AIDS Research and Treatment http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis Thu, 04 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/art/2014/967073/ Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03–1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00–2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only. Katy A. van Galen, Jeannine F. Nellen, and Pythia T. Nieuwkerk Copyright © 2014 Katy A. van Galen et al. All rights reserved. Oral Health Status and Oromucosal Lesions in Patients Living with HIV/AIDS in India: A Comparative Study Wed, 20 Aug 2014 10:37:36 +0000 http://www.hindawi.com/journals/art/2014/480247/ Oral health status of HIV positive individuals is in poor condition which may be a sequela of variety of factors. This study was aimed at assessing and comparing the oral health status and oromucosal lesions between HIV positive and negative individuals in India. A total of 126 HIV positive and 532 HIV negative individuals were recruited for the study. Oral health status and oromucosal lesions were recorded using WHO oral health assessment form (1997). Data was analyzed using chi-square and independent sample student’s t test. Majority (85.7%) of people suffering from HIV belonged to lower socioeconomic status. The mean for DMFT score was found to be significantly higher in HIV positive individuals () as compared to HIV negative individuals () ( value ). Nearly 75% of HIV positive individuals showed oromucosal lesions with candidiasis (36%) being the most common. Nearly 50% of HIV positive individuals had community periodontal index (CPI) and loss of attachment (LOA) score >2. In conclusion HIV positive individuals have poor oral health status and poor periodontal status compared to control group. Effective policies need to be drafted to take care of the oral health of this high risk group. Sandeep Kumar, Prashant Mishra, Shilpa Warhekar, Bhuvnesh Airen, Deepika Jain, and Shaijal Godha Copyright © 2014 Sandeep Kumar et al. All rights reserved. Serum Micronutrient Status of Haart-Naïve, HIV Infected Children in South Western Nigeria: A Case Controlled Study Mon, 11 Aug 2014 12:35:09 +0000 http://www.hindawi.com/journals/art/2014/351043/ Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population. H. C. Anyabolu, E. A. Adejuyigbe, and O. O. Adeodu Copyright © 2014 H. C. Anyabolu et al. All rights reserved. Determinants of Mortality among Adult HIV-Infected Patients on Antiretroviral Therapy in a Rural Hospital in Southeastern Nigeria: A 5-Year Cohort Study Wed, 06 Aug 2014 08:05:46 +0000 http://www.hindawi.com/journals/art/2014/867827/ Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens. Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45). Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL. Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators. Kelechi N. Eguzo, Adegboyega K. Lawal, Cynthia E. Eseigbe, and Chisara C. Umezurike Copyright © 2014 Kelechi N. Eguzo et al. All rights reserved. Exploration of the Effect of Tobacco Smoking on Metabolic Measures in Young People Living with HIV Wed, 09 Jul 2014 11:15:33 +0000 http://www.hindawi.com/journals/art/2014/740545/ We conducted cross-sectional, multicenter studies in HIV-positive young women and men to assess metabolic and morphologic complications from tobacco smoking in 372 behaviorally infected HIV-positive youth, aged 14–25 years. Measurements included self-reported tobacco use, fasting lipids, glucose, fat distribution, and bone mineral density (BMD; dual-energy X-ray absorptiometry scans). Overall, 144 (38.7%) self-reported smoking tobacco and 69 (47.9%) of these reported smoking greater than five cigarettes per day. Smokers versus nonsmokers had lower mean total cholesterol (146.0 versus 156.1 mg/dL; ) and lower mean total body fat percent (24.1% versus 27.2%, ). There was no difference between smokers and nonsmokers in fasting glucose or BMD. There appear to be only minimal effects from tobacco smoking on markers of cardiac risk and bone health in this population of HIV-positive youth. While these smokers may not have had sufficient exposure to tobacco to detect changes in the outcome measures, given the long-term risks associated with smoking and HIV, it is critical that we encourage HIV-positive youth smokers to quit before the deleterious effects become apparent. Mark L. Rubinstein, D. Robert Harris, Bret J. Rudy, Bill G. Kapogiannis, Grace M. Aldrovandi, and Kathleen Mulligan Copyright © 2014 Mark L. Rubinstein et al. All rights reserved. Cost of Care for HIV-Infected Patients with Co-Occurring Substance Use Disorder or Psychiatric Disease: Report from a Large, Integrated Health Plan Sun, 22 Jun 2014 07:43:15 +0000 http://www.hindawi.com/journals/art/2014/570546/ Background. The costs of providing care to HIV-infected (HIV+) patients with co-occurring diagnoses of substance use (SU) disorder or psychiatric disease (PD) are not well documented. It is our objective to evaluate costs in these HIV+ patients receiving care in a large health plan. Methods. We conducted a retrospective cohort study from 1995 to 2010 to compare costs of healthcare in HIV+ patients with and without co-occurring SU disorder and/or PD diagnoses. Estimates of proportional differences in costs (rate ratios) were obtained from repeated measures generalized linear regression. Models were stratified by cost category (e.g., inpatient, outpatient). Results. Mean total healthcare costs per patient per year were higher in HIV+ patients diagnosed with SU disorder or PD compared to HIV+ patients without these comorbid conditions. After controlling for confounders, total mean costs remained significantly higher in patients diagnosed with SU disorder (RR = 1.24, 95% CI = 1.18–1.31) or PD (RR = 1.19, 95% CI = 1.15–1.24). Mean outpatient care costs were significantly greater in patients with both SU disorder and PD (RR = 1.52, 95% CI = 1.41–1.64). Conclusions. Given these higher expenditures in the care of HIV+ patients with comorbid SU disorder and/or PD, greater efforts to facilitate SU disorder or PD treatment initiation and persistence could provide substantial savings. Gerald N. DeLorenze, Ai-Lin Tsai, Michael A. Horberg, and Charles P. Quesenberry Jr. Copyright © 2014 Gerald N. DeLorenze et al. All rights reserved. Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria Tue, 17 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/art/2014/560623/ Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 () and 24 weeks () with similar responses at 48 weeks () and higher rates of viral suppression (<400 c/mL) at 12 () and 48 weeks (), but similar responses at 24 weeks (). Mortality was 2.3% versus 5.0% () at prime and satellite sites, while transfer rate was 8.7% versus 5.5% () at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care. Prosper Okonkwo, Atiene S. Sagay, Patricia A. Agaba, Stephen Yohanna, Oche O. Agbaji, Godwin E. Imade, Bolanle Banigbe, Juliet Adeola, Tinuade A. Oyebode, John A. Idoko, and Phyllis J. Kanki Copyright © 2014 Prosper Okonkwo et al. All rights reserved. Point-of-Care Tests for HIV, Related Coinfections, and Blood-Borne Infections Tue, 06 May 2014 08:48:37 +0000 http://www.hindawi.com/journals/art/2014/625082/ Nitika Pant Pai, Rosanna W. Peeling, Bryce D. Smith, and David Dowdy Copyright © 2014 Nitika Pant Pai et al. All rights reserved. HIV Prevention Messages Targeting Young Latino Immigrant MSM Thu, 17 Apr 2014 06:45:30 +0000 http://www.hindawi.com/journals/art/2014/353092/ Young Latino immigrant men who have sex with men (MSM) are at risk for HIV and for delayed diagnosis. A need exists to raise awareness about HIV prevention in this population, including the benefits of timely HIV testing. This project was developed through collaboration between University of WA researchers and Entre Hermanos, a community-based organization serving Latinos. Building from a community-based participatory research approach, the researchers developed a campaign that was executed by Activate Brands, based in Denver, Colorado. The authors (a) describe the development of HIV prevention messages through the integration of previously collected formative data; (b) describe the process of translating these messages into PSAs, including the application of a marketing strategy; (c) describe testing the PSAs within the Latino MSM community; and (c) determine a set of important factors to consider when developing HIV prevention messages for young Latino MSM who do not identify as gay. Rosa Solorio, Pamela Norton-Shelpuk, Mark Forehand, Marcos Martinez, and Joel Aguirre Copyright © 2014 Rosa Solorio et al. All rights reserved. Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS Thu, 03 Apr 2014 08:30:21 +0000 http://www.hindawi.com/journals/art/2014/675739/ Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial () that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care. Patrice K. Nicholas, Suzanne Willard, Clinton Thompson, Carol Dawson-Rose, Inge B. Corless, Dean J. Wantland, Elizabeth F. Sefcik, Kathleen M. Nokes, Kenn M. Kirksey, Mary Jane Hamilton, William L. Holzemer, Carmen J. Portillo, Marta Rivero Mendez, Linda M. Robinson, Maria Rosa, Sarie P. Human, Yvette Cuca, Emily Huang, Mary Maryland, John Arudo, Lucille Sanzero Eller, Mark A. Stanton, MaryKate Driscoll, Joachim G. Voss, and Shahnaz Moezzi Copyright © 2014 Patrice K. Nicholas et al. All rights reserved. Poor Reporting of Outcomes Beyond Accuracy in Point-of-Care Tests for Syphilis: A Call for a Framework Thu, 27 Mar 2014 07:53:35 +0000 http://www.hindawi.com/journals/art/2014/465932/ Background. Point-of-care (POC) diagnostics for syphilis can contribute to epidemic control by offering a timely knowledge of serostatus. Although accuracy data on POC syphilis tests have been widely published, few studies have evaluated broader outcomes beyond accuracy that impact patients and health systems. We comprehensively reviewed evidence and reporting of these implementation research outcomes (IROs), and proposed a framework to improve their quality. Methods. Three reviewers systematically searched 6 electronic databases from 1980 to 2014 for syphilis POC studies reporting IROs. Data were abstracted and findings synthesised narratively. Results. Of 71 studies identified, 38 documented IROs. IROs were subclassified into preference (7), acceptability (15), feasibility (15), barriers and challenges (15), impact (13), and prevalence (23). Using our framework and definitions, a pattern of incomplete documentation, inconsistent definitions, and lack of clarity was identified across all IROs. Conclusion. Although POC screening tests for syphilis were generally favourably evaluated across a range of outcomes, the quality of evidence was compromised by inconsistent definitions, poor methodology, and documentation of outcomes. A framework for standardized reporting of outcomes beyond accuracy was proposed and considered a necessary first step towards an effective implementation of these metrics in POC diagnostics research. Yalda Jafari, Mira Johri, Lawrence Joseph, Caroline Vadnais, and Nitika Pant Pai Copyright © 2014 Yalda Jafari et al. All rights reserved. Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia Mon, 10 Mar 2014 09:52:10 +0000 http://www.hindawi.com/journals/art/2014/235483/ Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ≤6 months after first presenting to care at the study sites. Data on time in care and resources utilized during the 6 months prior to ART initiation were extracted from patient medical records. Costs were estimated from the provider’s perspective and are reported in 2011 USD. Results. For the patients who initiated ART ≤6 months after presenting to care, median age at presentation to care was 3.9 years; median CD4 percentage was 13%. Median time to ART initiation was 26 days. Patients made, on average, 2.38 clinic visits prior to ART initiation and received 0.81 CD4 tests, 0.74 full blood count tests, and 0.49 blood chemistry tests. The mean cost of pre-ART care was $20 per patient. Conclusions. Zambian pediatric patients initiating ART ≤6 months after presenting to care do so quickly, utilize fewer resources than mandated by national guidelines, and accrue low costs. Hari S. Iyer, Callie A. Scott, Deophine Lembela Bwalya, Gesine Meyer-Rath, Crispin Moyo, Carolyn Bolton Moore, Bruce A. Larson, and Sydney Rosen Copyright © 2014 Hari S. Iyer et al. All rights reserved. Etravirine as a Switching Option for Patients with HIV RNA Suppression: A Review of Recent Trials Tue, 25 Feb 2014 07:26:07 +0000 http://www.hindawi.com/journals/art/2014/636584/ Unlike other nonnucleoside reverse transcriptase inhibitors, etravirine is only approved for use in treatment-experienced patients. In the DUET 1 and 2 trials, 1203 highly treatment-experienced patients were randomized to etravirine or placebo, in combination with darunavir/ritonavir and optimized background treatment. In these trials, etravirine showed significantly higher rates of HIV RNA suppression when compared with placebo (61% versus 40% at Week 48). There was no significant rise of lipids or neuropsychiatric adverse events, but there was an increase in the risk of rash with etravirine treatment. In the SENSE trial, which evaluated etravirine and efavirenz in 157 treatment-naïve patients in combination with 2 nucleoside analogues, there was a lower risk of lipid elevations and neuropsychiatric adverse events with etravirine when compared to efavirenz. Etravirine has been evaluated in three randomized switching studies. In the SSAT029 switch trial, 38 patients who had neuropsychiatric adverse events possibly related to efavirenz showed an improvement in these after switching to etravirine. The Swiss Switch-EE recruited 58 individuals without neuropsychiatric adverse events who were receiving efavirenz, and no benefit was shown when switching to etravirine. In the Spanish ETRA-SWITCH trial (), there were improvements in lipids when individuals switched from a protease inhibitor to etravirine. These switching trials were conducted in patients with full HIV RNA suppression: <50 copies/mL and with no history of virological failure or resistance to therapy. The results from these three randomized switching studies suggest a possible new role for etravirine, in combination with two nucleoside analogues, as a switching option for those with HIV RNA suppression but who are reporting adverse events possibly related to antiretroviral therapy. However a large well-powered trial would need to be conducted to strengthen the evidence from the pilot studies conducted so far. Mark Nelson, Andrew Hill, Yvon van Delft, and Christiane Moecklinghoff Copyright © 2014 Mark Nelson et al. All rights reserved. HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities Thu, 30 Jan 2014 09:39:40 +0000 http://www.hindawi.com/journals/art/2014/803685/ HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection. Jaime Galindo-Quintero, Hector Fabio Mueses-Marin, David Montaño-Agudelo, María Virginia Pinzón-Fernández, Inés Constanza Tello-Bolívar, Beatriz Eugenia Alvarado-Llano, and Jorge Luis Martinez-Cajas Copyright © 2014 Jaime Galindo-Quintero et al. All rights reserved. Point of Care Technologies for HIV Tue, 21 Jan 2014 10:53:29 +0000 http://www.hindawi.com/journals/art/2014/497046/ Effective prevention of HIV/AIDS requires early diagnosis, initiation of therapy, and regular plasma viral load monitoring of the infected individual. In addition, incidence estimation using accurate and sensitive assays is needed to facilitate HIV prevention efforts in the public health setting. Therefore, more affordable and accessible point-of-care (POC) technologies capable of providing early diagnosis, HIV viral load measurements, and CD4 counts in settings where HIV is most prevalent are needed to enable appropriate intervention strategies and ultimately stop transmission of the virus within these populations to achieve the future goal of an AIDS-free generation. This review discusses the available and emerging POC technologies for future application to these unmet public health needs. Mohan Kumar Haleyur Giri Setty and Indira K. Hewlett Copyright © 2014 Mohan Kumar Haleyur Giri Setty and Indira K. Hewlett. All rights reserved. Will an Unsupervised Self-Testing Strategy Be Feasible to Operationalize in Canada? Results from a Pilot Study in Students of a Large Canadian University Thu, 09 Jan 2014 11:24:36 +0000 http://www.hindawi.com/journals/art/2014/747619/ Background. A convenient, private, and accessible HIV self-testing strategy stands to complement facility-based conventional testing. Over-the-counter oral HIV self-tests are approved and available in the United States, but not yet in Canada. Canadian data on self-testing is nonexistent. We investigated the feasibility of offering an unsupervised self-testing strategy to Canadian students. Methods. Between September 2011 and May 2012, we recruited 145 students from a student health clinic of a large Canadian university. Feasibility of operationalization (i.e., self-test conduct, acceptability, convenience, and willingness to pay) was evaluated. Self-test conduct was computed with agreement between the self-test performed by the student and the test repeated by a healthcare professional. Other metrics were measured on a survey. Results. Participants were young (median age: 22 years), unmarried (97%), and 47% were out of province or international students. Approximately 52% self-reported a history of unprotected casual sex and sex with multiple partners. Self-test conduct agreement was high (100%), so were acceptability (81%), convenience (99%), and willingness to pay (74%) for self-tests. Concerns included accuracy of self-tests and availability of expedited linkages. Conclusion. An unsupervised self-testing strategy was found to be feasible in Canadian students. Findings call for studies in at-risk populations to inform Canadian policy. Nitika Pant Pai, Madhavi Bhargava, Lawrence Joseph, Jigyasa Sharma, Sabrina Pillay, Bhairavi Balram, and Pierre-Paul Tellier Copyright © 2014 Nitika Pant Pai et al. All rights reserved. Attitudes towards and Beliefs about HIV Testing among Latino Immigrant MSM: A Comparison of Testers and Nontesters Mon, 23 Dec 2013 14:46:37 +0000 http://www.hindawi.com/journals/art/2013/563537/ Latino immigrant men who have sex with men (MSM) are at risk for HIV and delayed diagnosis. An exploratory study using qualitative interviews that assess the beliefs and attitudes of 54 Latino immigrant MSM in Seattle, Washington, is presented. The goal of this research is to determine whether attitudinal differences exist between participants who had and had not been tested and to use any insight into the development of a media campaign to promote testing. Over one-third of the men have never been tested for HIV. Nontesters are more likely to be men who have sex with men and women, have less knowledge about HIV risks, perceive their sexual behaviors as less risky, and deflect HIV-related stigma. Testers are more likely to be self-identified as being gays. Both groups believe that fear of a positive result is the main barrier to testing. Both groups believe that family members have negative attitudes towards HIV testing and that having Latino staff at HIV testing sites hinders confidentiality. Financial concerns with regard to the cost of testing were also expressed by both groups. Based on these insights, recommended strategies for the development of HIV prevention and testing campaigns are made. Rosa Solorio, Mark Forehand, and Jane Simoni Copyright © 2013 Rosa Solorio et al. All rights reserved. Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic Sun, 22 Dec 2013 10:51:01 +0000 http://www.hindawi.com/journals/art/2013/528904/ Background. The Centers for Disease Control and Prevention (CDC) recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV), including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC) testing into standard operations at an urban STD clinic. Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC). All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative). Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection. A. Jewett, A. A. Al-Tayyib, L. Ginnett, and B. D. Smith Copyright © 2013 A. Jewett et al. All rights reserved. Feasibility and Field Performance of a Simultaneous Syphilis and HIV Point-of-Care Test Based Screening Strategy in at Risk Populations in Edmonton, Canada Thu, 19 Dec 2013 09:12:46 +0000 http://www.hindawi.com/journals/art/2013/819593/ Few studies have evaluated the feasibility of delivering syphilis point-of-care (POC) testing in outreach (nonclinical) settings in resource rich countries. The objectives of the study were to evaluate the feasibility and diagnostic performance of performing both HIV and syphilis POC testing in outreach settings and to document new cases identified in the study population. 1,265 outreach testing visits were offered syphilis and HIV POC testing and 81.5% () consented to testing. In our population, the SD Bioline 3.0 Syphilis Test had a sensitivity of 85.3% [CI (68.9–95.0)], specificity of 100.0% [CI (99.6–100.0)], positive predictive value (PPV) of 100.0% [CI (88.1–100.0)], and negative predictive value (NPV) of 99.5% [CI (98.9–99.8)]. Test characteristics for the INSTI HIV-1/HIV-2 Antibody Test had a 100.0% sensitivity [CI (39.8–100.00], 99.8 specificity [CI (99.3–100)], 66.7% PPV [CI (22.3–95.7)], and 100.0% NPV [CI (99.6–100.0)]. Four new cases of syphilis and four new HIV cases were diagnosed. In summary, at risk population seeking STI testing found POC tests to be acceptable, the POC tests performed well in outreach settings, and new cases of syphilis and HIV were identified and linked to treatment and care. Joshua Bergman, Jennifer Gratrix, Sabrina Plitt, Jayne Fenton, Chris Archibald, Tom Wong, and Ameeta E. Singh Copyright © 2013 Joshua Bergman et al. All rights reserved. Differences in Salivary Flow Level, Xerostomia, and Flavor Alteration in Mexican HIV Patients Who Did or Did Not Receive Antiretroviral Therapy Thu, 19 Dec 2013 09:10:38 +0000 http://www.hindawi.com/journals/art/2013/613278/ Introduction. Objective and subjective alterations related to salivary flow have been reported in patients infected with human immunodeficiency virus (HIV), and these alterations are associated with the introduction of antiretroviral therapy. The aim of the current study was to discern whether these alterations are disease induced or secondary to drug therapy. Objective. The objective was to determine the relationships between low salivary flow, xerostomia, and flavor alterations in HIV patients who did or did not receive antiretroviral therapy. Materials and Methods. In this cross-sectional study, HIV patients were divided into two groups based on whether they had received antiretroviral therapy. Those patients with a previous diagnosis of any salivary gland disease were excluded. A survey was used to assess subjective variables, and colorimetry and salivary flow rates were measured using the Schirmer global test. Results. A total of 293 patients were included. The therapy group showed a significantly lower average salivary flow than did the group without therapy, and we observed that the flow rate tended to decrease after one year of therapy. The results were not conclusive, despite significant differences in xerostomia and flavor alteration between the groups. Conclusion. The study results suggest that antiretroviral therapy can cause cumulative damage that affects the amount of salivary flow. Sandra López-Verdín, Jaime Andrade-Villanueva, Ana Lourdes Zamora-Perez, Ronell Bologna-Molina, José Justino Cervantes-Cabrera, and Nelly Molina-Frechero Copyright © 2013 Sandra López-Verdín et al. All rights reserved. Did Universal Access to ARVT in Mexico Impact Suboptimal Antiretroviral Prescriptions? Wed, 11 Dec 2013 08:32:39 +0000 http://www.hindawi.com/journals/art/2013/170417/ Background. Universal access to antiretroviral therapy (ARVT) started in Mexico in 2001; no evaluation of the features of ARVT prescriptions over time has been conducted. The aim of the study is to document trends in the quality of ARVT-prescription before and after universal access. Methods. We describe ARVT prescriptions before and after 2001 in three health facilities from the following subsystems: the Mexican Social Security (IMSS), the Ministry of Health (SSA), and National Institutes of Health (INS). Combinations of drugs and reasons for change were classified according to current Mexican guidelines and state-of-the-art therapy. Comparisons were made using tests. Results. Before 2001, 29% of patients starting ARVT received HAART; after 2001 it increased to 90%. The proportion of adequate prescriptions decreased within the two periods of study in all facilities ( value < 0.01). The INS and SSA were more likely to be prescribed adequately ( value < 0.01) compared to IMSS. The distribution of reasons for change was not significantly different during this time for all facilities ( value > 0.05). Conclusions. Universal ARVT access in Mexico was associated with changes in ARVT-prescription patterns over time. Health providers’ performance improved, but not homogeneously. Training of personnel and guidelines updating is essential to improve prescription. Yanink Caro-Vega, Patricia Volkow, Juan Sierra-Madero, M. Arantxa Colchero, Brenda Crabtree-Ramírez, and Sergio Bautista-Arredondo Copyright © 2013 Yanink Caro-Vega et al. All rights reserved. Using Mobile Health Technology to Improve HIV Care for Persons Living with HIV and Substance Abuse Thu, 05 Dec 2013 09:45:54 +0000 http://www.hindawi.com/journals/art/2013/194613/ Gregory D. Kirk, Seth S. Himelhoch, Ryan P. Westergaard, and Curt G. Beckwith Copyright © 2013 Gregory D. Kirk et al. All rights reserved. Intersection of HIV and Reproductive Health Sun, 24 Nov 2013 14:41:50 +0000 http://www.hindawi.com/journals/art/2013/418918/ Craig R. Cohen, Elizabeth Bukusi, Helen Rees, and Kelly Blanchard Copyright © 2013 Craig R. Cohen et al. All rights reserved. The Exposure Assessment in Current Time Study: Implementation, Feasibility, and Acceptability of Real-Time Data Collection in a Community Cohort of Illicit Drug Users Wed, 06 Nov 2013 15:09:35 +0000 http://www.hindawi.com/journals/art/2013/594671/ Objective. We describe the study design and evaluate the implementation, feasibility, and acceptability of an ecological momentary assessment (EMA) study of illicit drug users. Design. Four sequential field trials targeting observation of 30 individuals followed for a four week period. Participants. Participants were recruited from an ongoing community-cohort of current or former injection drug users. Of 113 individuals enrolled, 109 completed study procedures during four trials conducted from November 2008 to May 2013. Methods. Hand-held electronic diaries used in the initial trials were transitioned to a smartphone platform for the final trial with identical data collection. Random-prompts delivered five times daily assessed participant location, activity, mood, and social context. Event-contingent data collection involved participant self-reports of illicit drug use and craving. Main Outcome Measures. Feasibility measures included participant retention, days of followup, random-prompt response rates, and device loss rate. Acceptability was evaluated from an end-of-trial questionnaire. Sociodemographic, behavioral, clinical, and trial characteristics were evaluated as correlates of weekly random-prompt response rates ≥80% using logistic regression with generalized estimating equations. Results. Study participants were a median of 48.5 years old, 90% African American, 52% male, and 59% HIV-infected with limited income and educational attainment. During a median followup of 28 days, 78% of 11,181 random-prompts delivered were answered (mean of 2.8 responses daily), while 2,798 participant-initiated events were reported (30% drug use events; 70% craving events). Self-reported acceptability to study procedures was uniformly favorable. Device loss was rare (only 1 lost device every 190 person-days of observation). Higher educational attainment was consistently associated with a higher response rate to random-prompts, while an association of HIV infection with lower response rates was not observed after accounting for differences in trial recruitment procedures. Conclusion. Near real-time EMA data collection in the field is feasible and acceptable among community-dwelling illicit drug users. These data provide the basis for future studies of EMA-informed interventions to prevent drug relapse and improve HIV treatment outcomes in this population. Gregory D. Kirk, Beth S. Linas, Ryan P. Westergaard, Damani Piggott, Robert C. Bollinger, Larry W. Chang, and Andrew Genz Copyright © 2013 Gregory D. Kirk et al. All rights reserved. Determinants of Tuberculosis Infection among Adult HIV Positives Attending Clinical Care in Western Ethiopia: A Case-Control Study Tue, 08 Oct 2013 13:24:43 +0000 http://www.hindawi.com/journals/art/2013/279876/ There has been a drastic rise of tuberculosis (TB) infection across the world associated with the pandemic occurrence of HIV/AIDS. There are various determinants factors that increase the chance of TB infection among HIV positives (TB/HIV confection) that varies contextually. This study aimed to assess the determinants of TB/HIV coinfection among adult HIV positives attending clinical care at two public health facilities in Nekemte, western Ethiopia. Unmatched case-control study was conducted from December 26, 2011, to February 29, 2012. Cases were 123 TB infected HIV positives, and controls were 246 non-TB infected HIV positives. Being divorced/widowed , 95% CI (1.70, 7.88), not attending formal education , 95% CI (2.20, 14.15), being underweight ( kg/m2) , 95% CI (2.18, 6.87), having history of diabetic mellitus , 95% CI (1.33, 9.94), and being in advanced WHO HIV/AIDS clinical staging , 95% CI (1.32, 3.98), were determinant factors associated with TB/HIV co-infection. Having a separate kitchen , 95% CI (0.28, 0.81) showed protective role. For most of these determinants interventions can be made at individual and institutional levels, whereas, factors like education and nutrition need societal level integrations. Hatoluf Melkamu, Berhanu Seyoum, and Yadeta Dessie Copyright © 2013 Hatoluf Melkamu et al. All rights reserved. Ethical Issues in mHealth Research Involving Persons Living with HIV/AIDS and Substance Abuse Thu, 19 Sep 2013 17:07:49 +0000 http://www.hindawi.com/journals/art/2013/189645/ We aim to raise awareness and stimulate dialogue among investigators and research ethics committees regarding ethical issues that arise specifically in the design and conduct of mHealth research involving persons living with HIV/AIDS and substance abuse. Following a brief background discussion of mHealth research in general, we offer a case example to illustrate the characteristics of mHealth research involving people living with HIV/AIDS and substance abuse. With reference to a well-established systematic general ethical framework for biomedical research with human participants, we identify a range of ethical issues that have particular salience for the protection of participants in mHealth research on HIV/AIDS and substance abuse. Alain B. Labrique, Gregory D. Kirk, Ryan P. Westergaard, and Maria W. Merritt Copyright © 2013 Alain B. Labrique et al. All rights reserved. Smartphone Delivery of Mobile HIV Risk Reduction Education Tue, 17 Sep 2013 18:32:41 +0000 http://www.hindawi.com/journals/art/2013/231956/ We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability “as is” in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all ). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings. Karran A. Phillips, David H. Epstein, Mustapha Mezghanni, Massoud Vahabzadeh, David Reamer, Daniel Agage, and Kenzie L. Preston Copyright © 2013 Karran A. Phillips et al. All rights reserved. Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US Tue, 17 Sep 2013 10:36:46 +0000 http://www.hindawi.com/journals/art/2013/789413/ The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US. Anne Zinski, Sarah M. Dougherty, Ashutosh Tamhane, Kelly L. Ross-Davis, and James L. Raper Copyright © 2013 Anne Zinski et al. All rights reserved. Preliminary Evidence for Feasibility, Use, and Acceptability of Individualized Texting for Adherence Building for Antiretroviral Adherence and Substance Use Assessment among HIV-Infected Methamphetamine Users Tue, 03 Sep 2013 10:28:21 +0000 http://www.hindawi.com/journals/art/2013/585143/ The feasibility, use, and acceptability of text messages to track methamphetamine use and promote antiretroviral treatment (ART) adherence among HIV-infected methamphetamine users was examined. From an ongoing randomized controlled trial, 30-day text response rates of participants assigned to the intervention (individualized texting for adherence building (iTAB), n = 20) were compared to those in the active comparison condition (n = 9). Both groups received daily texts assessing methamphetamine use, and the iTAB group additionally received personalized daily ART adherence reminder texts. Response rate for methamphetamine use texts was 72.9% with methamphetamine use endorsed 14.7% of the time. Text-derived methamphetamine use data was correlated with data from a structured substance use interview covering the same time period (). The iTAB group responded to 69.0% of adherence reminder texts; among those responses, 81.8% endorsed taking ART medication. Standardized feedback questionnaire responses indicated little difficulty with the texts, satisfaction with the study, and beliefs that future text-based interventions would be helpful. Moreover, most participants believed the intervention reduced methamphetamine use and improved adherence. Qualitative feedback regarding the intervention was positive. Future studies will refine and improve iTAB for optimal acceptability and efficacy. This trial is registered with ClinicalTrials.gov NCT01317277. David J. Moore, Jessica L. Montoya, Kaitlin Blackstone, Alexandra Rooney, Ben Gouaux, Shereen Georges, Colin A. Depp, J. Hampton Atkinson, and The TMARC Group Copyright © 2013 David J. Moore et al. All rights reserved. Acceptability of Mobile Phone Technology for Medication Adherence Interventions among HIV-Positive Patients at an Urban Clinic Tue, 13 Aug 2013 13:19:30 +0000 http://www.hindawi.com/journals/art/2013/670525/ Mobile phone technology is increasingly used to overcome traditional barriers limiting access to care. The goal of this study was to evaluate access and willingness to use smart and mobile phone technology for promoting adherence among people attending an urban HIV clinic. One hundred consecutive HIV-positive patients attending an urban HIV outpatient clinic were surveyed. The questionnaire evaluated access to and utilization of mobile phones and willingness to use them to enhance adherence to HIV medication. The survey also included the CASE adherence index as a measure of adherence. The average age was 46.4 (). The majority of participants were males (63%), black (93%), and Hispanic (11.4%) and reported earning less than $10,000 per year (67.3%). Most identified themselves as being current smokers (57%). The vast majority reported currently taking HAART (83.5%). Approximately half of the participants reported some difficulty with adherence (CASE < 10). Ninety-six percent reported owning a mobile phone. Among owners of mobile phones 47.4% reported currently owning more than one device. Over a quarter reported owning a smartphone. About 60% used their phones for texting and 1/3 used their phone to search the Internet. Nearly 70% reported that they would use a mobile device to help with HIV adherence. Those who reported being very likely or likely to use a mobile device to improve adherence were significantly more likely to use their phone daily () and use their phone for text messages (). The vast majority of patients in an urban HIV clinic own mobile phones and would use them to enhance adherence interventions to HIV medication. Christopher W. T. Miller and Seth Himelhoch Copyright © 2013 Christopher W. T. Miller and Seth Himelhoch. All rights reserved.