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    IDweek Poster No397 Final Corrected

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    Under routine conditions at a Peruvian referral hospital between 2005-2014: - Only 10% of eligible partners of people living with HIV had initial HIV testing, and 36% had follow-up testing. - 51% of HIV tests among partners were unrelated to prevention activities after the index case's HIV diagnosis. - 42% of index cases had visits that did not result in their partner getting tested. - Partners who were tested within 3 months of the index case's enrollment were less likely to have advanced HIV disease or be hospitalized compared to index cases.

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    IDweek Poster No397 Final Corrected

    Uploaded by

    analuvc
    67 views1 page
    Under routine conditions at a Peruvian referral hospital between 2005-2014: - Only 10% of eligible partners of people living with HIV had initial HIV testing, and 36% had follow-up testing. - 51% of HIV tests among partners were unrelated to prevention activities after the index case's HIV diagnosis. - 42% of index cases had visits that did not result in their partner getting tested. - Partners who were tested within 3 months of the index case's enrollment were less likely to have advanced HIV disease or be hospitalized compared to index cases.

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    Under routine conditions at a Peruvian referral hospital between 2005-2014: - Only 10% of eligible partners of people living with HIV had initial HIV testing, and 36% had follow-up testing. - 51% of HIV tests among partners were unrelated to prevention activities after the index case's HIV diagnosis. - 42% of index cases had visits that did not result in their partner getting tested. - Partners who were tested within 3 months of the index case's enrollment were less likely to have advanced HIV disease or be hospitalized compared to index cases.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    67 views1 page

    IDweek Poster No397 Final Corrected

    Uploaded by

    analuvc
    Under routine conditions at a Peruvian referral hospital between 2005-2014: - Only 10% of eligible partners of people living with HIV had initial HIV testing, and 36% had follow-up testing. - 51% of HIV tests among partners were unrelated to prevention activities after the index case's HIV diagnosis. - 42% of index cases had visits that did not result in their partner getting tested. - Partners who were tested within 3 months of the index case's enrollment were less likely to have advanced HIV disease or be hospitalized compared to index cases.

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    © All Rights Reserved
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    of 1

    Partners of People Living with HIV: Health Care Delivery in a

    1,2
    1,2
    2
    1,2
    Ana Vsquez, MD ; Renato A. Errea, MD ; Daniel Hoces, MD ; Elsa Gonzlez, MD ; Eduardo
    Referral Hospital in
    Lima-Peru
    1,2,3

    No.
    397

    Ana Luca Vsquez Choy, MD


    Universidad Peruana Cayetano
    Heredia
    Email: [email protected]
    Phone: +511 987 760 449
    Address: Calle 27 N290 San Borja
    3
    ,
    Lima- Peru
    Table 1. HIV concordant couples: Comparison
    of clinical

    Gotuzzo, MD

    Contact

    School of Medicine - Universidad Peruana Cayetano Heredia (UPCH), 2Instituto de Medicina Tropical Alexander von Humboldt UPCH Hospital
    Cayetano
    Heredia,
    Lima
    Fig 1. Initial and follow-up HIV testing among eligible partners
    Abstract
    Methods
    characteristics between index cases and their partners enrolled in

    Background: Given the recommendation of antiretroviral


    therapy to people living with HIV (PLWH) in serodiscordant
    couples, partners of PLWH concentrate major health needs. We
    describe the frequency and circumstances for partners HIV
    testing under the routine of a Peruvian referral hospital during a
    ten-year period.
    Methods: Secondary data analysis of five routine databases from
    the study center. Index cases (ICs) were PLWH at least age 18
    enrolled at the HIV program between 2005 and 2014 reporting a
    unique partner not previously tested for HIV at the study center. If
    ICs reported at entry that their partners HIV status was
    Unknown or Negative, these partners were eligible for HIV
    testing. The main outcome was the frequency of HIV tests among
    eligible partners. Secondary outcomes were: (a) Circumstances
    under which partners HIV testing occurred, (b) not occurred, and
    (c) clinical differences among HIV concordant ICs and partners
    enrolled in the HIV program.
    Results: 3677 PLWHs were enrolled in the HIV program, 39%
    reported a unique partner, 40% reported not knowing their
    partners HIV status. Among partners eligible for HIV testing (n =
    896), 10% had initial HIV testing; follow-up testing was 36%; and
    51% of HIV tests were unrelated to preventive activities after IC
    diagnosis. 42% of ICs had posterior visits at the study center that
    did not result in partners testing. Partners that were timely
    tested (within 3 months after entry of the IC), found to be HIVpositive and enrolled in the HIV program had less hospital
    admissions and were less in HIV WHO stage IV compared to ICs
    (p<0.05).

    Background

    Conclusion:
    Under
    this routine conditions,
    there
    are still
    Given that HIV
    transmission
    is primarily
    driven
    by missed
    sexual
    opportunities for the timely provision of health services to
    contact, the partners of people living with HIV (PLWH)
    partners of PLWH. This situation
    1-3 can preclude the successful
    concentrate major health needs .
    implementation of treatment as prevention for serodiscordant
    couples.
    Within the concept of Treatment as Prevention (TasP),
    antiretroviral (ARV) therapy to PLWH in serodiscordant couples
    is being progressively implemented 4-5, as recently occurred in
    Peru6. However, partners identification and notification still
    collide with ethical and legal aspects.

    This study describes the results of health care delivery to


    partners of PLWH, with special focus on frequency and
    circumstances for partners HIV testing under routine
    conditions in a Peruvian referral center during a ten-year
    period.

    Study Design and Data Sources


    Secondary data analysis of routine databases available at the study
    center including the HIV program, laboratory, inpatient and
    outpatient infectious diseases services.
    At entry at the HIV program, PLWH are routinely asked about the
    HIV status of their sexual partners.
    In order to identify Index cases and partners, databases were linked
    by a compound identifier formed with the initials, sex and year of
    birth.
    Definitions:
    Index cases (ICs) were PLWH with at least age 18 enrolled at the
    HIV program between Jan 2005 and Dec 2014 reporting a unique
    partner not previously tested for HIV at the study center.
    If ICs reported at time of entry that their partners HIV status was
    Unknown or Negative, these partners were considered eligible
    for HIV testing.
    The first partners HIV test after entry of the IC was reported as
    Initial. The subsequent test up to March 2015 were reported as
    Follow-up.
    Timely tested was a partners HIV test done up to 3mo after entry
    of the IC.
    Data Measurements:
    Main outcome: Frequency of initial and follow-up HIV tests among
    eligible partners.
    Secondary outcomes: (a) Circumstances under which HIV testing
    occurred, (b) encounters of the IC with the study center that did
    NOT lead to partners HIV testing, and (c) clinical differences
    Results
    between IC and partners with
    positive HIV status enrolled in the HIV
    program
    During the study period, 3677 PLWHs were enrolled in the HIV
    program.
    At entry, 39% reported a unique partner with 4 years
    Ethical
    aspects:
    The
    (IQR: study
    1.6-9) protocol
    as median
    in thebyrelationship;
    40%
    was time
    approved
    the IRBs from
    the(571)
    two
    reported not knowing
    partners
    HIV and
    status.
    institutions
    involved.their
    Match
    of IC
    partners was done
    anonymously.
    Among partners eligible for HIV testing, 10% (88/896) had initial
    HIV testing; follow-up testing was 36% (8/25). (Fig. 1)
    Among partners eligible for HIV testing, the frequency of initial HIV
    tests did not increase throughout the ten year period.
    Among eligible partners, 51% (45) of HIV tests were unrelated to
    preventive activities after IC diagnosis; 42% (343) of ICs had
    encounters with health services at the study center that did not
    result in partners testing. (Fig. 2)
    Compared to ICs, the subgroup of partners that were timely tested
    with a resulting positive HIV test and posteriorly enrolled in the HIV
    program had significantly less hospital admissions and were less
    likely to be in HIVAcknowledgments
    WHO stage IV. (Table 1)
    We are grateful to all the staff from the HIV program at Hospital Cayetano
    Heredia and at the HIV Research Unit of the Institute of Tropical Medicine
    Alexander von Humboldt .
    This study was supported by Fogarty International Center at the U.S. National
    Institutes of Health (NIH) through the Program for Advanced Research
    Capacities for AIDS in Peru (PARACAS) [grant number D43TW00976301].

    the HIV program


    Clinical
    characteristic

    Reason for HIV


    testing
    Signs and
    symptoms of
    HIV/AIDS infection
    Seropositive
    partner
    Perceived risk
    Pregnancy

    Index
    cases
    (n=48)
    N (%)

    HIV-positive
    partners
    (n=48)
    N (%)

    19(40)

    2(4)

    0.36

    0(0)

    39(82)

    0.82

    7(15)

    0(0)

    0.15

    7(15)

    2(4)

    0.11

    3(6)

    1(2)

    0.04

    12(24)

    4(8)

    0.16

    Prevalence
    difference

    P [IC]

    Others

    <0.001
    (0.21,0.51)
    <0.001
    (0.71,0.93)
    0.005
    (0.05,0.25)
    0.06 (0.01,0.23)
    0.3 (-0.04,0.12)

    Unknown

    0.03 (0.02,0.3)

    WHO Clinical
    Stage IV at
    enrollment
    Late tester

    14 (30)

    3 (7)

    0.23

    22 (46)

    15 (32)

    0.14

    Indication of

    30(63)

    23 (49)

    0.14

    HAART
    Linkage to care

    30 (63)

    23 (49)

    0.14

    Viral suppression

    Fig 2. HIV testing and not testing among eligible partners:


    Circumstances of HIV testing and encounters of index cases not
    leading to partners HIV testing

    26/34 (77)
    Limitations

    31/42 (74)

    0.03

    0.003
    (0.09,0.38)
    0.16 (0.05,0.33)
    0.18 (0.06,0.33)
    0.18 (0.06,033)
    0.75 (-

    0.19,0.14)
    We did not have information of disclosure rates to partners
    or
    Hospital
    23/139 (17) 8/184 (4)
    0.12
    <0.001
    information
    of
    partners
    that
    might
    receive
    care
    in other
    admission
    (0.05,0.19)
    health
    centers.
    index
    (personyear)
    In spite of <%5 missing data, probably not every couple
    Mortality
    3(6)
    0(0)
    0.06
    0.08 (0.01,0.13)
    could be identified
    and matched.
    We excluded subjects with multiple partners and did not
    consider sexual orientation, as such information was limited
    in the original data sources.
    Conclusions

    In the setting described, we identified missed opportunities


    for the timely provision of health services to partners of
    PLWH. Furthermore, many of the HIV tests in partners may
    not have been the result of prevention services, but of
    posterior clinical needs of partners.
    Under routine conditions, HIV programs might struggle to
    timely deliver prevention services, which might be restricted
    to the initial encounters and may not be aligned to PLWH
    changing needs in time.
    This situation can preclude the implementation of treatment
    as prevention for serodiscordant couples, as currently
    recommended.
    References
    1.
    2.
    3.
    4.
    5.

    Maartens G, Celum C, Lewin S. HIV infection: epidemiology, pathogenesis, treatment, and prevention. Lancet 2014;384:258-71
    Fideli U, Allen S, Musonda R, Trask B, Hahn H, et al. Virologic and immunologic determinants of heterosexual transmission of HIV-type 1(HIV-1) in Africa. AIDS Res Hum Retrovir. 2001;17:90110.
    Vermund SH. Global HIV epidemiology: a guide for strategies in prevention and care. Curr HIV/AIDS Rep. 2014;11:9398.
    Vermund S, Van Lith L, Holtgrave D. Strategic roles for health communication in combination HIV prevention and care programs. J Acquir Immune Defic Syndr. 2014;66(3):237-40
    WHO. Guidance On Couples HIV Testing And Counselling Including Antiretroviral Therapy For Treatment And Prevention In Serodiscordant Couples: Recommendations for a public health approach.
    Geneva, Switzerland: World Health Organization;2012
    6. Ministerio de Salud del Per. Norma Tcnica de Salud de Atencin Integral Del Adulto con Infeccin por El Virus de La Inmunodeficiencia Humana (VIH). Lima, Per:MINSA;2014.
    7. Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) Informe Nacional sobre los progresos realizados en el pas, Per. Periodo 2012 diciembre 2013 [Internet] Ginebra, Suiza:
    ONUSIDA; 2014. [citado el 10 ene de 2015]. Disponible en: http://www.unaids.org/en/dataanalysis/knowyourresponse/ countryprogressreports/2014countries

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