Current Issue : October - December Volume : 2014 Issue Number : 4 Articles : 6 Articles
Background. The costs of providing care to HIV-infected (HIV+) patients with co-occurring diagnoses of substance use (SU)\ndisorder or psychiatric disease (PD) are not well documented. It is our objective to evaluate costs in these HIV+ patients receiving\ncare in a large health plan. Methods.We conducted a retrospective cohort study from 1995 to 2010 to compare costs of healthcare in\nHIV+ patients with and without co-occurring SUdisorder and/or PDdiagnoses. Estimates of proportional differences in costs (rate\nratios) were obtained fromrepeated measures generalized linear regression.Models were stratified by cost category (e.g., inpatient,\noutpatient). Results. Mean total healthcare costs per patient per year were higher in HIV+ patients diagnosed with SU disorder or\nPD compared to HIV+ patients without these comorbid conditions. After controlling for confounders, total mean costs remained\nsignificantly higher in patients diagnosed with SU disorder (RR = 1.24, 95% CI = 1.18ââ?¬â??1.31) or PD (RR = 1.19, 95% CI = 1.15ââ?¬â??1.24).\nMean outpatient care costs were significantly greater in patients with both SU disorder and PD (RR = 1.52, 95% CI = 1.41ââ?¬â??1.64).\nConclusions. Given these higher expenditures in the care of HIV+ patients with comorbid SU disorder and/or PD, greater efforts\nto facilitate SU disorder or PD treatment initiation and persistence could provide substantial savings....
Young Latino immigrant men who have sex with men (MSM) are at risk for HIV and for delayed diagnosis. A need exists to\nraise awareness about HIV prevention in this population, including the benefits of timely HIV testing. This project was developed\nthrough collaboration between University ofWA researchers and Entre Hermanos, a community-based organization serving Latinos.\nBuilding from a community-based participatory research approach, the researchers developed a campaign that was executed\nby Activate Brands, based in Denver, Colorado.The authors (a) describe the development of HIV prevention messages through the\nintegration of previously collected formative data; (b) describe the process of translating these messages into PSAs, including the\napplication of a marketing strategy; (c) describe testing the PSAs within the Latino MSM community; and (c) determine a set of\nimportant factors to consider when developing HIV prevention messages for young Latino MSM who do not identify as gay....
Alteration in the humoral immune response has been observed during HIV infection. The polymorphisms of enhancer HS1,2,\nmember of the 3???? regulatory region of the Ig heavy chain cluster, may play a role in the variation of the humoral response leading\nto pathological conditions. To assess the role of the HS1,2 polymorphic variants in the progression of AIDS, the HS1,2-A allelic\nfrequencies were investigated in a cohort of HIV infected pediatric subjects froma nosocomial outbreak with amonophyletic strain\nof HIV. From a total group of 418 HIV infected children in the outbreak cohort, 42 nonprogressors and 31 progressors without bias\ndue to antiretroviral therapy were evaluated. HS1,2 allele ?1 has been associated with nonprogressors (allelic frequency: 51.19%\nversus 33.87% in progressors, OR 0.5, and P = 0.0437), while allele ?2 has been associated with progression (allelic frequency:\n48.39% versus 30.95% in nonprogressors, OR 2.1, and P = 0.0393). Further, only subjects carrying allele ?2 in absence of allele ?1,\neither in homozygous condition for allele ?2 [nonprogressors 2/42 (4.76%), Progressors 7/31 (22.58%),OR 5.8, and P = 0.0315] or in\ncombination with other allelic variants [nonprogressors 7/42 (16.67%), Progressors 13/31 (41.93%), OR 3.61, and P = 0.0321], have\nbeen associated with HIV progression to AIDS. In conclusion, while the HS1,2 allele ?1 has a protective effect on HIV progression\nwhen present, allele ?2 is associated with progression toward AIDS when allele ?1 is absent....
A nonlinear dynamical system is proposed and qualitatively analyzed to study the dynamics of HIV/AIDS in the workplace.The\ndisease-free equilibrium point of the model is shown to be locally asymptotically stable if the basic reproductive number,R0, is less\nthan unity and the model is shown to exhibit a unique endemic equilibrium when the basic reproductive number is greater than\nunity. It is shown that, in the absence of recruitment of infectives, the disease is eradicated whenR0 < 1, whiles the disease is shown\nto persist in the presence of recruitment of infected persons.Thebasicmodel is extended to include control efforts aimed at reducing\ninfection, irresponsibility, and nonproductivity at the workplace. This leads to an optimal control problem which is qualitatively\nanalyzed using Pontryagin�s Maximum Principle (PMP). Numerical simulation of the resulting optimal control problem is carried\nout to gain quantitative insights into the implications of the model.The simulation reveals that a multifaceted approach to the fight\nagainst the disease is more effective than single control strategies....
Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment\nfor people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program\nin Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13\nsecondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic\ndata on previously antiretroviral drug na�¨?ve patients aged ?15 years that received HAART for at least 6 months and compared\ntreatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites\nwhile on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24\nweeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001)\nand 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and\nsatellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is\nfeasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care....
Background. Expanded HIV surveillance in TB patients forms part of the World Health Organization framework for strategic\ncollaborative activity. Surveillance helps understand the epidemiology of the local dual epidemic and enables design of a tailored\nresponse to these challenges. Methods.We conducted an observational, cross-sectional study of anonymous unlinked HIV testing\nfor 741 consecutive TB suspects attending an urban TB facility during a seven-week period in 2008. Results. A total of 512 patients\nwere found to have TB.The mean age was 35.7 years, and 63% were male.The prevalence of HIV was 72.2% (95% CI: 68.2ââ?¬â??75.9)\nin all TB cases, 69.8% (95% CI: 65.3ââ?¬â??74.2) in pulmonary tuberculosis (PTB), 81.6% (95% CI: 72.9ââ?¬â??90.3) in extrapulmonary disease,\nand 66.8% (95% CI: 60.7ââ?¬â??72.9) in those without TB disease. HIV prevalence in TB patients was higher in females than males\nand in younger age groups (18ââ?¬â??29 years). The sex ratio of PTB patients correlated with the sex ratio of the prevalence of HIV\nin the respective age groups (???? < 0.05). Conclusion. The use of a rapid HIV test performed on sputum anonymously provides\nan opportunity for HIV surveillance in this high-burdened setting, which has the potential to lend valuable insight into the\ncoepidemics....
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