Delayed linkage to HIV care among asylum seekers

Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, CanadaBMC Public Health 191683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

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.

Reproductive health of HIV-positive women being neglected, says Swiss study

nam/aidsmap, 06 February 2018

HIV-positive women in Switzerland are mainly relying on male condoms for contraception, investigators report in HIV Medicine. “Male condoms remained the most frequently used contraceptive method, whereas the use of long-acting reversible contraceptives was very uncommon,” note the researchers. “One in six women using contraceptives experienced an unwanted pregnancy, with 42% occurring while using a combined hormonal pill.

The investigators suggest that HIV clinicians need to do more to encourage effective contraceptive use by women with HIV, especially in the light of growing awareness that people with HIV with undetectable viral load do not transmit HIV. If couples stop using the male condom, women need information about which contraceptive options are suitable for them.

Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors Among Female Sex Workers in Australia

Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors Among Female Sex Workers in Australia: A Retrospective Cohort Study

Authors

Denton Callander, PhD,*† Hamish McManus, PhD,* Rebecca Guy, PhD,* Margaret Hellard, PhD,‡ Catherine C. O’Connor, DrPH,*§¶ Christopher K. Fairley, PhD,||** Eric P.F. Chow, PhD,||** Anna McNulty, MM,†† David A. Lewis, DA, PhD,‡‡§§ Christopher Carmody, MB, BS,¶¶ Heather-Marie A. Schmidt, PhD,|||| Jules Kim,*** and Basil Donovan, MD*††

From the *The Kirby Institute, †Centre for Social Research in Health,
UNSW Australia, Sydney, NSW; ‡Burnet Institute, Melbourne, VIC;
§RPA Sexual Health Clinic, Community Health, Sydney Local Health
District; ¶Central Clinical School, University of Sydney, Sydney, NSW;
||Melbourne Sexual Health Centre, Alfred Health; **Central Clinical
School, Faculty of Medicine, Nursing and Health Sciences, Monash
University, Melbourne, VIC; ††Sydney Sexual Health Centre,
Sydney Hospital, Sydney; ‡‡Western Sydney Sexual Health Centre,
Parramatta; §§Marie Bashir Institute for Infectious Diseases and
Biosecurity & Sydney Medical School-Westmead, University of
Sydney, Sydney; ¶¶Liverpool Sexual Health Centre, Liverpool; ||||
New South Wales Ministry of Health; and ***Scarlet Alliance, Australian
Sex Worker Association, Sydney, NSW, Australia

Abstract:

Background: Female sex workers in Australia have achieved some of the lowest documented prevalences of human immunodeficiency virus (HIV) and other sexually transmissible infections globally but rates overall are increasing in Australia and warrant closer investigation.

Methods: We constructed a retrospective cohort using repeat testing data extracted from a network of 42 sexual health clinics. Poisson and Cox regression were used to determined trends in incidence and risk factors for HIV, chlamydia, gonorrhoea, and infectious syphilis among female sex workers.

Results: From 2009 to 2015, 18,475 women reporting sex work attended a participating service. The overall incidence of urogenital chlamydia was 7.7/100 person years (PY), declining by 38% from 2009 to 2013 before increasing by 43% to 2015 (P < 0.001); anorectal chlamydia incidence was 0.6/100 PY, and pharyngeal was 1.9/100 PY, which increased significantly during the study period (P < 0.001, both). For gonorrhoea, the urogenital incidence was 1.4/100 PY, anorectal incidence was 0.3/100 PY, P < 0.001), and 3.6/100 PY for pharyngeal; urogenital incidence doubled during the study period, anorectal increased fivefold, and pharyngeal more than tripled (P < 0.001, all). Incidence of infectious syphilis was 0.4/100 PY, which remained stable from 2009 to 2015 (P = 0.09). There were seven incident infections of HIV among female sex workers (0.1/100 PY). Inconsistent condom use with private partners, higher number of private partner numbers, recent injecting drug use, younger age, and country of birth variously predicted sexually transmissible infections among female sex workers.

Conclusions: Although infectious syphilis and HIV remain uncommon in female sex workers attending Australian sexual health clinics, the increasing incidence of gonorrhoea across anatomical sites and increasing chlamydia after a period of decline demands enhanced health promotion initiatives.

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The Evidence for U=U: Why Negligible Risk Is Zero Risk

August 10, 2017

Over the last year, hundreds of HIV organisations have joined a new campaign to endorse the statement that HIV transmission does not occur when viral load is undetectable on ART.

And while the dramatic impact of ART on reducing HIV transmission has been known for a long time, it is new to say ART stops transmission completely.

Quality of Life and Social Functioning during Treatment of Recent Hepatitis C Infection

Quality of Life and Social Functioning during Treatment of Recent Hepatitis C Infection: A Multi-Centre Prospective Cohort. 

PLoS ONE. 2016;11(6):e0150655. doi:10.1371/journal.pone.0150655

Despite effective treatment for recent hepatitis C (HCV) infection, side-effects and adherence concerns limit its use among people who inject drugs (PWID).

This study evaluated health-related quality of life (HRQoL) and social functioning following infection and during recent HCV treatment.

Conclusions:

Social functioning can predict recent HCV treatment uptake and SVR. Efforts to maximise social stability may improve treatment response. Pegylated-interferon treatment is associated with reduced HRQoL on-treatment in an already vulnerable population of PWID that would be better served by interferon-free regimens particularly in treated target at PWID to prevent transmission

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HIV life expectancy ‘near normal’ thanks to new drugs

BBC news, 11 May 2017

Young people on the latest HIV drugs now have near-normal life expectancy because of improvements in treatments, a new study in The Lancet suggests.

Twenty-year-olds who started antiretroviral therapy in 2010 are projected to live 10 years longer than those first using it in 1996, it found.

Doctors say that starting treatment early is crucial to achieve a long and healthy life.