Kozak M, Zinski A, Leeper C, et al. Late diagnosis, delayed presentation and late presentation in HIV: proposed definitions, methodological considerations and health implications

Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Antiviral therapy (Impact Factor: 3.02). 01/2013; 18(1). DOI: 10.3851/IMP2534
Source: PubMed


Contemporary literature emphasizes HIV treatment across multiple stages of the care continuum, beginning with HIV testing, followed by linkage and retention in medical care. As a sizeable global population remains undiagnosed or not engaged in medical care, researchers must evaluate the earliest phases of the HIV treatment cascade in order to optimize individual health outcomes and treatment-as-prevention initiatives. Because ambiguity persists for classification of these early stages of HIV care, the aim of this review is to propose a congruous approach to defining the constructs of late diagnosis, delayed presentation and late presentation for HIV medical care, as well as focus attention on methodological considerations and associated clinical and public health implications for these entities.

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    • "With the accessibility of HIV testing as well as the significant personal benefits of timely HIV diagnosis, it is remarkable that a substantial proportion of MSM delay HIV testing and remain unaware of their HIV infection (Chen et al., 2012). While previous research in this area has attempted to understand the sociodemographic factors that are related to delayed HIV diagnosis, limited work has examined personal and contextual factors (Kozak et al., 2013; MacKellar et al., 2005; Mukolo et al., 2013; Nelson et al., 2010). Our study sought to provide a preliminary view of the complicated interactions between personal and contextual factors that may lead to delayed testing among MSM. "
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    ABSTRACT: Delayed HIV diagnosis among men who have sex with men (MSM) in the United States continues to be a significant personal and public health issue. Using qualitative and quantitative data from 75 recently tested, HIV-sero-positive MSM (38 delayed and 37 nondelayed testers), the authors sought to further elucidate potential personal and contextual factors that may contribute to delayed HIV diagnosis among MSM. Findings indicate that MSM who experience multiple life stressors, whether personal or contextual, have an increased likelihood of delaying HIV diagnosis. Furthermore, MSM who experience multiple life stressors without the scaffolding of social support, stable mental health, and self-efficacy to engage in protective health behaviors may be particularly vulnerable to delaying diagnosis. Interventions targeting these factors as well as structural interventions targeting physiological and safety concerns are needed to help MSM handle their life stressors more effectively and seek HIV testing in a timelier manner.
    AIDS education and prevention: official publication of the International Society for AIDS Education 04/2014; 26(2):122-33. DOI:10.1521/aeap.2014.26.2.122 · 1.51 Impact Factor
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    • "H.A. Prentice et al. / Virology 449 (2014) 254–262 259 DOI is an important parameter when cross-sectional VL results are assessed in clinical research (Prentice et al., 2013; Prentice and Tang, 2012; Tang et al., 2010). As early diagnosis of HIV-1 infection remains costly and difficult (Kozak et al., 2013), few studies can actually assess the timing of VL measurements in prevalent HIV-1 infection. One reasonable compromise is to down-play findings based solely on random sampling of cross-sectional data. "
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    ABSTRACT: In HIV-1 infection, plasma viral load (VL) has dual implications for pathogenesis and public health. Based on well-known patterns of HIV-1 evolution and immune escape, we hypothesized that VL is an evolving quantitative trait that depends heavily on duration of infection (DOI), demographic features, human leukocyte antigen (HLA) genotypes and viral characteristics. Prospective data from 421 African seroconverters with at least four eligible visits did show relatively steady VL beyond 3 months of untreated infection, but host and viral factors independently associated with cross-sectional and longitudinal VL often varied by analytical approaches and sliding time windows. Specifically, the effects of age, HLA-B⁎53 and infecting HIV-1 subtypes (A1, C and others) on VL were either sporadic or highly sensitive to time windows. These observations were strengthened by the addition of 111 seroconverters with 2–3 eligible VL results, suggesting that DOI should be a critical parameter in epidemiological and clinical studies.
    Virology 01/2014; 449:254–262. DOI:10.1016/j.virol.2013.11.024 · 3.32 Impact Factor
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    ABSTRACT: In this article, we describe a process of the San Francisco collaboration to select optimal measures of linkage to care in response to the Enhanced Comprehensive HIV Prevention Planning program of the Centers for Disease Control and Prevention and to understand the implications of measure selection and the challenges of accessing data sources to measure outcomes along the HIV care continuum. Challenges identified are the variety of definitions of linkage to care and the nonintegrative nature of the multiple data systems necessary to measure linkage to care and other continuum outcomes. The choice of linkage measures, which at the extremes is a choice between higher-resolution measures based on clinical visit data in a subset of patients vs. a lower-resolution proxy measure based on surveillance data, has key implications. Choosing between the options needs to be informed by the primary use of the measure. For representing trends in the overall performance and response to interventions, more generalizable measures based on surveillance data are optimal. For identifying barriers to linkage to care for specific populations and potential intervention targets within the linkage process, higher-resolution measures of linkage that include clinical, laboratory, and social work visit information are optimal. Cataloging the different data systems along the continuum and observations of challenges of data sharing between the systems highlighted the promise of integrated data management systems that span HIV surveillance and care systems. Such integrated data management systems would have the ability to support detailed investigation and would provide simplified data to match newly developed, cross-agency Health and Human Service measures of HIV care continuum outcomes.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 11/2013; 64:S27-S32. DOI:10.1097/QAI.0b013e3182a99c73 · 4.56 Impact Factor
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