UNITED STATES:   “Establishment, Retention and Loss to Follow-Up in Outpatient HIV Care”
Journal of Acquired Immune Deficiency Syndromes Vol. 60; No. 3: P. 249-259    (07.01.12):: John A. Fleishman, PhD; and others

Though HIV-infected patients optimally benefit from indefinite, periodic outpatient care, the initial establishment of HIV care and subsequent care retention are problematic. The study authors examined establishment, retention, and loss to follow-up (LTFU) in patients receiving care at 12 clinics in the HIV Research Network.

Medical records were reviewed for 22,984 adult HIV patients who were treated between 2001 and 2009. Three dichotomous outcome measures were based on each patient’s outpatient visit history. Establishment indicated whether the patient made outpatient visits for longer than six months after initial enrollment. Retention reflected whether the patient had at least two outpatient visits separated by 90 days in each year in care. Patients who had no outpatient visits for more than 12 months without returning were classified as LTFU. The demographic and clinical correlates of each outcome and the combined outcome of meeting all three measures were examined using multiple logistic regression.

“Overall, 21.7 percent of patients never established HIV care after an initial visit. Among established patients, 57.4 percent did not meet the retention criterion in all years, and 34.9 percent were LTFU. Only 20.4 percent of all patients met all three criteria,” according to the study results, which noted the odds of successfully meeting all three criteria were higher for women, older patients, Hispanics compared with whites, and those with CD4 levels =50 cells per cubic millimeter.

The authors concluded that the data “highlight the need to improve establishment and retention in HIV care.”

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Establishment, Retention, and Loss to Follow-Up in Outpatient HIV Care.

Will and Should Women in the U.S. Use PrEP?  Findings from a Focus Group Study of At-risk HIV-negative Women in Oakland, Memphis, San Diego, and Washington, DC

Reported by Jules Levin

IAC Wash DC 2012 July 22-27

Judith D. Auerbach, Research Consultant to AIDS United & San Francisco AIDS Foundation, San Francisco, CA, Alyx Banyan, Project Consultant to AIDS United, Oakland, CA, Maura Riordan, AIDS United, Washington, DC

Download full summary here: [Download not found]

To read the Policy Mic article, click here.

We already know that things can get pretty hot and heavy in the Olympic village; there will be about 100,000 condoms provided to over 12,000 athletes who are participating in the games. Yet few know that the International Olympic Committee’s (IOC) is doing so as part of its commitment to promoting AIDS awareness and prevention.

Due to the impact of HIV and AIDS on the sporting world, the IOC demonstrates its genuine concern for the athletes in the Olympics and all the potential Olympians that reside in countries ravaged by the disease. Thus, the IOC has established a framework that anyone can follow if they want to really put up a fight against HIV and AIDS.

In 2004, the IOC signed a memorandum of understanding with the Joint United Nations Programme on HIV and AIDS (UNAIDS) in Lausanne, Switzerland, agreeing to use its leverage to help combat the devastating disease. To do so, the IOC developed a toolkit that is passed out to coaches and other sports administrators as a guide to help them share information about the disease to athletes. The guide has all the basics of AIDS, such as what it is and how it can be prevented, but it also includes a section specifically about the relationship between sports and HIV. Additionally, the IOC strongly encourages any Olympic athletes that have HIV or AIDS to make their condition public, thus helping to end some of the stigma attached to the disease.

The kits have been so effective, national Olympic committees (NOC) of countries with high prevalence of AIDS cases have implemented their own initiatives. The Kenyan NOC partners with the National AIDS Control Council to bring in athletes to talk about AIDS prevention, while the NOC of South Africa hosts an annual walk to raise money for AIDS research and preventive projects. This narrative plays out in over 10 other countries, each modifying the kit to fit the needs of its people. The work of the IOC is a wonderful example of how a powerful organization can positively impact people by giving them tools to protect themselves against AIDS.

Although the distribution of 100,000 condoms to Olympic athletes might be seen as provocative, it’s important not to lose focus on the real reason why those condoms are so crucial.

THAILAND:   “Sex, Drugs, Stigma Put Thai Transsexuals at HIV Risk”  

Agence France Presse     (08.23.12)

HIV infection rates among Thailand’s estimated 180,000 transgenders are thought to be on the rise as prostitution, drug use and a lack of targeted health care services take their toll on one of the country’s most marginalized groups.

No official figures detail HIV statistics among transgenders, who are known as “katoey” or “lady-boys.” But in the Chonburi province, local data released this year show 11 percent of transgenders there had HIV, a figure that increased to 20 percent among those age 29 and older. Chonburi is home to Pattaya, one of the centers of Thailand’s booming sex trade. During the tourist season, the city’s population of transgenders swells to 3,000.

Chonburi’s data mirror the regional assessment by the UN Development Program this May, when a study estimated HIV prevalence rates among transgenders across Asia-Pacific could be as high as 49 percent. According to UNDP, many transgenders operate on the “social, economic, and legal” margins of society – pushed there by sex work, drugs, stigma, and a lack of health care.

“HIV is also just one of a whole range of risks transgender people encounter every day,” said Alex Duke of PSI, the global health organization that conducted the survey on behalf of UNDP.

Though Thailand has a famously permissive attitude toward sexuality, discrimination against transgenders is common, said Prempreeda Pramoj Na Ayutthaya, a transgender researcher and activist. Transgender persons often are rejected by their families and schools, resulting in social immobility that may drive them into sex work. “Many transgender people find that sex work is the only way to make a small amount of money and maintain their identity,” said Prempreeda.

Advocates are calling for more resources to prevent, diagnose, and treat HIV among transgenders, and to study how the disease is impacting the community.

CLICK HERE to see the full Special Issue in Science Magazine

HIV/AIDS in America

The epidemic of acquired immunodeficiency syndrome was first recognized in the United States. As clinicians from Los Angeles, California, reported in the 5 June 1981 issue of Morbidity and Mortality Weekly Report, they had seen odd immune problems and opportunistic infections in five young “active homosexuals.” Similar reports soon came in from all over the country and the world, making it clear that AIDS affected heterosexuals and homosexuals alike and also spread from mother to child and via tainted blood products and dirty needles. In the following years, U.S. researchers helped prove that HIV causes the disease, which led to a critical blood test to detect the novel retrovirus. The U.S. National Institutes of Health and the Centers for Disease Control and Prevention—prodded by AIDS activists such as Mark Harrington of the Treatment Action Group (pictured here)—steadily ramped up support for basic research as well as efforts to develop and test treatment and prevention interventions. In the early 2000s, the U.S. government poured billions of dollars into programs that now bring life-saving antiretrovirals to millions of people in cash-strapped countries.

It may seem odd, then, that since 1990 this country has not hosted the International AIDS Conference, a megameeting that has gathered 20,000 participants every other year. But that will change on 22 to 27 July, when the gathering will take place in Washington, D.C. The meeting organizers shunned the United States because of an immigration ban on HIV-infected people imposed by Congress in 1987, which President Barack Obama ended in 2010.

In keeping with that shift, Science is focusing this special HIV/AIDS issue on America, now home to an estimated 1.2 million HIV-infected people—many of whom have little in common with the original five gay men in Los Angeles. The Deep South has become the epicenter; blacks—gay and straight—face a far higher risk of becoming infected than whites, and poverty is a major driver for all races. The biggest challenge the country faces today is diagnosing all of its HIV-infected people and helping them take full advantage of the existing treatments, which both stave off disease and make people less infectious. It is a problem shared worldwide.

Correspondent Jon Cohen, working with photographers Malcolm Linton and Darrow Montgomery, visited 10 U.S. cities this spring, and the package of stories that begins on p. 168 describes the varied epidemics and responses. A News Focus by Cohen spends a day with Anthony Fauci, who leads the NIH branch that funds more HIV/AIDS researchers than any institution in the world (p. 152). This special issue also includes an Editorial by Salim Abdool Karim (p. 133), who highlights problems rolling out what’s known as pre-exposure prophylaxis, as well as an update on HIV antibody research by Dennis Burton and colleagues (p. 183) that promises to inform AIDS vaccine development. Online, a slideshow offers more images and stories about the country’s epidemic, and Science Careers features profiles of two young HIV/AIDS public health workers making a big dent in big-city epidemics.

CLICK HERE to read the original article by Laura Whitehorn on POZ.com

Where financial resources are limited, targeting groups at high risk for HIV infection for testing and immediate treatment is more cost effective than a community-wide test-and-treat initiative, according to New York City modeling data presented Monday, July 23, at the XIX International AIDS Conference in Washington, DC.

Public health initiatives are moving away from risk-based testing to identify people in need of care and antiretroviral (ARV) therapy and now beginning to focus on testing all adults living with HIV in the general population, said Jason Kessler, MD, of New York University School of Medicine, the lead author of the presented research. Whether or not this should be a priority in areas where the resources may be limited in terms of providing adequate care and support for people found to be living with the virus remains a matter of controversy.

TLC-Plus is a test-and-treat initiative being evaluated in HIV Prevention Trials Network study 065 (HPTN 065), currently under way in New York City and Washington, DC. It involves community-wide HIV testing and, for those found to be positive for the virus, linkage to care, immediate treatment and supportive services.

Kessler and his colleagues at the New York City Department of Health and Mental Hygiene used statistical modeling to determine the usefulness and cost-effectiveness of TLC-Plus, executed according to its original design or modified to focus primarily on populations at high risk for HIV infection (e.g., men who have sex with men and/or injection drug users).

Over a 20-year period, Kessler and his colleagues estimated that there would be roughly 59,000 new HIV infections in New York City in the absence of TLC-Plus.

TLC-Plus with immediate ARV therapy could avert 20 percent of these infections in New York City—roughly 47,600 new infections, down from 59,000—provided that it is implemented in the general population of city residents.

More “focused” prioritization, the researchers’ modeling found, resulted in fewer infections averted overall. Prioritization to populations at higher risk for HIV transmission and or acquisition, Kessler explained, only retained 14 to 68 percent of the overall effect.

These compromises, however, came with reduced total costs and cost-per-infection averted. Whereas the cost-per-infection averted would be more than $1.5 million under the general community roll-out of TLC-Plus, a roll-out of TLC-Plus targeting high-risk individuals would come with a cost-per-infection averted of $360,000.

“Without consideration of costs it makes most sense to roll [TLC-Plus] out to as many people as you can possibly reach,” Kessler said. “When you bring cost into the equation—you want to optimize the bang for your buck—it makes the most sense to prioritize your intervention on the highest risk groups.”

Given limited budgets, he concluded, the analysis favors targeting high-prevalence populations and neighborhoods for TLC-Plus.

CLICK HERE to view the original article by Kate Ferguson on POZ.com

New results from the NA-ACCORD study, involving more than 45,000 North American people living with HIV enrolled in one of 20 cohorts, indicate that the percentage of HIV-positive individuals on antiretroviral therapy with low viral loads increased substantially between 2000 and 2008.

These data were presented by Keri Althoff, PhD, MPH, of Johns Hopkins University Bloomberg School of Public Health and her colleagues on Monday, July 22, at the XIX International AIDS Conference (AIDS 2012) in Washington, DC.

A central goal of the National HIV/AIDS Strategy is to get more people living with HIV on antiretroviral (ARV) treatment and responding well, both virologically and immunologically. One way to determine whether or not this objective is being met is by evaluating data from cohorts following people living with HIV.

The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study utilizes the data being collected by more than 20 such cohorts. Althoff and her colleagues analyzed data collected between 2000 and 2008 to look for trends in ARV use, undetectable viral loads and average CD4 cell counts.

Between 2000 and 2008, the percentage of people living with HIV participating in NA-ACCORD increased from 74 percent to 83 percent.

Notable were the percentages of patients with undetectable viral loads. In 2000, only 46 percent of all NA-ACCORD patients had undetectable viral loads. By 2005, this rate reached 54 percent. And by 2008, 72 percent of all NA-ACCORD participants had undetectable viral loads.

Also of interest were data available for the nearly 4,500 people with HIV who died while participating in NA-ACCORD.

In 2000, 75 percent of those who died were under 50 years of age. In 2008, this percentage decreased to 47 percent—in other words, the majority of those who died were over the age of 50 in the most recent year of available NA-ACCORD data.

“From 2000-2008, increases were observed in the percentage prescribed combination [ARV therapy], the percentage who achieved a suppressed HIV [viral load], and the median age and CD4 count at death,” Althoff and her colleagues concluded. “Our data show improved control of HIV with contemporary management in the U.S. and the utility of NA-ACCORD for monitoring these trends.”

Project’s aim is to reduce HIV transmission between serodiscordant couples
 

            The National Institute of Mental Health has awarded a $2.5 million grant for a UCLA-led project designed to implement an evidence-based HIV-risk reduction intervention (“Eban”) that changes sexual risk behaviors and promotes healthier living among heterosexual African American couples.

Dr. Gail E. Wyatt, Professor in the UCLA Department of Psychiatry and Biobehavioral Sciences, Co-Director of the UCLA AIDS Institute, and lead study investigator, previously developed and tested Eban with 535 heterosexual HIV-serodiscordant couples in four cities.  The Eban intervention is a highly innovative, culturally congruent program designed for couples rather than individuals.  In the controlled trial, Eban helped couples, where one partner was HIV-infected and the other was not, to significantly reduce engaging in unprotected sex by increasing condom use.  It was estimated that if Eban participants had not received the intervention, six women and four men would have become infected in one year, and 25 women and 15 men would have become HIV-infected over 5 years.  Based on the successful outcomes in that controlled trial, the next step is to assess how well the intervention works in the “real world” – as delivered in community-based agencies that serve African American clients.  This newly awarded study, called the Eban II Project, will support a careful, in-depth assessment of the barriers and facilitators to community-based implementation and the cost-effectiveness of treating HIV-positive and negative individuals in a relationship.

“The Eban II Project aims to deepen our understanding of how to best help African American couples enhance their health,” explained Dr. Wyatt. “The word ‘Eban’ means ‘fence’ in Yoruba, a West African language, and represents safety, security and love within one’s family and community,” she added.

Due to the severe impact that HIV and AIDS has had on the African American community, this program is targeted to African American couples.  In 2009, African American men accounted for 42% of new HIV infections among men, and African American women accounted for 64% of new infections among women, despite only representing 11% and 12% of the US population respectively.  Over the course of their lives, approximately 1 in 16 African American men will be diagnosed with HIV, as will 1 in 32 African American women.

“We hope that the Project will create a comfortable space for romantic partners to talk about their health concerns while encouraging each to lead healthier lives,” said Dr. Wyatt.

“The Eban II Project is tailored to address the realities of urban African American couples affected by HIV,” notes Dr. Hector F. Myers, Co-Investigator and Professor of Psychology at UCLA.  “We want to help couples make meaningful decisions about their physical, emotional and sexual health, cope with the HIV infection, and strengthen their relationships.”

The Project will take place in ten community-based organizations in Northern and Southern California, with a focus on how to incorporate this evidence-based intervention into usual care.  These organizations serve the largest number of African Americans in the state of California.  The research team will include intervention and implementation experts, as well as cost effectiveness and statistical experts.  The team is also supported by the State of California Implementation Network, which is comprised of statewide stakeholders in the fight against HIV/AIDS. Should the Eban II Project be successful, the next step will be to nationally disseminate the intervention using the Eban implementation model.  It is hoped that by doing so, more couples will be reached and ultimately, the incidence of heterosexually-transmitted HIV among African Americans will be reduced.

CLICK HERE to see the original article on blogs.wsj.com

More than half of the people diagnosed with the HIV virus in the U.S. aren’t getting treatment for their infection, the U.S government said today.

African-Americans and younger people are least likely to be receiving regular treatment, meaning that programs to keep them under a doctor’s care aren’t working or aren’t plentiful enough, according to a report by the Centers for Disease Control and Prevention.

While 81% of those African Americans estimated to be infected are diagnosed, only 29% get ongoing care, and just 21% are “virally suppressed,” or have their virus controlled by a regular regimen of antiretroviral, or ARV, drugs. Among Americans ages 25 to 34, 72% of those infected are diagnosed, but 28% get care and a mere 15% are virally suppressed.

Overall, an estimated 1.1 million Americans are infected with HIV. Only 46% of those who are diagnosed with HIV get regular treatment, while a quarter of all those estimated to be infected are virally suppressed.

“We’ve got to do better,” says Jonathan Mermin, director of the CDC’s division of HIV/AIDS Prevention.

The data were released at the XIX International AIDS Conference in Washington, D.C.

The challenge is to find ways to make HIV testing more widespread, and then make it easier to link those who are diagnosed directly into care — and to make sure they stay there, says Mermin.  “I want to make the healthy choice the easy choice,” he says.

One possible solution is to import programs or ideas from Africa and other developing nations that have sharply stepped up their battle against the disease, including putting millions of people on ARV drugs over the past few years. Some retain as many of 90% of their patients in ongoing care.  “We need to reverse engineer; we understand how many other countries are doing this better and often with U.S. tax dollars,” says Nancy Mahon, global executive director of the MAC AIDS Fund and chair of President Barack Obama’s Advisory Council on HIV/AIDS.

The MAC AIDS Fund, which donated $38 million to AIDS programs in 2011, this week, said it is supporting some initiatives with the U.S. Department of Health and Human Services to improve retention in HIV care. They include a two-year mobile texting pilot program in the southern U.S. called UCARE4LIFE to help patients get reminders and tips about managing their disease. The MAC AIDS Fund is also supporting a forum to explore other successful programs from the U.S. President’s Emergency Plan for AIDS Relief program and others.