, of whom 81.5% achieved and maintained virologic suppression on BIC/FTC/TAF during follow-up. Only two patients discontinued BIC/FTC/TAF due to adverse events, with rash being the predominant cause. By month 12, the median changes in weight was +4 kg (IQR, −1.8 to 8.2). There were no significant differences from baseline to the end of follow-up in triglycerides (p = 0.07), total cholesterol (p = 0.92), LDL-C (p = 0.12), and HDL-C (p = 0.053).ConclusionThe results of this real-world cohort study suggest that switching to BIC/FTC/TAF may be an option to achieve and maintain virological suppression, even in patients with residual viremia at baseline. Our results also demonstrated a low discontinuation rate, a moderate gain in weight, and no significant increases in lipid levels with BIC/FTC/TAF. However, studies with larger sample sizes are warranted to evaluate the clinical implications of our findings.

Two-fold increase in the HIV viral load suppression rate along with decreased incidence over six years in Ndhiwa sub-county, Kenya.

BackgroundHIV‐positive individuals who maintain an undetectable viral load cannot transmit the virus to others. In 2012, an HIV population‐based survey was conducted in Ndhiwa sub‐county (Kenya) to provide information on the HIV local epidemic. We carried out a second survey 6 years after the first one, to assess progress in HIV diagnosis and care and differences in the HIV prevalence and incidence between the two surveys.MethodsA cross‐sectional, population‐based survey using cluster sampling and geospatial random selection was implemented in 2018, using the same design as 2012. Consenting participants aged 15–59 years were interviewed and tested for HIV at home. HIV‐positive individuals received viral load testing (viral suppression defined as <1000 copies/ml) and Lag‐Avidity EIA assay (to measure recent infection). The 90–90–90 UNAIDS indicators were also assessed.ResultsOverall, 6029 individuals were included in 2018. HIV prevalence was 16.9%. Viral suppression among all HIV‐positive was 88.3% in 2018 (vs. 39.9% in 2012, p < 0.001). HIV incidence was 0.75% in 2018 vs. 1.90% in 2012 (p = 0.07). In 2018, the 90–90–90 indicators were 93%–97%–95% (vs. 60%–68%–83% in 2012).ConclusionA two‐fold increase in the HIV viral load suppression rate along with a decreasing trend in incidence was observed over 6 years in Ndhiwa sub‐county. Achieving high rates of viral suppression in HIV populations that can lead to reducing HIV transmission in sub‐Saharan contexts is feasible. Nevertheless, we will need further efforts to sustain this progress.

The HIV Treat Pillar: An Update and Summary of Promising Approaches

The Treat pillar of the Ending the HIV Epidemic in the U.S. plan calls for comprehensive strategies to enhance linkage to, and engagement in, HIV medical care to improve viral suppression among people with HIV and achieve the goal of 95% viral suppression by 2025. The U.S. has seen large increases in the proportion of people with HIV who have a suppressed viral load. Viral suppression has increased 41%, from 46% in 2010 to 65% in 2018. An additional increase of 46% is needed to meet the Ending the HIV Epidemic in the U.S. goal. The rate of viral suppression among those in care increased to 85% in 2018, highlighting the need to ensure sustained care for people with HIV. Greater increases in all steps along the HIV care continuum are needed for those disproportionately impacted by HIV, especially the young, sexual and racial/ethnic minorities, people experiencing homelessness, and people who inject drugs. Informed by systematic reviews and current research findings, this paper describes more recent promising practices that suggest an impact on HIV care outcomes. It highlights rapid linkage and treatment interventions; interventions that identify and re-engage people in HIV care through new collaborations among health departments, providers, and hospital systems; coordinated care and low-barrier clinic models; and telemedicine-delivered HIV care approaches. The interventions presented in this paper provide additional approaches that state and local jurisdictions can use to reach their local HIV elimination plans' goals and the ambitious Ending the HIV Epidemic in the U.S. Treat pillar targets by 2030.

Efficacy and Safety of Triple versus Dolutegravir-based Dual Therapy in Patients with HIV-1 Infection: A Meta-analysis of Randomized Controlled Trials.

A new strategy of simplification therapy shown the unique benefits in clinical treatment, by reducing pill burden and avoid drug exposure. To provide more evidence for the strategy, we compared the efficacy and safety of dolutegravir (DTG)-containing simplified dual combination antiretroviral therapy (cART) and traditional triple cART for people living with HIV/AIDS. The meta-analysis of randomized controlled trials compared DTG-containing dual therapy with triple cART. The primary outcome was virologic suppression. The secondary outcomes included CD4T cell recovery, lipids change from baseline, and adverse events (AEs). A total of 7 studies, 4852 patients were eligible, 2423 (49.9%) received DTG-based simplified dual cART, and 2429 (50.1%) received triple cART. The viral suppression rate was 94.7% at 24 weeks, 93.0% at 48 weeks, and 96.6% at 96 weeks in dual cART. The viral suppression rate of dual cART was non-inferior to triple cART at 24 weeks (risk difference [RD], -0.00; 95% confidence interval [CI] -0.02-0.01), at 48 weeks (RD, -0.01; 95% CI -0.02-0.01), and at 96 weeks (RD, -0.01; 95% CI -0.02-0.00). Sub-analysis results were consistent with the overall results. With regard to other outcomes (CD4T counts, lipids, any AEs, and AEs grade ≥ 3), there was no significant statistical difference between the two regimens. DTG-based simplified dual cART was non-inferior to triple cART in terms of efficacy and safety. This finding provides strong support for current consensus guidelines recommended the dual regimen as first-line treatment.

Treatment outcomes among adults with HIV/non-communicable disease multimorbidity attending integrated care clubs in Cape Town, South Africa

BackgroundThe growing burden of the HIV and non-communicable disease (NCD) syndemic in Sub- Saharan Africa has necessitated introduction of integrated models of care in order to leverage existing HIV care infrastructure for NCDs. However, there is paucity of literature on treatment outcomes for multimorbid patients attending integrated care. We describe 12-month treatment outcomes among multimorbid patients attending integrated antiretroviral treatment (ART) and NCD clubs in Cape Town, South Africa.MethodsAs part of an integrated clubs (IC) model pilot implemented in 2016 by the local government at two primary health care clinics in Cape Town, we identified all multimorbid patients who were enrolled for IC for at least 12 months by August 2017. Mean adherence percentages (using proxy of medication collection and attendance of club visits) and optimal disease control (defined as the proportion of participants achieving optimal blood pressure, glycosylated haemoglobin control and HIV viral load suppression where appropriate) were calculated at 12 months before, at the point of IC enrolment and 12 months after IC enrolment. Predictors of NCD control 12 months post IC enrolment were investigated using multivariable logistic regression.ResultsAs of 31 August 2017, 247 HIV-infected patients in total had been enrolled into IC for at least 12 months. Of these, 221 (89.5%) had hypertension, 4 (1.6%) had diabetes mellitus and 22 (8.9%) had both diseases. Adherence was maintained before and after IC enrolment with mean adherence percentages of 92.2% and 94.2% respectively. HIV viral suppression rates were 98.6%, 99.5% and 99.4% at the three time points respectively. Retention in care was high with 6.9% lost to follow up at 12 months post IC enrolment. Across the 3 time-points, optimal blood pressure control was achieved in 43.1%, 58.9% and 49.4% of participants while optimal glycaemic control was achieved in 47.4%, 87.5% and 53.3% of participants with diabetes respectively. Multivariable logistic analyses showed no independent variables significantly associated with NCD control.ConclusionMultimorbid adults living with HIV achieved high levels of HIV control in integrated HIV and NCD clubs. However, intensified interventions are needed to maintain NCD control in the long term.

Viral suppression after transition from nonnucleoside reverse transcriptase inhibitor- to dolutegravir-based antiretroviral therapy: A prospective cohort study in Lesotho (DO-REAL study).

ObjectivesSince 2018, the World Health Organization has recommended dolutegravir (DTG)‐containing antiretroviral therapy (ART) for most people living with HIV. Country programmes across Africa have subsequently transitioned from other, mostly nonnucleoside reverse transcriptase inhibitor (NNRTI)‐based ART to DTG‐based ART. This study aims to assess the virological impact of programmatic transitioning to DTG‐based ART in Lesotho.MethodsThe prospective Dolutegravir in Real‐Life in Lesotho (DO‐REAL) cohort enrols people living with HIV initiating or transitioning to DTG‐based ART in Lesotho. Here, we present data from participants who transitioned from NNRTI‐ to DTG‐based ART between February and December 2020. Blood samples collected at transition and at 16 weeks’ follow‐up (window 8–32 weeks) were used for viral load (VL) and resistance testing.ResultsAmong 1347 participants, follow‐up data was available for 1225. The majority (60%) were female, median age at transition was 47 years [interquartile range (IQR): 38–56], and median (IQR) time since ART initiation was 5.9 (3.5–9.0) years. Among those with complete VL data, the rate of viral suppression to < 100 copies/mL was 1093/1116 (98%) before, 1073/1116 (96%) at, and 1098/1116 (98%) after transition. Even among those with a VL ≥ 100 copies/mL at transition, 42/44 (95%) achieved suppression to < 100 copies/mL at follow‐up. Seven participants had a VL ≥ 1000 copies/mL at follow‐up and did not harbour any integrase mutations associated with resistance to DTG.ConclusionsThe high levels of viral suppression observed are encouraging regarding virological outcomes upon programmatic transitioning from NNRTI‐ to DTG‐based ART.

Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis

BackgroundAchieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa.MethodsA cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression.ResultsThe mean age of the participants was 14.75 years (SD = 2.9), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9386 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among ALHIV who were: female (AOR = 1.21, 95% CI 1.05–1.39), and had most recent CD4 count > 200 (AOR = 2.53, 95% CI 2.06–3.11). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count > 200 at baseline (AOR = 0.73, 95% CI 0.61–0.87), and who were switched to second line regimen (AOR = 0.41, 95% CI 0.34–0.49).ConclusionsViral suppression amongst ALHIV at 74% is considerably lower than the WHO target of 95%. Of particular concern for intervention is the lower rates of viral suppression amongst male ALHIV. Greater emphasis should be placed to early enrolment of ALHIV on ART and keeping them engaged in care (beyond 6 months). Furthermore, improved and regular viral load monitoring will help to adequately identify and manage ALHIV with unsuppressed viral load and subsequently switching to second line treatment.

Body weight changes in treated hepatitis B patients switching to tenofovir alafenamide☆

Switching to a tenofovir alafenamide (TAF)-containing regimen has been reported to be associated with body weight gain in human immunodeficiency virus-infected subjects. We aimed to investigate the body weight change and virological, hepatic, and renal outcomes of TAF switching among chronic hepatitis B (CHB) patients. This retrospective study included 121 CHB patients who were switched to TAF after >12 months of treatment with another nucleot(s)ide analog (NUC). All patients were monitored for 12 months. The cohort was mostly Asian (96.7%) with a mean age of 55 years, 72% male, 14% cirrhosis, 21% HBeAg positive, and 75% with prior use of tenofovir disoproxil fumarate. At 12 months after TAF switching, their body weight significantly increased from 66.4±11.8 to 67.8±12.3kg (p<0.001), and 21.1% of the subjects had a ≥5% weight gain. Patients without diabetes or hypertension were more likely to have a body weight gain. Meanwhile, the complete viral suppression rate increased significantly from 89.3% to 96.2% (p=0.016). The rate of alanine aminotransferase normalization also increased significantly from 71.1% to 87.6% (p<0.001) by local criteria and from 58.7% to 70.2% (p=0.029) by AASLD criteria. The mean eGFR (mL/min/1.73m2) did not change (88.2±18.8 vs. 87.2±17.5, p=0.28). However, for the subgroup with GFR <90at TAF switching, there was a significant improvement in eGFR (72.9±12.0 vs. 75.7±14.2, p=0.027). In real-world NUC-experienced CHB patients, unexpected body weight gain was observed after TAF switching. The mechanism needs to be investigated in the future.

Antiretroviral therapy adherence and viral suppression among HIV-infected adolescents and young adults at a tertiary hospital in Ghana

With the introduction of antiretroviral therapy (ART), many HIV-infected children are growing into adolescence and adulthood. A facility-based cross-sectional study was conducted at the Fevers Unit of one of the teaching hospitals in Ghana. The Morisky Medication Adherence Scale (MMAS-8) and pill count were used to assess adherence, while measured viral load levels of participants were used to assess viral suppression. The rate of viral suppression (<400 copies/ml) was 68.2%. Participants with high MMAS-8 scores were 8.4 times more likely to be virally suppressed compared to those with low MMAS-8 scores (OR = 8.4, p = 0.003, 95% CI: 2.11–33.48). The commonest reason for missing doses of their antiretroviral drugs (ARVs) was forgetfulness. Efforts must be made by all stakeholders involved in HIV care to engage adolescents and young adults living with HIV (AYALHIV) on personal and/or group levels to help identify and improve particular ART adherence issues so as to increase viral suppression rates.

Five Cities Launch Mobile Health Units for Treatment of OUD, HIV Patients

Back to table of contents Previous article Next article Clinical & ResearchFull AccessFive Cities Launch Mobile Health Units for Treatment of OUD, HIV PatientsTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:24 Sep 2021https://doi.org/10.1176/appi.pn.2021.9.4AbstractThe INTEGRA study will compare the feasibility, impact, and cost-effectiveness of delivering care via mobile health units compared with referring patients to community-based agencies.Mobile clinics in the INTEGRA study will be staffed by health professionals and peer navigators and offer primary care services as well as comprehensive services for treating patients with OUD and preventing and treating HIV.Lifeline MobileSubstance use disorders (SUDs) that involve injection drugs carry a high risk of infection with human immunodeficiency virus (HIV). According to the Centers for Disease Control and Prevention, nearly 1 in 10 new HIV diagnoses in the United States is at least partly attributable to the use of illicit injection drugs, and sharing needles is the second riskiest behavior for being infected with HIV. Yet many people who need treatment for either SUD, HIV, or both face multiple barriers to care such as a lack of health insurance, a lack of transportation, and homelessness.This summer five cities launched one-stop mobile clinics to address the needs of this vulnerable population as part of INTEGRA, a study funded by the National Institute on Drug Abuse and sponsored by the National Institute of Allergy and Infectious Diseases. The mobile clinics, brightly colored RVs staffed by health care professionals and peer navigators, will offer integrated health services to patients in Houston, Los Angeles, New York City (the Bronx), Philadelphia, and Washington, D.C., with opioid use disorder (OUD) who inject drugs.“The benefit to having a mobile unit is that you can move services to where the people are and go home at the end of the day, as opposed to making people go to where the services are, where they may congregate and local businesses and neighborhood groups may feel they are a problem,” INTEGRA protocol chair Steven Shoptaw, Ph.D., told Psychiatric News. Shoptaw is the director of the Center for Behavioral and Addiction Medicine at the University of California, Los Angeles.The study aims to enroll 860 people who will be randomly assigned to one of two groups, the control group or the treatment group, for 26 weeks.Patients in the control group will receive peer navigation to connect them to health services available at community-based agencies. The agencies offer services such as harm reduction; testing for COVID-19; and testing for HIV, sexually transmitted infections, and hepatitis A, B, and C. However, many of these agencies are located in downtown and commercial areas that may be difficult for people with limited transportation options to access.The treatment group, via the mobile clinics, will be offered the same services available at community agencies, but with the addition of medication treatment with buprenorphine for OUD, naloxone, syringe services where available, pre-exposure prophylaxis (PrEP) for HIV prevention, antiretroviral therapy for HIV treatment, and primary care services. Mobile clinics will be placed in residential areas determined to be accessible for those affected by HIV and those who inject opioids.“We wanted to provide simple interventions—primary care, testing, treatment, medications, and referrals to psychiatrists and other mental health professionals. We wanted to have everything Beny Primm said patients should have,” Shoptaw said, referring to the late Beny Primm, M.D., a physician who started several of New York City’s first methadone clinics. He later rose to prominence for his expertise in addiction treatment and HIV/AIDS and served in the presidential administrations of Ronald Reagan and George H. W. Bush.At weeks 26 and 52, the researchers will evaluate both groups’ use of medications for OUD; rates of viral suppression among participants with HIV; use of PrEP among HIV-negative participants; use of opioids and other substances based on participant self-report and urine screenings; drug overdose events; and new diagnoses of HIV, COVID-19, hepatitis C, and sexually transmitted infections. They will also analyze the cost-effectiveness of delivering care through mobile clinics compared with community-based agencies. The researchers hope to have results from the study in 2025. ■Details of the study are posted here.“HIV and Injection Drug Use” is posted here. ISSUES NewArchived

Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data.

IntroductionThe rapid increase in the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Akwa Ibom and Cross River states in Nigeria led to overcrowding at clinics. Patients were devolved to receive ART refills through five differentiated service delivery (DSD) models: fast‐track (FT), adolescent refill clubs (ARCs), community pharmacy ART refill programs (CPARPs), community ART refill clubs (CARCs) and community ART refill groups (CARGs) designed to meet the needs of different groups of PLHIV. In the context of COVID‐19‐related travel restrictions, out‐of‐facility models offered critical mechanisms for continuity of treatment. We compared retention and viral suppression among those devolved to DSD with those who continued standard care at facilities.MethodsA retrospective cohort study was conducted among patients devolved to DSD from January 2018 to December 2020. Bivariate analyses were conducted to assess differences in retention and viral suppression by socio‐demographic characteristics. Kaplan–Meier assessed retention at 3, 6, 9 and 12 months. Differences in proportions were compared using the chi‐square test; a p‐value of <0.05 was considered significant.ResultsA total of 40,800 PLHIV from 84 facilities received ART through the five models: CARC (53%), FT (19.1%), ARC (12.1%), CPARP (10.4%) and CARG (5.4%). Retention rates at 6 months exceeded 96% for all models compared to 94% among those continuing standard care. Among those using DSD, retention rate at 12 months was higher among adults than children (97.8% vs. 96.7%, p = 0.04). No significant sex differences in retention rates were found among those enrolled in DSD. Viral suppression rates among PLHIV served through DSD were significantly higher among adults than children (95.4% vs. 89.2%; p <0.01). Among adults, 95.4% enrolled in DSD were virally suppressed compared to 91.8% of those in standard care (p <0.01). For children, 89.2% enrolled in DSD were virally suppressed compared to 83.2% in standard care (p <0.01).ConclusionsPLHIV receiving ART through DSD models had retention but higher viral suppression rates compared to those receiving standard care. Expanding DSD during COVID‐19 has helped ensure uninterrupted access to ART in Nigeria. Further scale‐up is warranted to decongest facilities and improve clinical outcomes.

Neighborhood Factors Associated with Racial/Ethnic Disparities in Achieving Sustained HIV Viral Suppression Among Miami-Dade County Ryan White Program Clients.

Racial/ethnic minorities are disproportionately affected by poor HIV care outcomes. Studies have also examined the effects of neighborhood-level factor on an individual's health outcomes. Thus, the objective of this study was to assess the effects of neighborhood factors on the association between race/ethnicity and sustained viral suppression (all viral load tests <200 copies/mL per year). Data for 6491 people with HIV in the 2017 Miami-Dade County Ryan White Program and neighborhood-level data by ZIP code tabulated areas from the American Community Survey were utilized. Multi-level logistic regression models were used to assess the role of neighborhood factors on the association between race/ethnicity and sustained viral suppression. Results show that non-Hispanic Blacks had lower odds of sustained viral suppression in low socioeconomic disadvantage [adjusted odds ratio (aOR): 0.39; 95% confidence interval (CI): 0.20-0.74], moderate residential instability (aOR: 0.31; 95% CI: 0.15-0.65), and low and high racial/language homogeneity neighborhoods (aOR: 0.38; 95% CI: 0.16-0.88) and (aOR: 0.38; 95% CI: 0.19-0.75), respectively, when compared to non-Hispanic Whites (NHWs). Haitians also exhibited poor outcomes in neighborhoods characterized by moderate residential instability (aOR: 0.42; 95% CI: 0.18-0.97) and high racial/language homogeneity (aOR: 0.49; 95% CI: 0.26-0.93), when compared to NHWs. In conclusion, disparities in rates of sustained viral suppression were observed for racial/ethnic minorities within various neighborhood-level factors. These findings indicate the importance of addressing neighborhood characteristics to achieve optimal care for minorities.

Retention in care and viral suppression after same-day ART initiation: One-year outcomes of the SLATE I and II individually randomized clinical trials in South Africa.

IntroductionSame‐day initiation (SDI) of antiretroviral therapy (ART) for HIV consistently increases ART uptake, but concerns remain about higher attrition from care after initiation. We analysed 12‐month retention in the SLATE SDI trials.MethodsSLATE I (Simplified Algorithms for Treatment Eligibility I, enrolment 06 March–28 July 2017) and SLATE II (enrolment 14 March–18 September 2018) were individually randomized trials at public outpatient clinics in Johannesburg that enrolled patients not yet on ART and administered the SLATE I or II algorithm. This included a symptom self‐report, medical history, brief physical examination and readiness questionnaire to assess the eligibility for SDI. The studies compared the offer of SDI using the SLATE algorithms to standard of care initiation procedures. ART uptake and early retention were previously reported. Using routine clinic records, we conducted a pooled analysis of retention in care and HIV viral suppression 14 months after study enrolment, a time point equivalent to 12 months potential on ART, with an additional month allowed on either end to initiate ART and to return for the 12‐month visit.Results and discussionWe enrolled 1193 study participants (standard arms, n = 599, 50%; intervention arms, n = 594, 50%) and analysed by originally assigned groups. By 14 months after enrolment, 50% of intervention arm patients and 46% of standard arm patients remained in care at the initiating site (crude risk difference 4% (95% confidence interval −1%‐10%); crude relative risk 1.10 (0.97–1.23), with similar viral suppression between arms. Observed attrition from care at site by 14 months was high in both study arms, but we found no evidence that the offer of SDI led to greater overall attrition or lower rates of viral suppression 1 year after starting ART and may have generated small improvements. SDI may have shifted some attrition from before to after dispensing of the first dose of medication.ConclusionsAn offer of SDI of ART, following a carefully designed protocol to identify patients who are eligible and ready to start treatment, is not inherently associated with an overall increase in patient attrition from care and leads to similar rates of viral suppression.Trial registrationClinicaltrials.gov NCT02891135, registered 01 September 2016. First participant enrolled 06 March 2017 in South Africa. Clinicaltrials.gov NCT03315013, registered 19 October 2017. First participant enrolled 14 March 2018.

A changing demographic - Ten years of HIV care.

We aimed to benchmark the quality of care and describe characteristics of patients newly attending the HIV clinic at differing time points over the past 10years, against the Infectious Disease Society of America HIV/AIDS performance measures. We performed a retrospective analysis of records for patients newly attending the HIV clinic in 2011, 2016 and 2018. There was an increase in male attendees in 2018 and 2016 compared to 2011 (88%, 88% vs. 59% p < .001), viral suppression rates were 97%, 83% and 99% (p < .001), respectively. We observed an increase in patients of South American origin over time. Acquisition risk changed, with increased proportion of MSM (24% in 2011 vs 78% in 2018, p < .001), lower rates of heterosexual (20% in 2018 vs 48% in 2011, p < .001) and IDU transmission (1.5% in 2018 vs 24% in 2011, p < .001). There were lower rates of Chlamydia trachomatis and Neisseria gonorrhoeae testing in 2018 (72%, p < .001), compared to 2016 (84%) and 2011 (83%). Hepatitis B virus vaccination and pneumococcal vaccine rates are declining (p < .001). We demonstrate the changes in both ethnicity and risk of acquisition over time, high rates of antiretroviral therapy prescription and viral suppression, and highlight the importance of health prevention with sexual health screening and vaccination in this population.

Household factors associated with managing the HIV positive population and meeting the UNAIDS goals

Background While poor countries have made progress attaining the The Joint United Nations Programme on HIV/AIDS (UNAIDS) goals for 2025, continued progress depends on continued accessibility of program services, as well as continued improvements in compliant behavior by HIV positive populations. This paper examines household survey data in four African countries pertaining to those critical behaviors and identifies the key population barriers for attaining UNAIDS goals. Methods This study used Population-based HIV Impact Assessment (PHIA) survey data for Zambia, Malawi, Eswatini, and Tanzania to examine household and other influences associated with effectively managing HIV-infected adults using three key outcomes: (i) self-awareness of HIV status, (ii) antiretroviral therapy adherence, and (iii) rate of viral load suppression (VLS). Results Factors found to increase HIV risk also posed barriers to awareness and viral suppression, such as being young, having multiple partners, and having a job outside the home. Additional barriers to awareness and viral suppression were low education, low wealth, low knowledge of HIV, and the HIV status and gender of the household head. The most consistent factor influencing awareness and viral load suppression was the gender of the individual. Women were much more likely to be aware of their HIV status and more likely to be virally suppressed at rates almost twice as high as comparable men. Our analysis shows that the gender differential for awareness seems primarily due the testing and other services provided for women giving birth. We also found that the VLS gender gap was not related birthing-related services. Conclusions The most substantial barrier to achieving UNAIDS goals appears to be poorer compliance by men regarding testing and sustained VLS. Routinely providing HIV testing and other HIV information during antenatal care (ANC) may have contributed to improved rates of HIV-status awareness of birthing-age women. New programs to routinely integrate HIV testing into men’s health care in workplaces or other settings could improve men’s awareness and compliance with treatment. Also needed are more effective interventions to target sectors of the population that are less likely to adhere to treatment regimens, such as persons with low-education levels, low wealth, and/or low knowledge of HIV.

Virological failure and associated factors among children receivinganti-retroviral therapy, Northwest Ethiopia.

BackgroundVirological failure is under-recognized issue among children living with human immunodeficiency virus in developing countries. This partly may lead to failure to achieve the global goal of 90-90-90 targets in most developing countries including Ethiopia.ObjectivesThis study aimed to assess the virological failure and its predictors among children receiving antiretroviral therapy at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.MethodsAn institutional based cross-sectional study was conducted among 253 study cohorts from January 2020-April 2021. Socio-demographic characteristics were collected using a structured questionnaire via a face-to-face interview, while detailed clinical data of the children were collected by reviewing the medical record. About 5 ml of blood were collected for the analysis of complete blood count and viral load quantification. Data were analyzed using SPSS version 20 and variables at p-value < 0.05 in the multivariable analysis were considered as statistically significant.ResultsIn this study, the viral load suppression rate among antiretroviral therapy experienced children was 68.8%. Meanwhile, the overall virological failure among study participants was 19.4%. Children living without family (AOR = 3.63; 95%CI: 1.27–10.24), children with unemployed family (AOR = 4.95; 95%CI: 1.74–14.12), being wasted (AOR = 3.02; 95%CI: 1.19–7.67) being stunted (AOR = 2.38;95%CI:1.03–5.46), anemia (AOR = 5.50:95%CI;1.37–22.04) and being lymphopenic (AOR = 2.69:95%CI;1.04–7.75) were significantly associated with virological failure among children under treatment.ConclusionHigher virological failure among children was noteworthy in the present study. Caretakers other than immediate family, unemployed family, wasted, stunted, anemia, and lymphopenia were significant independent predictors of virological failure. Hence, standard, and optimal management of children under treatment should be warranted.

Clinical Safety Considerations of Integrase Strand Transfer Inhibitors in the Older PopulationLiving with HIV.

There are approximately 40 million people living with HIV globally, and 21% (7.9 million) are older adults (aged > 50 years) as of 2019. The average age of HIV-positive patients is predicted to increase to 58 by 2035. The favorable clinical efficacy of integrase strand transfer inhibitors has led to high rates of viral suppression and have now become the preferred agents by the AIDS guideline when initiating antiretroviral therapy. There are concerns of increasing adverse effects from HIV medications, such as integrase strand transfer inhibitors, as a result of changes in pharmacodynamic and pharmacokinetic parameters within the older population. The authors aim to describe the safety concerns of the current integrase strand transfer inhibitors based upon a narrative literature review, including recommendations for drug-drug interactions, and relevant comorbidities to consider for selection of the most appropriate integrase strand transfer inhibitor for older people living with HIV. Raltegravir is a well-tolerated option with minor adverse events; however, adherence to a twice-daily regimen may be difficult in older patients who are also taking many other medications for various comorbidities. Elvitegravir is also well tolerated with limited adverse effects, but has many drug-drug interactions that may pose problems for older patients with polypharmacy. Dolutegravir has been associated with more frequent adverse events, such as neuropsychiatric disorders.