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1.
HIV Med ; 25(5): 600-607, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38213087

RESUMO

OBJECTIVE: Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited. METHODS: Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses. RESULTS: Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0-50) and 57 days (range 5-365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability. CONCLUSION: Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.


Assuntos
Emtricitabina , Infecções por HIV , Determinantes Sociais da Saúde , Tenofovir , Migrantes , Humanos , Infecções por HIV/tratamento farmacológico , Feminino , Masculino , Adulto , Estudos Prospectivos , Migrantes/estatística & dados numéricos , Tenofovir/uso terapêutico , Emtricitabina/uso terapêutico , Projetos Piloto , Pessoa de Meia-Idade , Alanina/uso terapêutico , Alanina/análogos & derivados , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Tempo para o Tratamento , Combinação de Medicamentos , Carga Viral , Estudos de Viabilidade , Adulto Jovem , Canadá , Amidas , Piperazinas , Piridonas
2.
Liver Int ; 44(10): 2615-2624, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39011563

RESUMO

BACKGROUND: Socioeconomic status (SES) is a driver of health disparities and chronic diseases. People with HIV (PWH) are at risk for chronic liver diseases. We evaluated the association between low SES and hepatic outcomes in PWH. METHODS: We included PWH from a prospective cohort. SES was assessed by the Pampalon material and social deprivation index to classify the cohort into quintiles of deprivation. Multivariable linear regression was used to investigate associations of material and social deprivation with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) as markers of hepatic fibrosis and steatosis, respectively. Incidence of outcomes was evaluated through survival analysis. RESULTS: Among the 804 PWH included, 45% and 72% were living in areas of the highest material and social deprivation, respectively. Materially deprived PWH were more frequently female and of non-white ethnicity and had higher prevalence of metabolic comorbidities. After adjustments, material deprivation correlated with increased LSM (ß = 1.86, 95% CI 0.53-3.17) but not with CAP (ß = 6.47, 95% CI -5.55-18.49). Patients were observed for a median follow-up of 3.8 years. Incidence of liver-related events was higher in most materially deprived compared to most privileged PWH (hazard ratio 3.03, 95% CI 1.03-8.92), while there was no difference in extrahepatic outcomes or all-cause mortality. Social deprivation showed no association with either LSM or clinical outcomes. CONCLUSIONS: Living in materially deprived neighbourhoods as a proxy for lower SES, is associated with LSM and liver-related events in PWH. Future strategies should explore mechanisms underlying these relationships and whether enhanced material security improves hepatic outcomes.


Assuntos
Infecções por HIV , Cirrose Hepática , Humanos , Feminino , Masculino , Infecções por HIV/complicações , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Técnicas de Imagem por Elasticidade , Classe Social , Fígado/patologia , Incidência , Modelos Lineares , Fatores de Risco , Análise Multivariada , Disparidades nos Níveis de Saúde
3.
AIDS Res Ther ; 21(1): 40, 2024 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890671

RESUMO

BACKGROUND: Scholars recommend providing migrants living with HIV (MLWH) with free treatment, rapidly, once linked to care to optimize their HIV-related experiences and health outcomes. Quantitative evaluations of patient-reported measures for MLWH in such models are necessary to explore the viability of these recommendations. METHODS: Within a 96-week prospective cohort study at a multidisciplinary HIV clinic, participants received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for free and rapidly following care linkage. Eight patient-reported measures were administered at weeks 4, 24, and 48: (1) mMOS-SS to measure perceived social support; (2) IA-RSS to measure internalized stigma; (3) K6 to measure psychological distress; (4) PROMIS to measure self-efficacy with treatment taking; (5) G-MISS to measure perceived compliance with clinicians' treatment plans; (6) HIVTSQ to measure treatment satisfaction; (7) CARE to measure perceived provider empathy; and (8) PRPCC to measure perceived clinician cultural competence. Linear mixed modelling with bootstrapping was conducted to identify significant differences by sociodemographics and time. RESULTS: Across weeks 4, 24, and 48, results suggest that MLWH enrolled in this study experienced moderate levels of social support; elevated levels of HIV-related stigma; moderate levels of distress; high self-efficacy with daily medication self-management; great compliance with clinicians' treatment plans; high treatment satisfaction; high perceived empathy; and high perceived cultural competence. Experience of social support (i.e., mMOS-SS scores) differed significantly by birth region. Experience of HIV-related stigma (i.e., IA-RSS scores) differed significantly by birth region, age, and language. Experience of distress (i.e., K6 scores) differed significantly by sexual orientation. Experience of treatment satisfaction (i.e., HIVTSQ scores) differed significantly by birth region and age. No significant differences were identified by time for any measure. CONCLUSION: Overall, participants expressed positive experiences around treatment and care, alongside comparably lower perceptions of social support, internalized stigma, and distress, potentially underscoring a need to embed targeted, well-funded, and accessible mental health support within HIV care models.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Medidas de Resultados Relatados pelo Paciente , Estigma Social , Migrantes , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Masculino , Feminino , Adulto , Estudos Prospectivos , Fármacos Anti-HIV/uso terapêutico , Pessoa de Meia-Idade , Apoio Social , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Tenofovir/uso terapêutico , Emtricitabina/uso terapêutico , Piperazinas/uso terapêutico , Adesão à Medicação , Piridonas/uso terapêutico , Combinação de Medicamentos , Satisfação do Paciente , Adulto Jovem , Autoeficácia , Amidas , Compostos Heterocíclicos com 3 Anéis
4.
AIDS Behav ; 27(5): 1531-1547, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36271984

RESUMO

Being out of HIV care (OOC) is associated with increased morbidity and mortality. We assessed implementation of Lost & Found, a clinic-based intervention to reengage OOC patients. OOC patients were identified using a nurse-validated, real-time OOC list within the electronic medical records (EMR) system. Nurses called OOC patients. Implementation occurred at the McGill University Health Centre from April 2018 to 2019. Results from questionnaires to nurses showed elevated scores for implementation outcomes throughout, but with lower, more variable scores during pre-implementation to month 3 [e.g., adoption subscales (scale: 1-5): range from pre-implementation to month 3, 3.7-4.9; thereafter, 4.2-4.9]. Qualitative results from focus groups with nurses were consistent with observed quantitative trends. Barriers concerning the EMR and nursing staff shortages explained reductions in fidelity. Strategies for overcoming barriers to implementation were crucial in early months of implementation. Intervention compatibility, information systems support, as well as nurses' team processes, knowledge, and skills facilitated implementation.


Assuntos
Infecções por HIV , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Grupos Focais , Pacientes , Instituições de Assistência Ambulatorial
5.
Clin Infect Dis ; 75(1): e165-e173, 2022 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-35037053

RESUMO

BACKGROUND: People in prison are at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We examined the seroprevalence of SARS-CoV-2 and associated carceral risk factors among incarcerated adult men in Quebec, Canada. METHODS: We conducted a cross-sectional seroprevalence study in 2021 across 3 provincial prisons, representing 45% of Quebec's incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity (Roche Elecsys serology test). Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard errors. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CIs) were calculated. RESULTS: Between 19 January 2021 and 15 September 2021, 246 of 1100 (22%) recruited individuals tested positive across 3 prisons (range, 15%-27%). Seropositivity increased with time spent in prison since March 2020 (aPR, 2.17; 95% CI, 1.53-3.07 for "all" vs "little time"), employment during incarceration (aPR, 1.64; 95% CI, 1.28-2.11 vs not), shared meal consumption during incarceration ("with cellmates": aPR, 1.46; 95% CI, 1.08-1.97 vs "alone"; "with sector": aPR, 1.34; 95% CI, 1.03-1.74 vs "alone"), and incarceration post-prison outbreak (aPR, 2.32; 95% CI, 1.69-3.18 vs "pre-outbreak"). CONCLUSIONS: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied among prisons. Several carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.


Assuntos
COVID-19 , Prisioneiros , Adulto , Anticorpos Antivirais , COVID-19/epidemiologia , Estudos Transversais , Humanos , Masculino , Quebeque/epidemiologia , Fatores de Risco , SARS-CoV-2 , Estudos Soroepidemiológicos
6.
Am Heart J ; 247: 76-89, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35143744

RESUMO

BACKGROUND: Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection coronavirus disease 2019 (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical outcomes. METHODS: The RAAS-COVID-19 trial was a randomized, open label study in adult patients previously treated with RAASi who are hospitalized with COVID-19 (NCT04508985). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]) and the intention-to-treat principle. RESULTS: Overall, 46 participants were enrolled; 21 participants were randomized to discontinue RAASi and 25 to continue. Patients' mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a non-statistically different mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5); P = .60). The negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.67 [95% CI 1.06-2.62]; P = .027); RAASi discontinuation increased brain natriuretic peptide levels (% change from baseline: +16.7% vs -27.5%; P = .024) and the incidence of acute heart failure (33% vs 4.2%, P = .016). CONCLUSION: RAASi continuation in participants hospitalized with COVID-19 appears safe; discontinuation increased brain natriuretic peptide levels and may increase risk of acute heart failure; where possible, RAASi should be continued.


Assuntos
COVID-19 , Insuficiência Cardíaca , Adulto , Idoso , Aldosterona , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Hospitais , Humanos , Peptídeo Natriurético Encefálico , Sistema Renina-Angiotensina
7.
CMAJ ; 194(7): E242-E251, 2022 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-35045989

RESUMO

BACKGROUND: The role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems. METHODS: We performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard care alone. The primary outcome was in-hospital mortality. Secondary outcomes included changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates. We performed a priori subgroup analyses according to duration of symptoms before enrolment, age, sex and severity of symptoms on presentation. RESULTS: Across 52 Canadian hospitals, we randomized 1282 patients between Aug. 14, 2020, and Apr. 1, 2021, to remdesivir (n = 634) or standard of care (n = 648). Of these, 15 withdrew consent or were still in hospital, for a total sample of 1267 patients. Among patients assigned to receive remdesivir, in-hospital mortality was 18.7%, compared with 22.6% in the standard-of-care arm (relative risk [RR] 0.83 (95% confidence interval [CI] 0.67 to 1.03), and 60-day mortality was 24.8% and 28.2%, respectively (95% CI 0.72 to 1.07). For patients not mechanically ventilated at baseline, the need for mechanical ventilation was 8.0% in those assigned remdesivir, and 15.0% in those receiving standard of care (RR 0.53, 95% CI 0.38 to 0.75). Mean oxygen-free and ventilator-free days at day 28 were 15.9 (± standard deviation [SD] 10.5) and 21.4 (± SD 11.3) in those receiving remdesivir and 14.2 (± SD 11) and 19.5 (± SD 12.3) in those receiving standard of care (p = 0.006 and 0.007, respectively). There was no difference in safety events of new dialysis, change in creatinine, or new hepatic dysfunction between the 2 groups. INTERPRETATION: Remdesivir, when compared with standard of care, has a modest but significant effect on outcomes important to patients and health systems, such as the need for mechanical ventilation. Trial registration: ClinicalTrials.gov, no. NCT04330690.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/administração & dosagem , Tratamento Farmacológico da COVID-19 , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/efeitos adversos , Idoso , Alanina/administração & dosagem , Alanina/efeitos adversos , Antivirais/efeitos adversos , COVID-19/epidemiologia , COVID-19/mortalidade , Canadá/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Respiração Artificial/estatística & dados numéricos , SARS-CoV-2
8.
AIDS Care ; 34(5): 663-669, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-33779425

RESUMO

People living with HIV (PLWH) often have worse health outcomes compared to HIV-uninfected individuals. We characterized PLWH followed at a tertiary care clinic in Montreal who acquired COVID-19 and described their outcomes during the first wave of the pandemic. A retrospective chart review was performed for PLWH followed at the Chronic Viral Illness Service with a positive COVID-19 nasopharyngeal PCR or symptoms suggestive of COVID-19 between 1 March and 15 June 2020. Data on demographics, socioeconomic status, co-morbidities and severity of COVID-19 and outcomes were extracted. Of 1702 individuals, 32 (1.9%) had a positive COVID-19 test (n = 24) or symptoms suspicious for COVID-19 (n = 3). Median age was 52 years [IQR 40, 62]. Nearly all (97%) earned $34,999 Canadian dollars or less. Eleven (34%) individuals worked in long-term care (LTC) homes while 5 (6%) lived in LTC homes. Median CD4 count was 566 cells/mm3 [347, 726] and six had detectable plasma HIV viral loads. Median duration of HIV was 17 years [7, 22] and 30 individuals had been prescribed antiretroviral therapy. Five persons were asymptomatic. Of symptomatic persons, 21 (12%), 1 (4%) and 3 (12%) individuals had mild, moderate and severe disease, respectively. Three individuals died with COVID-19. In one case, the cause of death was due to COVID-19, whereas in the other two cases, the individuals died with positive COVID-19 test results but the immediate cause of death is unclear. PLWH who tested positive for COVID-19 had low socioeconomic status and had employment or living conditions that put them at high risk. PLWH may be disproportionately impacted by the social determinants of health which predispose them to COVID-19.


Assuntos
COVID-19 , Infecções por HIV , COVID-19/epidemiologia , Canadá , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção Terciária
9.
Clin Infect Dis ; 73(3): 468-477, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-32504083

RESUMO

BACKGROUND: Noninvasive markers of liver fibrosis such as aspartate aminotransferase-to-platelet ratio (APRI) and transient elastography (TE) have largely replaced liver biopsy for staging hepatitis C virus (HCV). As there is little longitudinal data, we compared changes in these markers before and after sustained virologic response (SVR) in human immunodeficiency virus (HIV)-HCV coinfected patients. METHODS: Participants from the Canadian Coinfection Cohort study who achieved SVR after a first treatment with either interferon/ribavirin or direct acting antivirals (DAAs), with at least 1 pre- and posttreatment fibrosis measure were selected. Changes in APRI or TE (DAA era only) were modeled using a generalized additive mixed model, assuming a gamma distribution and adjusting for sex, age at HCV acquisition, duration of HCV infection, and time-dependent body mass index, binge drinking, and detectable HIV RNA. RESULTS: Of 1981 patients, 151 achieved SVR with interferon and 553 with DAAs; 94 and 382 met inclusion criteria, respectively. In the DAA era, APRI increased (0.03 units/year; 95% credible interval (CrI): -.05, .12) before, declined dramatically during, and then changed minimally (-0.03 units/year; 95% CrI: -.06, .01) after treatment. TE values, however, increased (0.74 kPa/year; 95% CrI: .36, 1.14) before treatment, changed little by the end of treatment, and then declined (-0.55 kPa/year; 95% CrI: -.80, -.31) after SVR. CONCLUSIONS: TE should be the preferred noninvasive tool for monitoring fibrosis regression following cure. Future studies should assess the risk of liver-related outcomes such as hepatocellular carcinoma according to trajectories of fibrosis regression measured using TE to determine if and when it will become safe to discontinue screening.


Assuntos
Coinfecção , Infecções por HIV , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Antivirais/uso terapêutico , Canadá , Estudos de Coortes , Coinfecção/tratamento farmacológico , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepacivirus , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Cirrose Hepática/tratamento farmacológico , Resposta Viral Sustentada
10.
J Infect Dis ; 222(5): 787-797, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32249283

RESUMO

BACKGROUND: Cardiovascular and liver disease are main causes of death in people with human immunodeficiency virus (HIV) (PWH). In HIV-uninfected patients, nonalcoholic fatty liver disease (NAFLD) is associated with incident metabolic complications. We investigated the effect of NAFLD on development of metabolic comorbid conditions in PWH. METHODS: We included PWH undergoing a screening program for NAFLD using transient elastography. NAFLD was defined as a controlled attenuation parameter ≥248 dB/m with exclusion of other liver diseases. Incident diabetes, hypertension, dyslipidemia, and chronic kidney disease were investigated using survival analysis and Cox proportional hazards. RESULTS: The study included 485 HIV-monoinfected patients. During a median follow-up of 40.1 months (interquartile range, 26.5-50.7 months), patients with NAFLD had higher incidences of diabetes (4.74 [95% confidence interval, 3.09-7.27] vs 0.87 [.42-1.83] per 100 person-years) and dyslipidemia (8.16 [5.42-12.27] vs 3.99 [2.67-5.95] per 100 person-years) than those without NAFLD. With multivariable analysis, NAFLD was an independent predictor of diabetes (adjusted hazard ratio, 5.13; 95% confidence interval, 2.14-12.31) and dyslipidemia (2.35; 1.34-4.14) development. CONCLUSIONS: HIV-monoinfected patients with NAFLD are at higher risk of incident diabetes and dyslipidemia. Early referral strategies and timely management of metabolic risk may improve outcomes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Infecções por HIV/epidemiologia , Hipertensão/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Canadá/epidemiologia , Comorbidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Humanos , Incidência , Cirrose Hepática/epidemiologia , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
11.
J Viral Hepat ; 27(2): 205-220, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31638294

RESUMO

Elimination of hepatitis C virus (HCV) among short-term sentenced prison populations will require improved access to HCV care and specific strategies dedicated to linkage upon release. Prison-based HCV care has lagged behind HIV care, but much can be learned from HIV studies. We performed a systematic review to identify individual-, provider- and system-level barriers and facilitators to linkage to HCV and HIV care among released inmates. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials and Embase, and performed a grey literature search for English articles published up to November 2018. Two searches were conducted, one each for HCV and HIV; 323 and 684 unique articles were identified of which two and 27 studies were included, respectively. Facilitators to linkage to HCV care included social support, having an existing primary care provider, and receipt of methadone, whereas barriers included a perceived lack of healthcare information and a lack of specialized linkage to care programs. The principal facilitators to linkage to HIV care included social support, treatment for substance use and mental illness, the provision of education, case management, discharge planning and transportation assistance. Important barriers were unstable housing, age <30 years, HIV-related stigma, poor providers' attitudes and the lack of post-release reintegration assistance. While HCV care-specific studies are needed, much can be learned from linkage to HIV care studies. Ultimately, a multi-pronged approach, addressing several individual-level social determinants of health, and key provider- and system-level barriers may be an appropriate starting point for the development of HCV linkage to care strategies.


Assuntos
Acessibilidade aos Serviços de Saúde , Hepatite C Crônica/terapia , Prisioneiros/estatística & dados numéricos , Continuidade da Assistência ao Paciente , Infecções por HIV/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estigma Social , Apoio Social
12.
BMC Public Health ; 19(1): 1683, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842822

RESUMO

BACKGROUND: Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada. METHODS: We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral. RESULTS: Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/µl), 22% presented with advanced HIV (CD4 < 200 cells/µl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation. CONCLUSIONS: While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.


Assuntos
Infecções por HIV/terapia , Refugiados/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Resistência a Medicamentos/genética , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Quebeque , Estudos Retrospectivos
13.
AIDS Care ; 29(10): 1235-1242, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28610435

RESUMO

Attrition along the cascade of HIV care poses significant barriers to attaining the UNAIDS targets of 90-90-90 and achieving optimal treatment outcomes for people living with HIV. Understanding the correlates of attrition is critical and particularly for women living with HIV (WLWH) as gender disparities along the cascade have been found. We measured the proportion of the 1425 WLWH enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) who had never accessed HIV medical care, who reported delayed linkage into HIV care (>3 months between diagnosis and initial care linkage), and who were not engaged in HIV care at interview (<1 visit in prior year). Correlates of these cascade indicators were determined using univariate and multivariable logistic regression. We found that 2.8% of women had never accessed HIV care. Of women who had accessed HIV care, 28.7% reported delayed linkage and 3.7% were not engaged in HIV care. Indigenous women had higher adjusted odds of both a lack of access and delayed access to HIV care. Also, a younger age, unstable housing, history of recreational drug use, and experiences of everyday racism emerged as important barriers to ever accessing care. Programmatic efforts to support early linkage to and engagement in care for WLWH in Canada must address several social determinants of health, such as housing insecurity and social exclusion, and prioritize engagement of Indigenous women through culturally safe and competent practices.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Saúde Reprodutiva , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Idoso , Canadá/epidemiologia , Estudos de Coortes , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Saúde da Mulher
14.
AIDS Care ; 28(10): 1338-43, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27240624

RESUMO

Individuals with human immunodeficiency virus (HIV) represent a population that is at a higher risk of developing chronic obstructive pulmonary disease (COPD). In this study, we sought to determine the effects of smoking on respiratory symptoms and diseases among HIV-positive patients and to determine if symptomatic patients are being appropriately screened for COPD. HIV-positive individuals completed a self-administered questionnaire. The effects of smoking on respiratory symptoms and diseases were reported as odds ratios (ORs). The COPD screening criteria were adapted from the Canadian Thoracic Society (CTS) guidelines. Two hundred and forty-seven participants were recruited. The median age was 49 years; 75% were male and 92% were on highly active antiretroviral therapy. Smokers represented 66% of the population. Smoking had a statistically significant effect on respiratory symptoms including wheeze (OR 4.8 [95% confidence interval (CI) 1.6-14.2]), phlegm production (OR 4.9 [95% CI: 2.2-10.5]), cough (OR 7.0 [95% CI: 3.0-16.2]), and dyspnea (OR 7.2 [95% CI: 1.7-31.2]). Smoking had a higher odds of respiratory diseases including COPD (OR 4.9 [95% CI: 1.1-21.9]) and bronchitis (OR 3.8 [95% CI: 1.9-7.7]). Among HIV-positive smokers, 40% met the CTS screening criteria, while only 12% self-reported a diagnosis of COPD. The burden of smoking in the HIV population is significant. HIV-positive smokers are more likely to report both respiratory symptoms and diseases than HIV-positive non-smokers. A discrepancy exists between patients who met the CTS screening criteria and those who were diagnosed with COPD, raising the concern for under-recognition and under-diagnosis of COPD in this population.


Assuntos
Soropositividade para HIV/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Adulto , Terapia Antirretroviral de Alta Atividade , Bronquite/epidemiologia , Canadá/epidemiologia , Comorbidade , Tosse/etiologia , Dispneia/etiologia , Feminino , Soropositividade para HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Sons Respiratórios , Fumar/efeitos adversos , Inquéritos e Questionários
15.
Int J Drug Policy ; 131: 104549, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39141957

RESUMO

BACKGROUND: Prison needle exchange programs (PNEPs) are a critical component for harm reduction in prisons. Little is known about the PNEP access barriers for people who are incarcerated, but the low uptake in the Canadian program highlights these constraints. We aimed to identify the barriers and potential solutions for increasing PNEP coverage in the nine Canadian federal prisons where they operate. METHODS: Eighteen focus groups were conducted in nine prisons using nominal group technique (NGT) with two stakeholders: peer advocates and people who use or identified as potential users of the PNEP. NGT uses a round-robin technique followed by generating a list of barriers to PNEP enrolment within their prison. Participants then allocated votes to rank the highest priority barriers, followed by an identical process to generate solutions to address the top three barriers. Interview transcripts describing participant narratives during this process were de-identified and coded to generated themes. Barriers and solutions receiving >10 % of votes within respective participant groups, alongside associated narratives, are discussed more fully. RESULTS: Fear of repercussions due to drug use, lack of confidentiality, and fear of being targeted and sanctioned by correctional authorities were perceived by both stakeholder groups as the top barriers inhibiting PNEP enrolment. Stigma (peer advocates) and the application process for the program (PNEP users) were also ranked as a priority. Proposed solutions included education and external oversight of PNEP (i.e., not via correctional officers) by both groups. Peer advocates regarded improving participant confidentiality and a supervised/safe injection site as potential enablers for program participation, while PNEP users identified wrap-around services as likely to improve access. CONCLUSION: Barriers to increasing PNEP coverage in Canadian federal prisons proposed by participants highlight the importance of trust and perceived repercussions surrounding program participation. These barriers and proposed solutions highlight a need for changes in implementation to PNEP delivery if the potential health benefits of PNEPs are to be realised.


Assuntos
Grupos Focais , Redução do Dano , Programas de Troca de Agulhas , Prisioneiros , Prisões , Humanos , Canadá , Masculino , Prisioneiros/psicologia , Feminino , Adulto , Abuso de Substâncias por Via Intravenosa , Acessibilidade aos Serviços de Saúde , Pessoa de Meia-Idade , Confidencialidade
16.
Front Public Health ; 12: 1380126, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39109158

RESUMO

Background: Little is known about the impact of the COVID-19 pandemic on hepatitis C (HCV) screening efforts in carceral settings. We explored the impact of the pandemic on HCV screening in two of Quebec's largest provincial prisons. Methods: Retrospective data of HCV-related laboratory tests between July 2018 and February 2022 at l'Établissement de détention de Montréal (EDM) and l'Établissement de détention de Rivière-des-Prairies (EDRDP) were obtained. To examine the association between the pandemic and the number of HCV-antibody (HCV-Ab) tests, a three-level time period variable was created: pre-outbreak, outbreak, and post-outbreak. Negative binomial regression (with monthly admissions as an offset) was used to assess the change in HCV-Ab tests across time periods and by prisons. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated. Results: A total of 1,790 HCV-Ab tests were performed; 56 (3%) were positive. Among these, 44 (79%) HCV RNA tests were performed; 23 (52%) were positive. There was a significant decrease in HCV-Ab screening at EDM during the outbreak (aOR 0.29; 95% CI 0.17-0.48) and post-outbreak (aOR 0.49; 95% CI 0.35-0.69) periods, compared to the pre-outbreak period. There was no significant change in HCV-Ab screening at EDRDP during the outbreak (aOR 0.98; 95% CI 0.49-2.11) but a significant increase in HCV-Ab screening post-outbreak (aOR 1.66; 95% CI 1.04-2.72). Conclusion: The COVID-19 pandemic negatively affected HCV screening at EDM but had minimal impact at EDRDP. To eliminate HCV from carceral settings, minimizing screening interruptions during future outbreaks and combined HCV/SARS-CoV-2 screening should be prioritized.


Assuntos
COVID-19 , Hepacivirus , Hepatite C , Programas de Rastreamento , Prisões , Humanos , Quebeque/epidemiologia , COVID-19/epidemiologia , COVID-19/diagnóstico , Hepatite C/epidemiologia , Hepatite C/diagnóstico , Estudos Retrospectivos , Prisões/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Masculino , Feminino , Hepacivirus/isolamento & purificação , Adulto , Pessoa de Meia-Idade , SARS-CoV-2 , Pandemias
17.
Int J Drug Policy ; 130: 104540, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39079352

RESUMO

BACKGROUND: Elimination of bloodborne viruses including HIV and hepatitis C virus from prisons requires high coverage of evidence-based interventions that prevent bloodborne virus transmission, including needle and syringe programs. Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake identified by correctional officers and healthcare workers. METHODS: Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group. We identified the highest-ranking responses (≥10 % of the overall votes) to questions about barriers and facilitators to PNEP uptake. RESULTS: Between September 2023 and February 2024, 16 focus groups were conducted with 118 participants (n = 51 correctional officers; n = 67 healthcare workers). Among correctional officers, the top perceived barriers were bullying from peers (22 %), fear of being targeted by correctional officers (14 %), and fear of repercussions due to drug use (13 %). The top facilitators were safe injection sites (30 %), provision of wrap-around services (16 %), and education of correctional officers (10 %). Among healthcare workers, the top perceived barriers were lack of confidentiality (16 %), fear of being targeted by correctional officers (12 %), and a long and complex application process (11 %). The top facilitators were education of correctional officers (29 %), delivery of PNEP by an external provider (15 %), automatic approval for participation in the PNEP (13 %), and safe injection sites (12 %). CONCLUSION: Multiple modifiable barriers and solutions to improving PNEP uptake in Canadian federal prisons were identified by correctional employees. Both participant groups identified the potential for safe injection sites and education to correctional officers as enabling PNEP uptake. These data will inform Canadian efforts to improve engagement and to expand PNEP coverage.


Assuntos
Grupos Focais , Pessoal de Saúde , Programas de Troca de Agulhas , Prisões , Abuso de Substâncias por Via Intravenosa , Humanos , Canadá , Masculino , Feminino , Adulto , Infecções por HIV/prevenção & controle , Pessoa de Meia-Idade , Prisioneiros/psicologia , Hepatite C/prevenção & controle , Servidores Penitenciários
18.
Int J Drug Policy ; 123: 104283, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38109837

RESUMO

BACKGROUND: Little is known about global practices regarding the provision of reimbursement for the participation of people who are incarcerated in research. To determine current practices related to the reimbursement of incarcerated populations for research, we aimed to describe international variations in practice across countries and carceral environments to help inform the development of more consistent and equitable practices. METHODS: We conducted a scoping review by searching PubMed, Cochrane library, Medline, and Embase, and conducted a grey literature search for English- and French-language articles published until September 30, 2022. All studies evaluating any carceral-based research were included if recruitment of incarcerated participants occurred inside any non-juvenile carceral setting; we excluded studies if recruitment occurred exclusively following release. Where studies failed to indicate the presence or absence of reimbursement, we assumed none was provided. RESULTS: A total of 4,328 unique articles were identified, 2,765 were eligible for full text review, and 426 were included. Of these, 295 (69%) did not offer reimbursement to incarcerated individuals. A minority (n = 13; 4%) included reasons explaining the absence of reimbursement, primarily government-level policies (n = 7). Among the 131 (31%) studies that provided reimbursement, the most common form was monetary compensation (n = 122; 93%); five studies (4%) offered possible reduced sentencing. Reimbursement ranged between $3-610 USD in total and 14 studies (11%) explained the reason behind the reimbursements, primarily researchers' discretion (n = 9). CONCLUSIONS: The majority of research conducted to date in carceral settings globally has not reimbursed incarcerated participants. Increased transparency regarding reimbursement (or lack thereof) is needed as part of all carceral research and advocacy efforts are required to change policies prohibiting reimbursement of incarcerated individuals. Future work is needed to co-create international standards for the equitable reimbursement of incarcerated populations in research, incorporating the voices of people with lived and living experience of incarceration.


Assuntos
Participação do Paciente , Prisioneiros , Recompensa , Humanos , Participação do Paciente/economia
19.
Front Public Health ; 12: 1279572, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38560445

RESUMO

Introduction: Correctional facilities are high-priority settings for coordinated public health responses to the COVID-19 pandemic. These facilities are at high risk of disease transmission due to close contacts between people in prison and with the wider community. People in prison are also vulnerable to severe disease given their high burden of co-morbidities. Methods: We developed a mathematical model to evaluate the effect of various public health interventions, including vaccination, on the mitigation of COVID-19 outbreaks, applying it to prisons in Australia and Canada. Results: We found that, in the absence of any intervention, an outbreak would occur and infect almost 100% of people in prison within 20 days of the index case. However, the rapid rollout of vaccines with other non-pharmaceutical interventions would almost eliminate the risk of an outbreak. Discussion: Our study highlights that high vaccination coverage is required for variants with high transmission probability to completely mitigate the outbreak risk in prisons.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Prisões , Pandemias/prevenção & controle , Países Desenvolvidos , Surtos de Doenças/prevenção & controle
20.
Int J Drug Policy ; 126: 104386, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38492433

RESUMO

BACKGROUND: Carceral settings are a key focus of the 2030 WHO global hepatitis C virus (HCV) elimination goals. Despite this, access to HCV testing and treatment services in prisons remains low globally, limiting opportunities to achieve these goals. Advocacy efforts are needed to address service inequities and mobilise support for enhanced HCV programs in prisons globally. INHSU Prisons, a special interest group of the International Network on Health and Hepatitis in Substance Users (INHSU) is developing a Prisons HCV Advocacy Toolkit to address this need. Here we present findings of a mixed study to inform the development of the Toolkit. METHODS: The aim of this study was to inform the development of the Toolkit, including understanding barriers for scaling up prison-based HCV services globally and advocacy needs to address these. An online survey (n = 181) and in-depth interviews (n = 25) were conducted with key stakeholders from countries of different economic status globally. Quantitative data were statistically analysed using R Studio and qualitative data were analysed thematically. The data sets were merged using a convergent design. RESULTS: Key barriers for enhanced prison-based HCV services included lack of political will and action, lack of prison-based healthcare resources, and poor awareness about HCV and the importance of prison-based HCV services. These findings underscore how advocacy efforts are needed to motivate policymakers to prioritise HCV healthcare in prisons and ensure funds are available for services (including diagnostic tools and treatment, healthcare teams to implement services, and systems to measure their success). Advocacy resources to raise the awareness of policy makers, people working in the prison sector, and incarcerated populations were also identified as key to increasing HCV service uptake. CONCLUSION: The Toolkit has the potential to support advocacy efforts for reaching HCV elimination targets. By understanding the advocacy needs of potential Toolkit end-users, the findings can inform its development and increase its accessibility, acceptability, and uptake for a globally diverse audience.


Assuntos
Acessibilidade aos Serviços de Saúde , Hepatite C , Prisões , Humanos , Hepatite C/epidemiologia , Prisões/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Defesa do Paciente , Inquéritos e Questionários , Prisioneiros , Saúde Global
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