HIV clinical stage progression of patients at 241 outpatient clinics in Democratic Republic of Congo: Disparities by gender, TB status and rurality

Background: HIV clinical care programs are increasingly cognizant of the importance of customizing services according to patients’ clinical stage progression (WHO\u27s four-tiered staging) and other risk assessments. Understanding factors associated with Persons Living with HIV (PLHIV) patients’ progression through the treatment cascade and clinical stages is essential for programs to provide patient-centered, evidence-based services. Methods and materials: To analyze patient characteristics associated with disease progression stages for PLHIV on antiretroviral therapy (ART), this quantitative study used data, from January 2014–June 2019, from 49,460 PLHIV on ART from 241 HIV/AIDS outpatient clinics in 23 health zones in Haut-Katanga and Kinshasa provinces, Democratic Republic of Congo. To assess bivariate and multivariate associations, we performed Chi-square and multinomial logistic regression. Results: Among PLHIV receiving ART, 4.4% were at stage 4, and 30.7% at stage 3. Those at the less severe stages 2 and 1 constituted 22.9% and 41.9%. After controlling for covariates, patients with no TB were significantly more likely than those with TB (p\u3c = .05) to be at stage 1, rather than 3 or 4 (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98–6.59). Other characteristics significantly associated with higher odds of being at stage 1 included being female (AOR, 1.35; CI, 1.29–1.42), and shorter duration on ART (vs. \u3e 40.37 months); for ART duration less than 3.23 months the AOR was 2.47, for 3.23–14.52 months duration the AOR was 2.60, and for 14.53–40.37 months duration the AOR was 1.77 (quartile cut points used). Compared to patients in urban health zones, those in rural (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1. Conclusion: Significant and substantial variation in HIV clinical progression stage by geographic location and demographic characteristics existed, indicative of the need for targeted efforts to improve the effectiveness of HIV care. Patients with TB coinfection compared to those without coinfection had a much greater risk of being at stage 3 or 4, implying a need for customized approaches and clinical regimens for this high-risk population

Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged 50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection

Demographic and Clinical Characteristics Associated With Loss to Follow-up for HIV Primary Medical Care in the Coastal CARE Centers (Coastal Health District).

BACKGROUND: Staying in the medical care is essential for HIV patients to benefit from life-saving treatment. There are limited data on predictors of retention in HIV care from rural areas of Georgia. In the Coastal CARE Centers (CCC) located in the Coastal Health District, a substantial number of HIV patients are lost to follow-up (LTFU). METHODOLOGY: We extracted data from the electronic medical record for HIV/AIDS patients who had attended the CCC for their medical care between January 1, 2006 and October 30, 2012. We then matched the dataset with eHARS to determine those who met the criteria of LTFU for HIV care (absence of CD4, viral load, and ART for 12 months). Using logistic regression analysis, we assessed demographic and clinical factors associated with LTFU for HIV care. RESULTS: Factors associated with LTFU in the CCC were: being black/African American versus White/non-Hispanic (OR = 12.269, 95% CI: 9.034 to16.663); Being over 50 years old was three times more likely to be LTFU compared to ≤ 19 years. Having viral load \u3c 75 copies was 2 times more likely to be LTFU compared to those with viral load 10000-99999 copies. Having CD4 Count ≥ 500 cells/mm3 (OR = 2.820, 95% CI: 1.928 to 4.123) was more likely to drop out compared to CD4 \u3c 200 cells/mm3. CONCLUSION: Study of factors associated with LTFU can be used to identify patients at risk, and design strategies to improve retention as well as reducing HIV transmission in the Coastal Health District, Georgia

HIV clinical stage progression of patients at 241 outpatient clinics in DRC: Disparities by gender, TB status and rurality

Presentation given at APHA Annual Meeting and Expo. Background: HIV clinical care programs are increasingly customizing services to patients’ clinical stage progression (WHO’s four-tiered staging). Understanding factors associated with Persons Living with HIV (PLHIV)’s stage progression is essential for patient-centered services. Methods: To analyze PLHIV on antiretroviral therapy (ART) patients’ characteristics associated with progression stages, we used data, from 1/2014--6/2019, from 49,460 ART patients from 241 outpatient clinics in 23 health zones in Haut-Katanga and Kinshasa provinces, Democratic Republic of Congo. Chi-square and multinomial logistic regression assessed bivariate and multivariate associations. Results: ART patients were stage 4 (4.4%) and stage 3 (30.7%), with less severe stages 2 (22.9%) and 1 (41.9%). After covariate control, patients without TB were more likely than those with TB (p40.37 months); for ART duration \u3c 3.23 months the AOR was 2.47, for 3.23-14.52 months it was 2.60, and for 14.53-40.37 months it was 1.77 (quartile cut-points used). Compared to patients in urban health zones, those in rural (AOR, 0.32) and semi-rural zones (AOR, 0.79) were less likely to be stage 1. Conclusion: Significant variations in progression stage by location and demographic characteristics are indicative of the need for targeted efforts to improve HIV care. TB/HIV co-infected patients’ great risk of being stage 3 or 4 implies a particular need for customized approaches for this population

Demographic and Clinical Characteristics Associated With Loss to Follow-Up For HIV Primary Medical Care in The Coastal Care Centers (Coastal Health District)

This presentation was given during the National Association of County and City Health Officials Annual Meeting

Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo

Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. Results: A small proportion (i.e., 4.4%) of PLHIV were at WHO’s clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p ≤ 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98–6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29–1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. Conclusions: Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 er

TB-HIV Co-infection and Risk of Death, Loss to Follow Up, and Viral Load Suppression in Democratic Republic Of Congo

Presentation given at APHA Annual Meeting and Expo. Background: To provide efficient, equitable, patient-centered care to people living with HIV/AIDS (PLWH), this study analyzes two aspects of TB coinfection in PLWH: (a) variation in TB/HIV coinfection by demographic and clinical characteristics of patients; and (b) risks of negative outcomes among PLWH with TB coinfection compared to those without such coinfection. Methods: This quantitative study used data on 49,460 PLWH on ART from 241 HIV/AIDS clinics in two provinces of Democratic Republic of Congo, Haut-Katanga and Kinshasa. Chi-square and logistic regression analysis were performed. Results: TB coinfection existed in 3.6% of the patients. Significantly higher proportions of patients with TB/HIV coinfection were males (4.5% vs. 3.3%); new patients rather than transferred-in (3.7% vs. 1.6%) resided in the Kinshasa province rather than Haut-Katanga (4.0% vs. 2.7%) and were in an urban health zone (3.9%) and semi-rural (3.1%) rather than rural (1.2%) health zone. The logistic regression models showed that after controlling for other demographic and clinical variables, TB/HIV coinfection raised the risk of death (AOR, 2.26; CI, 1.94 to 2.64) and loss to follow up (AOR, 2.06; CI, 1.82 to 2.34). TB/HIV coinfection lowered the odds of viral load suppression below 1,000 copies per ml of blood (AOR, 0.58; CI, 0.46 TO 0.74). Conclusions: TB/HIV coinfection raises the risk of negative outcomes. HIV clinics in DRC and other African countries may consider these findings when customizing their interventions to improve HIV care and reduce disparities in PLWH

Risk Factors for TB/HIV Coinfection and Consequences for Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Cong

(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from 241 HIV/AIDS clinics in Haut-Katanga and Kinshasa, two provinces in the Democratic Republic of Congo. Chi-square and logistic regression analysis were performed. (3) Results: Significantly higher proportions of patients with TB/HIV coinfection were men (4.5%; women, 3.3%), were new patients (3.7%; transferred-in, 1.6%), resided in the Kinshasa province (4.0%; Haut-Katanga, 2.7%), and were in an urban health zone (3.9%) or semi-rural health zone (3.1%; rural, 1.2%). Logistic regression analysis showed that after controlling for demographic and clinical variables, TB/HIV coinfection increased the risk of death (adjusted odds ratio (AOR), 2.26 (95% confidence interval (CI): 1.94–2.64)) and LTFU (AOR, 2.06 (95% CI: 1.82–2.34)). TB/HIV coinfection decreased the odds of viral load suppression (AOR, 0.58 (95% CI: 0.46–0.74)). (4) Conclusions: TB/HIV coinfection raises the risk of negative outcomes such as death, LTFU, and lack of viral load suppression. Our findings can help HIV clinics in Democratic Republic of Congo and other African countries to customize their interventions to improve HIV care and reduce care disparities among patients

TB/HIV Coinfection and Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Congo

Presentation given at the 19th International Congress on Infectious Diseases

TB/HIV coinfection and patient outcomes: Evidence from 241 clinics in the Democratic Republic of Congo

Background: To provide efficient, equitable, patient-centered, and evidence-based services to people living with HIV/AIDS (PLWH), it is critical for the intervention programs to understand the nature of barriers to effective treatment and additional risks faced by PLWH with tuberculosis (TB) coinfection. This study analyzes two aspects of TB coinfection in PLWH: (a) variation in TB/HIV coinfection by demographic and clinical characteristics of patients; and (b) risks of negative outcomes such as death, loss to follow up, and higher viral load among PLWH with TB coinfection compared to those without such coinfection. Methods and materials: This quantitative study used data on 49,460 PLWH on ART from 241 HIV/AIDS clinics in two provinces of Democratic Republic of Congo, Haut-Katanga and Kinshasa. Chi-square and logistic regression analyses were performed. Three separate logistic regression analyses were performed to estimate the impact of TB status on three dichotomous dependent variables: death, LTFU (vs. in care or transferred out), and viral load above 1,000 copies per ml of blood, after controlling for other variables. Results: Significantly higher proportions of patients with TB/HIV coinfection were males (4.5% vs. 3.3%); new patients rather than transferred-in (3.7% vs. 1.6%) resided in the Kinshasa province rather than Haut-Katanga (4.0% vs. 2.7%) and were in an urban health zone (3.9%) and semi-rural (3.1%) rather than rural (1.2%) health zone. The logistic regression models showed that after controlling for other demographic and clinical variables, TB/HIV coinfection raised the risk of death (AOR, 2.26; CI, 1.94–2.64) and loss to follow up (AOR, 2.06; CI, 1.82 to B/HIV coinfection lowered the odds of viral load suppression (VLS) below 1,000 copies per ml of blood (AOR, 0.58; CI, 0.46–0.74). Conclusion: TB/HIV coinfection raises the risk of negative outcomes such as death, loss to follow up, and inability to have viral load suppressed below 1,000 copies per ml. HIV clinics in DRC and other African countries may consider these findings when customizing their interventions to improve HIV care and reduce disparities in PLWH