Journal of AIDS & Clinical Research

Objective: Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at “hub” (central) and “spoke” (decentralized) sites in a large public HIV treatment program in north central Nigeria.
Methods: This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patientlevel (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables.
Results: Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (-4.5%, 95% CI: -3.5,-5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08).
Conclusion: Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures.

Objective: Researchers and public health professionals have increased their attention to GPS-based social and sexual networking applications (apps) tailored to gay, bisexual, and other men who have sex with men (MSM) and transgender women. These populations continue to be disproportionately affected by HIV in the United States, therefore these apps, in particular Grindr, have become an important sampling venue for the recruitment of HIV-related research participants. As such, it is essential to identify differences among app users to avoid potential sampling bias. This paper seeks to identify differences in MSM and transgender women who use Grindr and those who use other similar apps.
Methods: A community-based participatory research (CBPR) approach was used to recruit participants online who then completed a 25-item anonymous survey. Five domains were assessed: sociodemographics, HIV testing, sexual risk, substance abuse, and use of GPS-based social and sexual networking apps.
Results: 457 participants completed surveys. There were significant differences in the sociodemographic characteristics by app use, including age, race/ethnicity, sexual orientation, and outness. After adjusting for the sociodemographic characteristics associated with app use, there were significant differences in HIV risk and substance use between the groups.
Conclusion: This paper is the first to report on findings that compare MSM and transgender women who report using Grindr to MSM and transgender women who report using other similar apps. GPS-based social and sexual networking apps may offer a valuable recruitment tool for future HIV research seeking to recruit populations at increased risk for HIV or those living with HIV for therapeutic trials. Because of the differences identified across users of different apps, these findings suggest that if researchers recruited participants from just one app, they could end up with a sample quite different than if they had recruited MSM and transgender women from other apps.

Background: HIV has become a chronic disease, due to the result of advances in HIV treatment in the past two decades. However, the processes shaped by socio-economic factors have been proven to be the main cause of vulnerabilities related to HIV among migrants globally. In spite of the development of effective HIV treatment in the past two decades, there are still many obstacles to delivering the care to different socio-economic and ethnic groups, such as late HIV testing. More knowledge of HIV care providers’ experiences is needed in order to support them in their work and create optimal health care for HIV-positive migrants.

Objective: The aim of this study was to explore the experiences of HIV caregivers in providing care to HIV-positive migrants.

Methods: A qualitative exploratory design with focus-group interviews for data collection was chosen. The participants were recruited from three infectious disease clinics in Sweden. Five focus-group interviews were conducted. Each focus group comprised three to five nurses and social workers.

Results: The study revealed that the HIV caregivers experienced that their patients suffered from stigma, selfstigma and social marginalisation, which in turn required more resources and support from them. The socio-economic vulnerability of the migrant patients necessitates particular social support from caregivers to these patients, depending on different migration processes that characterise the patients’ lives. Further, we found that the contact-tracing the social workers had to perform according to Swedish law could be contradictory to the supportive therapy of the patients.

Conclusion: Our study showed that the stigma and social vulnerability of HIV-positive migrants in different respects call for extra support from the caregivers in order to respond to the needs of HIV-positive migrants through targeted interventions. More resources are needed within the different fields of social support, in order to provide optimal care and support to HIV-positive migrants.

Background: We examined the association between EFV and non-EFV based ART regimens and pregnancy outcomes among women who were on HCI in a peri-urban HIV clinic in Tororo, Uganda.
Methods: We reviewed and extracted routinely collected data from the TASO Tororo HIV clinic family planning register. All women >18 years of age and on ART who received HCI between January, 2012 and June, 2014 were included in the study.
Results: Of the 148 women reviewed 9 (6.1%) conceived. All women who conceived were on an EFV-based regimen, while none of the women on non-EFV based regimens conceived (p=0.0003).
Conclusion: We observed a significant association (p=0.0003) between HIV-positive HCI users on EFV-based ART regimens as compared to HIV-positive HCI users on non-EFV based ART regimens.