How Do Outcomes Compare between Women & Men Living with HIV in Australia?

Background: 

Gender differences vary across geographical settings and are poorly reported in the literature. The aim of this study was to evaluate demographics and clinical characteristics of participants from the Australian HIV Observational Database (AHOD), and to explore any differences between females and males in the rate of new clinical outcomes, as well as initial immunological and virological response to antiretroviral therapy.

Methods: 

Time to a new clinical end-point, all-cause mortality and/or AIDS illness was analysed using standard survival methods. Univariate and covariate adjusted Cox proportional hazard models were used to evaluate the time to plasma viral load suppression in all patients that initiated antiretroviral therapy (ART) and time to switching from a first-line ART to a second-line ART regimen. 

Results: 

There was no significant difference between females and males for the hazard of all-cause mortality [adjusted hazard ratio: 0.98 (0.51, 1.55), P = 0.67], new AIDS illness [adjusted hazard ratio: 0.75 (0.38, 1.48), P = 0.41] or a composite end-point [adjusted hazard ratio: 0.74 (0.45, 1.21), P = 0.23]. Incident rates of all-cause mortality were similar between females and males; 1.14 (0.61, 1.95) vs 1.28 (1.12, 1.45) per 100 person years. Virological response to ART was similar for females and males when measured as time to viral suppression and/or time to virological failure. 

Conclusion: 

This study supports current Australian HIV clinical care as providing equivalent standards of care for male and female HIV-positive patients. Future studies should compare ART-associated toxicity differences between ART-associated toxicity differences between men and women living with HIV in Australia.

Purchase full article at:   http://goo.gl/uo3P3Z

By:  Michelle L. Giles A B I, Marin C. Zapata C, Stephen T. Wright D E, Kathy PetoumenosD, Miriam Grotowski F, Jennifer Broom G, Matthew G. Law D and Catherine C. O’Connor C D H 

A Department of Infectious Diseases, Monash University, Clayton, Vic. 3168, Australia. B Monash Infectious Diseases, Monash Health, Clayton, Vic. 3168, Australia. C RPA Sexual Health, Sydney Local Health District, Sydney, NSW 2050, Australia. D The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia. E School of Mathematical and Physical Sciences, University of Technology, Sydney, NSW 2007, Australia. F Tamworth Sexual Health Service, Tamworth, NSW 2340, Australia. G Department of Medicine, Nambour Hospital, Nambour, Qld 4560, Australia. H Central Clinical School, University of Sydney, Sydney, NSW 2052, Australia. I Corresponding author. Email: m.giles@alfred.org.au 

Sex Health. 2016 Feb 1. doi: 10.1071/SH15124. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

State Variation in HIV/AIDS Health Outcomes: The Effect of Spending on Social Services and Public Health

OBJECTIVE:

Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States.

DESIGN:

We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty.

METHODS:

We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors.

RESULTS:

States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05).

CONCLUSION:

Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.

Purchase full article at:   http://goo.gl/6gYf0q

By:  Talbert-Slagle KM1, Canavan ME, Rogan EM, Curry LA, Bradley EH.

• 1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA. 
• AIDS. 2016 Feb 20;30(4):657-63. doi: 10.1097/QAD.0000000000000978.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

 More about map:  http://goo.gl/Zrvl62

Trauma History in African-American Women Living with HIV: Effects on Psychiatric Symptom Severity and Religious Coping

Women living with HIV (WLHIV) have rates of post-traumatic stress disorder (PTSD) up to 5 times higher than the general population. Individuals living with HIV and a concurrent diagnosis of PTSD have poorer HIV-related outcomes; however, the prevalence and impact of PTSD on African-American WLHIV seeking mental health treatment is unknown. 

The aim of this study is to examine the associations between PTSD symptoms with psychiatric symptom severity and psychological/religious coping strategies in African-American WLHIV who are seeking mental health treatment. This is a cross-sectional study of 235 African-American WLHIV attending an urban community mental health clinic. Bivariate analyses were conducted to evaluate associations between a PTSD symptoms scale (PSS≥21 versus PSS<21) and (1) psychiatric severity, (2) coping strategies, and (3) religious coping strategies. 

Thirty-six percent reported symptoms consistent with PTSD (PSS≥21). These women were significantly more likely to have worse mental health symptoms and were more likely to employ negative psychological and religious coping strategies. On the contrary, women with a PSS<21 reported relatively low levels of mental health symptoms and were more likely to rely on positive psychological and religious coping strategies. 

Over one-third of African-American WLHIV attending an outpatient mental health clinic had symptoms associated with PTSD. These symptoms were associated with worse mental health symptoms and utilization of dysfunctional religious and nonreligious coping strategies. 

Untreated PTSD in WLHIV predicts poorer HIV-related health outcomes and may negatively impact comorbid mental health outcomes. Screening for PTSD in WLHIV could identify a subset that would benefit from evidence-based PTSD-specific therapies in addition to mental health interventions already in place. PTSD-specific interventions for WLHIV with PTSD may improve outcomes, improve coping strategies, and allow for more effective treatment of comorbid mental health disorders.

Purchase full article at:   http://goo.gl/otmzU8

By:   Brownley JR1, Fallot RD, Wolfson Berley R, Himelhoch SS.

• 1 Department of Psychiatry , University of Maryland School of Medicine, Baltimore , MD , USA. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Social Protection: Potential for Improving HIV Outcomes among Adolescents

Introduction

Advances in biomedical technologies provide potential for adolescent HIV prevention and HIV-positive survival. The UNAIDS 90–90–90 treatment targets provide a new roadmap for ending the HIV epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to antiretroviral therapy (ART) remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents’ capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations.

Discussion

New evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support (“cash, care and classroom”). These interventions have the potential to reduce the social and economic drivers of HIV risk, improve utilization of prevention technologies and improve adherence to ART for adolescent populations in the hyper-endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach and that it holds powerful potential for improved HIV, health and development outcomes.

Conclusions

Social protection is a largely untapped means of reducing HIV-risk behaviours and increasing uptake of and adherence to biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda: to actively combine programmes that increase availability of biomedical solutions with social protection policies that can boost their utilization.

Below:  Impacts of cash and care provision on HIV-risk behaviour among adolescents in South Africa (marginal effects models, controlling for covariates) 

Full article at:    http://goo.gl/6TM8hV

By:   Lucie D Cluver,§,1,2 Rebecca J Hodes,3,4 Lorraine Sherr,5 F Mark Orkin,6 Franziska Meinck,1 Patricia Lim Ah Ken,7Natalia E Winder-Rossi,8 Jason Wolfe,9 and Marissa Vicari10

¹Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK

²Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

³AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa

⁴Department of Historical Studies, University of Cape Town, Cape Town, South Africa

⁵Health Psychology Unit, Department of Infection & Population Health, University College London, London, UK

⁶School of Clinical Medicine and DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa

⁷HIV and AIDS Section, UNICEF, New York, USA

⁸UNICEF Regional Office for Eastern and Southern Africa, Nairobi, Kenya

⁹Office of HIV/AIDS, Bureau for Global Health, US Agency for International Development, Washington, DC, USA

¹⁰Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), International AIDS Society, Geneva, Switzerland

^§Corresponding author: Lucie D Cluver, Centre for Evidence-Based Interventions, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK. Tel: +44(0)1865 270325. (Email: ku.ca.xo.ips@revulC.eicuL)

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health