Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Estudios de cohortes; VIH; Pérdida de seguimientoCohort studies; HIV; Lost to follow-upEstudis de cohorts; VIH; Pèrdua del seguimentBackground Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90–90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods A scoping review was done following Arksey & O′Malley’s methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied.The project leading to these results (PISCIS Cohort) has received funding from “la Caixa” Banking Foundation under the project code LCF/PR/PR17/51120008. This work is supported by a grant from the Foundation Marató TV3 (project code 239/C/2018) aimed at the analysis of the LTFU patients of the PISCIS Cohort. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript

Envelliment i VIH: una interacció convergent; PISCIS cohort 1998-2017

Envelliment; VIH; Tractament antiretroviral; CohortEnvejecimiento; VIH; Tratamiento antiretroviral; CohorteAging; HIV; Antiretroviral treatment; CohortL’objectiu d’aquesta anàlisi és descriure la tendència d’envelliment en persones infectades pel VIH de més de 15 anys, entre el 1998 i el 2016, a Catalunya i les Illes Balears, i comparar les característiques clinicoepidemiològiques entre pacients <50 i ≥50 anys el 2017 i al reclutament en la cohort

Avaluació poblacional de la infecció per SARS-CoV-2 entre les persones que viuen amb el VIH i la població general de Catalunya (març – desembre 2020)

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; VIH; Avaluació poblacionalCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; VIH; Avaluación poblacionalCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; VIH; Population assessmentEn aquest estudi s’analitza la influència de la infecció pel SARS-Cov-2 sobre el diagnòstic i la gravetat de la infecció pel VIH

Determinants of long-term survival in late HIV presenters : The prospective PISCIS cohort study

Late HIV diagnosis (i.e CD4≤350 cells/µL) is associated with poorer outcomes. However, determinants of long-term mortality and factors influencing immune recovery within the first years after antiretroviral treatment (ART) initiation are poorly defined. From PISCIS cohort, we included all HIV-positive adults, two-year survivors after initiating ART between 2005-2019. The primary outcome was all-cause mortality according to the two-year CD4 count. We used Poisson regression. The secondary outcome was incomplete immune recovery (i.e., two-year CD4500 cells/µL, reference population). Overall, 113 patients (4·2%) died. Mortality was higher among LP with two-year CD4 count 200-500 cells/µL (aMRR 1·95[95%CI:1·06-3·61]) or 500 cells/µL, regardless of being initially LP or non-LP (aMRR 1·05[0·50-2·21]). Mortality rates within each two-year CD4 strata were not affected by the initial CD4 count at ART initiation (test-interaction, p = 0·48). The stronger factor influencing immune recovery was the CD4 count at ART initiation. First-line integrase-inhibitor-(INSTI)-based regimens were associated with reduced mortality compared to other regimens (aMRR 0·54[0·31-0·93]) and reduced risk of incomplete immune recovery in LP (aOR 0·70[0·52-0·95]). Two-year immune recovery is a good early predictor of long-term mortality in LP after surviving the first high-risk 2 years. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-LP. INSTI-based regimens were associated with higher rates of successful immune recovery and better survival compared to non-INSTI regimens. Southern-Denmark University, Danish AIDS-foundation, and Region of Southern Denmark

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied

Envelliment i VIH: una interacció convergent; PISCIS cohort 1998-2017

Envelliment; VIH; Tractament antiretroviral; CohortEnvejecimiento; VIH; Tratamiento antiretroviral; CohorteAging; HIV; Antiretroviral treatment; CohortL’objectiu d’aquesta anàlisi és descriure la tendència d’envelliment en persones infectades pel VIH de més de 15 anys, entre el 1998 i el 2016, a Catalunya i les Illes Balears, i comparar les característiques clinicoepidemiològiques entre pacients <50 i ≥50 anys el 2017 i al reclutament en la cohort

Comparative Analysis of Primary and Monovalent Booster SARS-CoV-2 Vaccination Coverage in Adults with and without HIV in Catalonia, Spain

People with HIV (PWH) may be more susceptible to SARS-CoV-2 infection and worse clinical outcomes. We investigated the disparity in SARS-CoV-2 vaccination coverage between PWH and those without HIV (PWoH) in Catalonia, Spain, assessing primary and monovalent booster vaccination coverage from December 2021 to July 2022. The vaccines administered were BNT162, ChAdOx1-S, mRNA-127, and Ad26.COV2.S. Using a 1:10 ratio of PWH to PWoH based on sex, age, and socioeconomic deprivation, the analysis included 201,630 individuals (183,300 PWoH and 18,330 PWH). Despite a higher prevalence of comorbidities, PWH exhibited lower rates of complete primary vaccination (78.2% vs. 81.8%, p < 0.001) but surpassed PWoH in booster coverage (68.5% vs. 63.1%, p < 0.001). Notably, complete vaccination rates were lower among PWH with CD4 <200 cells/μL, detectable HIV viremia, and migrants compared to PWoH (p < 0.001, all). However, PWH with CD4 < 200 cells/μL received more boosters (p < 0.001). In multivariable logistic regression analysis of the overall population, a prior SARS-CoV-2 diagnosis, HIV status, migrants, and mild-to-severe socioeconomic deprivation were associated with lower primary vaccination coverage, reflecting barriers to healthcare and vaccine access. However, booster vaccination was higher among PWH. Targeted interventions are needed to improve vaccine coverage and address hesitancy in vulnerable populations

Monitorización y evaluación del vih en Cataluña, cada vez más cerca de los objetivos 90-90-90

Background: Epidemiological surveillance of HIV infection allows monitoring its incidence as well as possible epidemiological changes, allowing specific interventions to be planned and their impact monitored. The objective of this article is to describe the results of the monitoring and evaluation of the response to the HIV epidemic in Catalonia, based on data included in the Integrated System of Epidemiological Surveillance of AIDS/HIV and Sexually Transmitted Infections of Catalonia (SIVES). Methods: A descriptive analysis of the data from the different sources of information of the SIVES was performed. The time period was defined based on the availability of data from each of the sources of information included in the analysis. The information was structured according to the conceptual representation of the cascade of HIV care, as described in the World Health Organization consolidated strategic information guidelines for HIV. Results: Of the total of 4,849 new diagnoses notified (2012- 2018), 86% were men, of these; the most frequently reported transmission group was men having sex with men with 65%. The trend in the number of new diagnoses decreased in all transmission groups. It is estimated that in 2018 there were 32,429 people living with HIV in Catalonia, of which 89% were diagnosed, of these, 83% were under follow-up in a specialized unit and 78% of them were under treatment. 73% of people in treatment had suppressed the viral load. Conclusions: SIVES as an integrated system of different sources of strategic information allows monitoring the HIV epidemic in Catalonia and evaluating the response to it, identifying key populations and determinants to acquire HIV, as well as the barriers to which people living with HIV they face to achieve viral suppression.Fundamentos: La vigilancia epidemiológica de la infección por el VIH permite monitorizar su incidencia así como eventuales cambios epidemiológicos, permitiendo planificar intervenciones específicas y monitorizar su impacto. El objetivo de este artículo fue describir los resultados de la monitorización y evaluación de la respuesta a la epidemia del VIH en Cataluña, a partir de los datos incluidos en el Sistema Integrado de Vigilancia Epidemiológica del Sida/VIH e Infecciones de transmisión sexual de Cataluña (SIVES). Métodos: Se realizó un análisis descriptivo de los datos de las diferentes fuentes de información del SIVES. El periodo de tiempo se definió a partir de la disponibilidad de los datos de cada una de las fuentes de información incluidas en el análisis. La información se estructuró de acuerdo a la representación conceptual de la cascada de diagnóstico y tratamiento de VIH, tal y como se describe en las directrices de información estratégica consolidada de la Organización Mundial de la Salud para el VIH. Resultados: Del total de 4.849 nuevos diagnósticos notificados (2012-2018), el 86% eran hombres. De estos, el grupo de transmisión informado más frecuente fueron los hombres que tiene sexo con hombres con un 65%. La tendencia del número de nuevos diagnósticos descendió en todos los grupos de transmisión. Se estima que en 2018 había 32.429 personas viviendo con el VIH en Cataluña, de las cuales el 89% estaban diagnosticadas. De estas, el 83% estaban en seguimiento en una unidad especializada, y el 78% de ellas estaban en tratamiento. El 73% de las personas en tratamiento tenían la carga viral suprimida. Conclusiones: El SIVES, como sistema integrado de diferentes fuentes de información estratégica, permite monitorizar la epidemia del VIH en Cataluña y evaluar la respuesta a la misma, identificando poblaciones claves y determinantes para adquirir el VIH, así como las barreras a las que se enfrentan las personas que viven con VIH para lograr a supresión viral

Syndemic conditions and quality of life in the PISCIS Cohort of people living with HIV in Catalonia and the Balearic Islands: a cross sectional study

Abstract Background People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH. Methods A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors. Results Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71–5.15) and Mental Health (MH) (B 5.08, 3.81–6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14–4.02; AI 2.69, 0.15–5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26–5.71), low income and perception of social isolation (AI 2.79, 0.27–5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99–5.91) on MH. Conclusion These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes