Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 6 Articles
Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health\r\ncare provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013).\r\nSubstance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni,\r\nBoyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized\r\ncontrolled trial (?? = 775) that investigated the efficacy of a self-care symptom management manual for participants living with\r\nHIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked\r\nwith lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented.\r\nClinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement\r\nwith care....
Unlike other nonnucleoside reverse transcriptase inhibitors, etravirine is only approved for use in treatment-experienced patients.\r\nIn the DUET 1 and 2 trials, 1203 highly treatment-experienced patients were randomized to etravirine or placebo, in combination\r\nwith darunavir/ritonavir and optimized background treatment. In these trials, etravirine showed significantly higher rates of\r\nHIV RNA suppression when compared with placebo (61% versus 40% at Week 48). There was no significant rise of lipids or\r\nneuropsychiatric adverse events, but there was an increase in the risk of rash with etravirine treatment. In the SENSE trial, which\r\nevaluated etravirine and efavirenz in 157 treatment-na�¨ive patients in combinationwith 2 nucleoside analogues, there was a lower risk\r\nof lipid elevations and neuropsychiatric adverse events with etravirine when compared to efavirenz. Etravirine has been evaluated\r\nin three randomized switching studies. In the SSAT029 switch trial, 38 patients who had neuropsychiatric adverse events possibly\r\nrelated to efavirenz showed an improvement in these after switching to etravirine. The Swiss Switch-EE recruited 58 individuals\r\nwithout neuropsychiatric adverse events who were receiving efavirenz, and no benefit was shown when switching to etravirine. In\r\nthe Spanish ETRA-SWITCH trial (?? = 46), there were improvements in lipids when individuals switched froma protease inhibitor\r\nto etravirine. These switching trials were conducted in patients with full HIV RNA suppression: <50 copies/mL and with no history\r\nof virological failure or resistance to therapy. The results from these three randomized switching studies suggest a possible new\r\nrole for etravirine, in combination with two nucleoside analogues, as a switching option for those with HIV RNA suppression but\r\nwho are reporting adverse events possibly related to antiretroviral therapy. However a large well-powered trial would need to be\r\nconducted to strengthen the evidence from the pilot studies conducted so far....
We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care\r\ndelivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based familycentred\r\napproach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in\r\nthe two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and\r\nclinical characteristics. KaplanMeier survival curves with log rank tests were used to describe and compare retention and survival.\r\nOverall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of followup\r\n(maximum 7.7 years). Median age was 53 (IQR: 11ââ?¬â??109) months at enrolment. In the CHBC, retention differed significantly\r\nbetween patients on ART and those not (log-rank test, adjusted, P< 0.001). Comparing ART patients in both models, there was\r\nno significant difference in long-term survival (log-rank test, P = 0.308, adjusted, P = 0.489), while retention was higher in the\r\nCHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P < 0.001, adjusted P= 0.006). Irrespective of model of care, children\r\nreceiving ART had better retention in care and survival....
HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue,\r\nthe Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV\r\ntesting/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low\r\nsocioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers\r\n(BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening\r\ntest, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling,\r\nconfirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals\r\nwere enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positiveconfirmed\r\nprevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care\r\n= 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led\r\nBAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection....
Effective prevention of HIV/AIDS requires early diagnosis, initiation of therapy, and regular plasma viral load monitoring of the\r\ninfected individual. In addition, incidence estimation using accurate and sensitive assays is needed to facilitate HIV prevention\r\nefforts in the public health setting. Therefore,more affordable and accessible point-of-care (POC) technologies capable of providing\r\nearly diagnosis, HIV viral load measurements, and CD4 counts in settings where HIV is most prevalent are needed to enable\r\nappropriate intervention strategies and ultimately stop transmission of the virus within these populations to achieve the future goal\r\nof an AIDS-free generation. This review discusses the available and emerging POC technologies for future application to these\r\nunmet public health needs....
Background. A convenient, private, and accessible HIV self-testing strategy stands to complement facility-based conventional\r\ntesting. Over-the-counter oral HIV self-tests are approved and available in the United States, but not yet in Canada. Canadian data\r\non self-testing is nonexistent.We investigated the feasibility of offering an unsupervised self-testing strategy to Canadian students.\r\nMethods. Between September 2011 andMay 2012, we recruited 145 students froma student health clinic of a large Canadian university.\r\nFeasibility of operationalization (i.e., self-test conduct, acceptability, convenience, and willingness to pay) was evaluated. Selftest\r\nconduct was computed with agreement between the self-test performed by the student and the test repeated by a healthcare professional.\r\nOther metrics were measured on a survey. Results. Participants were young (median age: 22 years), unmarried (97%), and\r\n47% were out of province or international students. Approximately 52% self-reported a history of unprotected casual sex and sex\r\nwith multiple partners. Self-test conduct agreement was high (100%), so were acceptability (81%), convenience (99%), and willingness\r\nto pay (74%) for self-tests. Concerns included accuracy of self-tests and availability of expedited linkages. Conclusion. An unsupervised\r\nself-testing strategy was found to be feasible in Canadian students. Findings call for studies in at-risk populations to inform\r\nCanadian policy....
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