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Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia.

ABSTRACT: In order to achieve the programmatic goals established in the National HIV/AIDS Strategy, virologic suppression remains the most important outcome within the HIV care continuum for individuals receiving antiretroviral therapy (ART). Therefore, clinicians have dedicated substantial resources to improve adherence and clinic retention for individuals on ART; however, these efforts should be focused first on those most at risk of morbidity and mortality related to AIDS. Our study aimed to characterize the factors that are associated with AIDS-defining illnesses (ADIs) amongst people living with HIV (PLHIV) who are poorly adherent or retained in care in order to identify those at highest risk of poor clinical outcomes. We recruited 99 adult PLHIV with a history of poor adherence to ART, poor clinic attendance, or unsuppressed viral load (VL) from the Infectious Disease Program (IDP) of the Grady Health System in Atlanta, Georgia between January and May 2011 to participate in a survey investigating the acceptability of a financial incentive for improving adherence. Clinical outcomes including the number of ADI episodes in the last five years, VLs, and CD4 counts were abstracted from medical records. Associations between survey items and number of ADIs were performed using chi-square analysis. In our study, 36.4% of participants had ?1 ADI in the last five years. The most common ADIs were Pneumocystis jirovecii pneumonia, recurrent bacterial pneumonia, and esophageal candidiasis. Age <42.5 years (OR 2.52, 95% CI = 1.08-5.86), male gender (OR 3.51, 95% CI = 1.08-11.34), CD4 nadir <200 cells/µL (OR 11.92, 95% CI = 1.51-94.15), unemployment (OR 3.54, 95% CI = 1.20-10.40), and travel time to clinic <30 minutes (OR 2.80, 95% CI = 1.20-6.52) were all significantly associated with a history of ?1 ADI in the last five years. Awareness of factors associated with ADIs may help clinicians identify which poorly adherent PLHIV are at highest risk of HIV-related morbidity.

SUBMITTER: Chow JY

PROVIDER: S-EPMC4400213 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia.

Chow Jeremy Y JY Alsan Marcella M Armstrong Wendy W del Rio Carlos C Marconi Vincent C VC

AIDS care 20150209 7

In order to achieve the programmatic goals established in the National HIV/AIDS Strategy, virologic suppression remains the most important outcome within the HIV care continuum for individuals receiving antiretroviral therapy (ART). Therefore, clinicians have dedicated substantial resources to improve adherence and clinic retention for individuals on ART; however, these efforts should be focused first on those most at risk of morbidity and mortality related to AIDS. Our study aimed to characteri ...[more]

PMID: 25660100

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Project description:BackgroundTobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality.ObjectivesTo assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions.Search methodsWe searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases.Selection criteriaControlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA.Data collection and analysisTwo review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria.Main resultsWe identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study.Authors' conclusionsThere is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.

Project description:BackgroundUp till today, studies carried in Lebanon have focused more on the prevalence of HIV and behaviors and quality of life of infected individuals, however, none of these studies discussed the degree of stigma towards these populations. Therefore, the aim of this study is to measure the rate of stigma in terms of knowledge, attitude and practice towards patients living with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (PLWHA) and examine the factors associated with this stigma.MethodsA cross-sectional survey, enrolling 862 participants, was carried across the five governorates in Lebanon: Beirut, Mount Lebanon, North, South and Bekaa. The survey was a self-administered questionnaire which covered information about participants' general demographics, their knowledge, attitudes, practices and awareness towards HIV/AIDS in Lebanon., attitudes towards PLWHA, practices related to HIV/AIDS and awareness regarding HIV/AIDS situation in Lebanon.ResultsThe response rate to the survey was 78.36% (862 participants). Being Muslim (Beta = -2.56) or Druze (Beta = -2.64) compared to Christians were significantly associated with lower knowledge towards HIV/AIDS, whereas having a secondary (Beta = 2.71) and a university (Beta = 3.04) levels of education compared to illiteracy and higher age (Beta = 0.05) were significantly associated with higher knowledge. Higher knowledge (Beta = 0.66) was significantly associated with better attitude, whereas higher age (Beta = -0.14) and being Muslim compared to Christian (Beta = -3.44) were significantly associated with worse attitude. Better attitude (Beta = 0.02) was significantly associated with better practice, whereas females compared to males (Beta = -0.39), having a secondary level of education compared to illiteracy (Beta = -0.88) and being Muslim compared to Christian (Beta = -0.32) were significantly associated with worse practice.ConclusionOur results stress the need for educational programs, advocacy campaigns and policies to help reduce HIV stigma. This will then help start developing interventions and strategies for a possible reduction in the stigmatization level.

Dataset Information

Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia.

Publications

Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia.

Similar Datasets

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