Use of recommended preventive health care services and variations in HIV care among women with HIV in the United States, 2013-2014: Opportunities for expanded partnerships in support of ending the HIV epidemic

Tue, 16 Jul 2019 00:00:00 GMT-05:00 - Short, William R.; Sutton, Madeline Y.; Luo, Qingwei; Frazier, Emma L.
Εισαγωγή: Despite recommendations for preventive health services and routine HIV care for HIV-positive women, limited data are available regarding uptake of recommendations.
Μέθοδοι: We used data from the 2013-2014 data cycles of the Medical Monitoring Project. We calculated weighted estimates and used multivariable logistic regression with adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to examine associations between preventive health screenings, routine HIV care (based on viral load (VL) and CD4 measures as proxies), and sociodemographic factors.
Αποτελέσματα: Of 2,766 women, 47.7% were ≥ 50 years old, 61.7% non-Hispanic black, 37.2% had > high school education, 63.3% had been living with HIV for ≥ 10 years, 68.4% were living ≤the federal poverty level, 67.3% had public health insurance; 93.8%were prescribed antiretroviral therapy (ART); 66.1%had sustained/durable suppression (12 months). For women aged ≥ 18 years, cervical cancer, breast cancer, and STI screenings were documented for 44.3%, 27.6%, and 34.7%, respectively; 26% did not meet 6-month, and 37% did not meet 12-month, VL and CD4 test measure goals. In multivariable analyses, women with no VLs in past 6 months were less likely to be durably suppressed, and women who did not have ≥ three CD4 or VL tests (past 12 months) were less likely to be living above the poverty level, and more likely to have public insurance, compared to private health insurance (p < 0.05).
Συμπέρασμα: Receipt of recommended preventive care was suboptimal. Targeted interventions are warranted to help ensure access to comprehensive HIV care and prevention services for women. Correspondence: Madeline Y. Sutton, MD, MPH Email: mysutton2019@gmail.com DHAP/NCHHSTP/CDC 1600 Clifton Rd NE MS E-45 Atlanta, GA 30333 Office: 404-639-1814 Fax: 404-639-6127 Conflicts of interest: The authors declare no conflicts of interest. Source of funding: Funding for the Medical Monitoring Project (MMP) is provided by a cooperative agreement (PS09-937) from the Centers for Disease Control and Prevention. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. - Β© 2019

The Impact of Cumulative Depression along the HIV Care Continuum in Women Living with HIV during the Era of Universal Antiretroviral Treatment

Tue, 16 Jul 2019 00:00:00 GMT-05:00 - Mills, Jon C.; Pence, Brian W.; Edmonds, Andrew; Adedimeji, Adebola; Schwartz, Rebecca M.; Kassaye, Seble; Cocohoba, Jennifer; Cohen, Mardge H.; Neigh, Gretchen; Fischl, Margaret A.; Kempf, Mirjam-Colette; Adimora, Adaora A.
Εισαγωγή: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. Setting: A cohort of WLWH (N=1,491) from the Women’s Interagency HIV Study (WIHS) at nine sites across the US.
Μέθοδοι: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of nine semi-annual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression (CES-D) scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL).
Αποτελέσματα: The risk of missing an HIV care appointment [risk ratio (RR)=1.16, 95% confidence interval (CI)=0.93 to 1.45; risk difference (RD)=0.01, -0.01 to 0.03], being <95% ART adherent (RR=1.27, 1.06 to 1.52; RD=0.04, -0.01 to 0.07), and virological failure (RR=1.09, 1.01 to 1.18; RD=0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent.
Συμπεράσματα: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence. Corresponding Author: Jon C. Mills Institute for Global Health and Infectious Diseases University of North Carolina at Chapel Hill McGavran-Greenberg Hall 2103B Chapel Hill, NC 27599 United States Phone: 919-966-7410 Fax: Email: jon_mills@med.unc.edu Conflicts of Interest: The authors have no conflicts of interest to report. Conference Presentations: None to report Sources of Funding: This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health [T32 AI007001 to A.A.]; and the Women’s Interagency HIV Study, a National Institutes of Health funded program made possible by the National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Services; National Cancer Institute, National Institute on Drug Abuse; and the National Institute on Mental Health [grant numbers U01-AI-103401 to M.K.; U01-AI-103408; U01-AI-035004; U01-AI-031834; U01-AI-034993 to M.C.; U01-AI-034994 to S.K.; U01-AI-103397 to M.F.; U01-AI-103390 to A.A.; U01-AI-034989; U01-AI-042590; U01-HD-032632]. Targeted supplemental funding for specific projects is also provided by the National Institutes of Health at the National Institute of Dental and Craniofacial Research; the National Institute on Alcohol Abuse and Alcoholism; the National Institute on Deafness and other Communication Disorders; and the Office of Research on Women’s Health. Women’s Interagency HIV Study data collection is also supported by UCSF CTSA [UL1-TR000004]; Atlanta CTSA [UL1-TR000454]; University of North Carolina at Chapel Hill Center for AIDS Research [P30-AI-050410]; and the University of Alabama at Birmingham Center for AIDS Research [P30-AI-027767]. - Β© 2019

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