C. del Rio

Factors associated with use of HIV primary care among persons recently diagnosed with HIV: Examination of variables from the behavioural model of health-care utilization

Abstract The delay between testing positive for human immunodeficiency virus (HIV) and entering medical care can be better understood by identifying variables associated with use of HIV primary care among persons recently diagnosed with the virus. We report findings from 270 HIV-positive persons enrolled in the Antiretroviral Treatment Access Study (ARTAS). 74% had not seen an HIV care provider before enrolment; 26% had one prior visit only. Based on Andersens behavioural model of health care utilization, several variables reflecting demographic, healthcare, illness, behavioural, and psychosocial dimensions were assessed and used to predict the likelihood that participants had seen an HIV care provider six months after enrolment. Overall, 69% had seen an HIV care provider by six months. In multivariate analysis, the likelihood of seeing a provider was significantly (p<.05) higher among men, Hispanics (vs. non-Hispanic Blacks), those with higher education, those who did not use injection drugs, those with three or more HIV-related symptoms, those with public health insurance (vs. no insurance), and those who received short-term case management (vs. passive referral). The findings support several conceptual categories of Andersens behavioural model of health services utilization as applied to the use of HIV medical care among persons recently diagnosed with HIV.

Prevention interventions for HIV positive individuals.

A public health priority Historically, HIV prevention initiatives have focused almost entirely on encouraging “harm reduction” behaviour in diverse at-risk HIV seronegative populations. Consequently, a growing number of behavioural interventions have been tested and applied to reduce HIV associated risk behaviours across diverse at-risk groups.1,2 In general, these programmes are theory driven and emphasise the development of cognitive, social, and technical competencies and skills associated with safer sex and drug use practices, and they attempt to modify individuals’ perceptions of peer norms as supporting HIV preventive practices.2 While designing effective risk reduction programmes for at-risk populations is a public health priority, one population that has been understudied and underserved with respect to sexual risk reduction prevention interventions is people living with HIV. The HIV pandemic continues unabated. Globally, an estimated 36 million people are currently living with HIV.3 In the developing world, recent advances in HIV therapy have markedly decreased HIV associated mortality and HIV is now viewed as a chronic disease.4 However, unlike most other chronic diseases, HIV is also an infectious disease that can be transmitted to others. Thus, programmes specifically designed to address the needs of people living with HIV are essential for curtailing the HIV epidemic and should be a public health priority.5–9 Indeed, it should be axiomatic that prevention does not stop with HIV infection. Quite the contrary, prevention efforts should be intensified for those individuals living with HIV as, ultimately, only infected individuals can transmit HIV.5 There are several compelling clinical and public health reasons to design and implement sexual risk reduction prevention programmes for HIV positive individuals. Firstly, there is cogent empirical evidence suggesting that sexual risk behaviours, although often reduced by many HIV positive individuals, remain prevalent. As many as one in three HIV …

The cascade of care in the Eastern European country of Georgia

Individual and public health benefits of antiretroviral therapy (ART) rely on successful engagement of HIV‐infected patients in care. We aimed to evaluate the HIV care continuum in the Eastern European country of Georgia.

Antiretroviral therapy in HIV‐positive men is associated with increased apolipoprotein CIII in triglyceride‐rich lipoproteins

Dyslipidaemia has become a common problem in HIV disease, especially in patients on current antiretroviral therapy. However, the pathogenic mechanisms involved are not well understood or documented using conventional lipid measurements.

Low educational level: a risk factor for sexually transmitted infections among commercial sex workers in Quito, Ecuador.

Few studies have assessed the effect of educational level on sexually transmitted infections (STIs) and risk-taking behaviours among commercial sex workers (CSWs). This study analysed this association among female CSWs in Quito, Ecuador. Eighty-five CSWs were given a Spanish-language questionnaire on behaviours, socioeconomics and demographics. The correlation between years of education and number of prior STIs was calculated. Three groups of varying education level were formed and risk factors were analysed by Chi-square tests and analysis of variances. Lower educational level was associated with more STIs (r = –0.36; F = 4.2; P = 0.04), poorer knowledge of HIV/AIDS (P = 0.03), earlier first prostitution (P = 0.05) and first sex (P = 0.00), willingness to engage in group sex (P = 0.05) and work on the street (P = 0.02), and presence of non-paying sexual partners (P = 0.05). CSWs with lower educational levels were disproportionately afflicted with STIs and participated in more high-risk behaviours. Low educational level may predispose CSWs to STIs and associated risk factors.

Characteristics of Ryan White and non-Ryan White funded HIV medical care facilities across four metropolitan areas: results from the antiretroviral treatment and access studies site survey

The Ryan White Comprehensive AIDS Resources Emergency Act 1990 (CARE Act) is one of the largest federal programmes funding medical and support services for individuals with HIV disease. Data that report services and gaps in service coverage from the organizational perspective are very limited. The Antiretroviral Treatment and Access Studies included a mail survey of 176 HIV medical care facilities in four US inner cities on clinic characteristics, services and practices, and patient characteristics. Characteristics of 143 (85%) responding Ryan White (RW) funded and non-RW funded facilities are described. RW funded facilities reported offering more services than non-funded facilities including evening/weekend hours (49% vs. 18%), transportation (71% vs. 22%), and on-site risk reduction counselling (88% vs. 55%). More RW funded facilities reported offering on-site adherence support services, such as support groups (44% vs. 12%), formal classes (20% vs. 2%), and pillboxes (83% vs. 43%), and served a larger proportion of uninsured patients (41% vs. 4%) than non-funded facilities. Our analysis showed that the RW funded HIV care facilities offered more clinic, non-clinic, and adherence support services than non-RW funded facilities, indicating that the disparities in services were still related to CARE Act funding, controlling for private–public facility type.

Building the Case for Localized Approaches to HIV: Structural Conditions and Health System Capacity to Address the HIV/AIDS Epidemic in Six US Cities

Since the discovery of the secondary preventive benefits of antiretroviral therapy, national and international governing bodies have called for countries to reach 90% diagnosis, ART engagement and viral suppression among people living with HIV/AIDS. The US HIV epidemic is dispersed primarily across large urban centers, each with different underlying epidemiological and structural features. We selected six US cities, including Atlanta, Baltimore, Los Angeles, Miami, New York, and Seattle, with the objective of demonstrating the breadth of epidemiological and structural differences affecting the HIV/AIDS response across the US. We synthesized current and publicly-available surveillance, legal statutes, entitlement and discretionary funding, and service location data for each city. The vast differences we observed in each domain reinforce disparities in access to HIV treatment and prevention, and necessitate targeted, localized strategies to optimize the limited resources available for each city’s HIV/AIDS response.

GROW: a model for mentorship to advance women's leadership in global health

In this essay, we discuss the under-representation of women in leadership positions in global health (GH) and the importance of mentorship to advance womens standing in the field. We then describe the mentorship model of GROW, Global Research for Women. We describe the theoretical origins of the model and an adapted theory of change explaining how the GROW model for mentorship advances womens careers in GH. We present testimonials from a range of mentees who participated in a pilot of the GROW model since 2015. These mentees describe the capability-enhancing benefits of their mentorship experience with GROW. Thus, preliminary findings suggest that the GROW mentorship model is a promising strategy to build womens leadership in GH. We discuss supplemental strategies under consideration and next steps to assess the impact of GROW, providing the evidence to inform best practices for curricula elsewhere to build womens leadership in GH.

S14.2 A study of African American and Latina women and human papillomavirus: lessons learnt

Background African American and Latina women in the United States suffer from sexually transmitted infections at higher rates than white women. It is particularly important to prevent HPV in these groups as they also suffer disproportionately from cervical cancer. From 2006, a prophylactic HPV vaccine has been approved for use in girls and women aged 9–26 years. However, public health focus has been on young girls and teens. There are limited options for young women over 19 years of age who have aged out of the Vaccines for Children entitlement program. The objectives of this study were to assess a sample of minority women who attend neighbourhood health centers to determine predictors of vaccination, and to assess for the presence of HPV infection in these women. Those without evidence of prior HPV infection may benefit from a prophylactic vaccine. Methods Between April 2009 and April 2010, we enrolled a convenience sample of 100 African American and 100 Latina women who completed a computer-assisted personal interview. Participants were queried regarding: demographics, risk for sexually transmitted infections including drug or alcohol use, HPV vaccine willingness, knowledge, attitudes and beliefs, and vaccination status. Frequencies were calculated using SAS, version 9.2. Self-collected vaginal swab samples from 118 participants were tested for HPV using line probe assay. Results Participants were poor with 113 (57%) having a household income of <

PREVALENCE AND RISK FACTORS FOR LATENT TUBERCULOSIS INFECTION AMONG HEALTH CARE WORKERS IN THE COUNTRY OF GEORGIA.: 338

20 000; and at risk for HPV infection. One hundred twenty-one (61%) did not use condom at last sex. However, only 17/118 (14%) were positive for any HPV. Predictors of vaccination could not be determined because there was not sufficient outcome response variation. A vast majority 161 (80%) of participants had not received HPV vaccination, though a most 136 (68%) reported willingness. Conclusions Three years after vaccine approval, the majority in a sample of vulnerable women had not been vaccinated despite their willingness. Public health campaigns have been successful at raising awareness and making vaccine acceptable, but may be less successful at providing the vaccine to vulnerable women. Strategies should focus on delivering vaccine to African American and Latina women in order to decrease cervical cancer disparities.