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Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004-2013.

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... [10] Most of the death cases in both groups were found in early 2 years after diagnosis indicating a strong correlation between risk of death and time after diagnosis, and late presentation as one of the major causes of death. [32] The death cases in pre-ART group about 35.8% of all cases in the group, most of them were male in the age group 51-70 years, the majority of them died during the period of LTFU (84.6), and the others due to late presentation. Mortality in ART group was about 18.5% of total cases, and most of the cases were male, and this rate is very high in the context of a patient taking ART drugs and higher than African countries. ...
... Mortality in ART group was about 18.5% of total cases, and most of the cases were male, and this rate is very high in the context of a patient taking ART drugs and higher than African countries. [33] This attributed to different factors leading to deaths and the most important causes, according to the clinical judgments were: (a) Late presentation of a large group of patient and this is documented problem leading to death, [32] (b) non-adherence to treatment, and this may be due to recurrent LTFU due to effect of depression, stigma, and discrimination, poverty and difficult to reach to the site, beliefs about the necessity of ART, low educational level, and defect in counseling before starting treatment. All these factors are found as barriers to adherence in multiple studies done elsewhere in the world. ...
... The most frequent transmission route was MSM (61.4%) followed by male (15.5%) and female heterosexual contact (13.7%). At treatment initiation, median age was 37 years [interquartile range (IQR): [31][32][33][34][35][36][37][38][39][40][41][42][43][44], median CD4 þ cell count was 308 cells/ ml (IQR: 180.0-452.0) and 40.1% had a viral load more than 100 000 copies/ml. ...
... This occurs both in the short term [30,[32][33][34], consistent with our results, as well as in the long term [17]. The lack of immune restoration during the first year of treatment agrees with data from CoRIS that showed the highest impact of late presentation on mortality during the first year after diagnosis [35,36]. ...
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Objectives: The aim of this study was to examine the impact of late presentation (CD4+ cell count <350 cells/μl or an AIDS-defining event) on effectiveness and safety of initial antiretroviral therapy (ART) and to evaluate whether treatment response depends on first-line ART regimen in late presenters. Design: ART-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting triple ART between 2010 and 2018. Methods: We used multivariable models to assess differences in viral suppression (viral load <50 copies/ml), immunological response (change in CD4+ cell count, CD4% (>29%) and CD4/CD8 normalization (>0.4 and >1) multiple T-cell marker recovery (MTMR): CD4+ cell count more than 500 cells/μl and CD4% >29% and CD4/CD8 >1), and treatment discontinuation due to adverse events (TDAE) at 48 weeks from ART initiation. Results: Out of 8002 participants, 48.7% were late presenters. Of them, 45.8% initiated ART with a NNRTI- (mostly TDF/FTC/EFV), 33.9% with a protease inhibitor (mostly TDF/FTC+boosted DRV) and 20.3% with an INI-based regimen (mostly ABC/3TC/DTG). At 48 weeks, late presenters had similar viral suppression, but worse immunological response, than non-late presenters with no difference on TDAE. Late presenters initiating with NNRTI-based regimens were more likely to achieve viral suppression than those starting with INI-based, due to the higher chance of achieving viral suppression observed with TDF/FTC/RPV compared to ABC/3TC/DTG. Initial treatment with NNRTI or protease inhibitor based showed similar immunological response than the INI-based regimens, which showed lower rates of TDAE than NNRTI- and protease inhibitor based regimens. Conclusion: Despite safety and effectiveness of initial ART in terms of viral suppression, late presenters may not experience complete immunological response. In late presenters, effectiveness and safety depends on both the class and the specific first-line ART regimen.
... In Denmark, it is estimated that 47% of all individuals diagnosed with HIV in 2016 were late presenters [7]. Late presentation has consequences both for the individual, in terms of poor treatment outcomes and increased morbidity and mortality [6,8], and for the general public health in terms of risk of transmission from individuals unaware of their HIV infection and increased healthcare costs [9,10]. Migrants constitute a fragile population and often lack proper access to health care facilities both in the country of origin and during the migration, but also in the immigration country [11], and they are, therefore, considered a group at risk of late presentation [12,13]. ...
... Our results are supported by data on epidemiological patterns of HIV infection in Western Europe, where migrants from countries with generalised HIV epidemics, particularly Sub-Saharan Africa, constitute a significant part of HIV infections [8,12,[18][19][20]. A recent study found that 38% of the HIV diagnoses reported in Europe between 2007 and 2012 were among migrants. ...
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Article
Purpose: Migrants represent a considerable proportion of HIV diagnoses in Europe and are considered a group at risk of late presentation. This study examined the incidence of HIV diagnoses and the risk of late presentation according to migrant status, ethnic origin and duration of residence. Methods: We conducted a historically prospective cohort study comprising all adult migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114.282), matched 1:6 to Danish born by age and sex. HIV diagnoses were retrieved from the National Surveillance Register and differences in incidence were assessed by Cox regression model. Differences in late presentation were assessed by logistic regression. Results: Both refugees (HR = 5.61; 95% CI 4.45-7.07) and family-reunified immigrants (HR = 10.48; 95% CI 8.88-12.36) had higher incidence of HIV diagnoses compared with Danish born and the incidence remained high over time of residence for both groups. Migrants from all regions, except Western Asia and North Africa, had higher incidence than Danish born. Late presentation was more common among refugees (OR = 1.87; 95% CI 1.07-3.26) and family-reunified immigrants (OR = 2.30; 95% CI 1.49-3.55) compared with Danish born. Southeast Asia and Sub-Saharan Africa were the only regions with a higher risk of late presentation. Late presentation was only higher for refugees within 1 year of residence, whereas it remained higher within 10 years of residence for family-reunified immigrants. Conclusions: This register-based study revealed a higher incidence of HIV diagnoses and late presentation among migrants compared with Danish born and the incidence remained surprisingly high over time.
... However, estimates for people living with HIV in Spain are roughly of 145,000, of whom 20% are unaware of it. This fact largely explains the high rate of late HIV presenters [3]. ...
... The number of new HIV diagnoses per year is roughly 2.5-fold compared to France or 1.5-fold compared to Germany, despite having larger populations and similar rates of antiretroviral coverage for their HIV patients ( Figure 6). Given that more than 80% of new HIV infections in Spain are occurring in MSM, mostly young native Spaniards, re-thinking education and behavioral interventions seems mandatory [3]. Viruses 2018, 10, x 11 of 21 Ultimately, the risk of HIV acquisition depends on the amount and quality of exposure to the infected source. ...
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Article
The first cases of AIDS in Spain were reported in 1982. Since then over 85,000 persons with AIDS have been cumulated, with 60,000 deaths. Current estimates for people living with HIV are of 145,000, of whom 20% are unaware of it. This explains the still high rate of late HIV presenters. Although the HIV epidemic in Spain was originally driven mostly by injection drug users, since the year 2000 men having sex with men (MSM) account for most new incident HIV cases. Currently, MSM represent over 80% of new yearly HIV diagnoses. In the 80s, a subset of young doctors and nurses working at Internal Medicine hospital wards became deeply engaged in attending HIV-infected persons. Before the introduction of antiretrovirals in the earlier 1990s, diagnosis and treatment of opportunistic infections was their major task. A new wave of infectious diseases specialists was born. Following the wide introduction of triple combination therapy in the late 1990s, drug side effects and antiretroviral resistance led to built a core of highly devoted HIV specialists across the country. Since then, HIV medicine has improved and currently is largely conducted by multidisciplinary teams of health care providers working at hospital-based outclinics, where HIV-positive persons are generally seen every six months. Antiretroviral therapy is currently prescribed to roughly 75,000 persons, almost all attended at clinics belonging to the government health public system. Overall, the impact of HIV/AIDS publications by Spanish teams is the third most important in Europe. HIV research in Spain has classically been funded mostly by national and European public agencies along with pharma companies. Chronologically, some of the major contributions of Spanish HIV research are being in the field of tuberculosis, toxoplasmosis, leishmaniasis, HIV variants including HIV-2, drug resistance, pharmacology, antiretroviral drug-related toxicities, coinfection with viral hepatitis, design and participation in clinical trials with antiretrovirals, immunopathogenesis, ageing, and vaccine development.
... Metabolic biomarkers such as alkaline phosphatase (AP) and plasma hemoglobin are closely related to mortality in people living with HIV [10]. Serum albumin level is a predictor of short-and long-term severe non-Page 3/15 AIDS events [11] and is associated with mortality after HIV/hepatitis C virus (HCV) co-infection [12]. Several studies have been conducted to determine the association between death risk and serum albumin levels. ...
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Background: Many patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) are still undiagnosed or diagnosed late, which leads to serious consequences and burdens. Low serum albumin levels are significantly correlated with disease prognosis. This study investigated the association between serum albumin concentration and 12-week mortality of HIV/AIDS with late diagnosis in mainland China. Methods: In this single-center retrospective cohort study, 1,079 inpatients with late HIV/AIDS diagnosis between January 2018 and December 2021 were included. The strata of serum albumin levels were categorized into tertiles. Disease progression was estimated using the 12-week mortality. Cox proportional hazards regression models were used to evaluate the serum albumin concentration with disease progression. The Kaplan–Meier method was used to analyze the effect of different serum albumin levels on mortality. Results: During the 12-week follow-up, 77 patients (7.1%) died. Serum albumin concentration was significantly correlated with late HIV/AIDS diagnosis progression. In Cox proportional hazards regression models, the mortality risk decreased by 8% with the increase in every 1g/L serum albumin after adjustment (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.88–0.97). Compared with that of the low serum albumin group (< 28 g/L), the middle group (28–33 g/L) mortality risk decreased by 70% (HR = 0.30, 95% CI: 0.16–0.60), and that of the high group (≥ 34 g/L) decreased by 45% (HR = 0.55, 95% CI: 0.27–1.15) after adjustment. Conclusions: Hospitalized patients with late HIV/AIDS diagnosis and low serum albumin concentrations in mainland China had a relatively high short-term mortality rate. Further research is needed to characterize the role of serum albumin in the timely prevention of 12-week mortality in patients with a late diagnosis.
... Prenatal and childbirth coverage in Brazil is close to 100% and the coverage of testing for HIV infection during pregnancy is over 80% [55][56][57]. Men tend to be diagnosed later than women with AIDS-related illnesses, thus increasing the risk of mortality, particularly early mortality [10,[58][59][60]. Here, it is important to highlight the significant burden of tuberculosis in our setting, as PWH with TB tend to seek care later than expected, with low CD4 count, greatly contributing to early mortality [61,62]. ...
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Article
Background Global mortality from AIDS-related diseases has been declining since 2005, resulting primarily from the widespread use and early initiation of combination antiretroviral therapy. Despite the significant improvements, high rates of early mortality, usually defined as that occurring within the 1st year of entry to care, have been observed, especially in resource-limited settings. This analysis draws upon data from an observational cohort of people with HIV (PWH) followed at a reference center for HIV/AIDS care and research in the city of Rio de Janeiro, Brazil, to identify the pattern and factors associated with early mortality. Methods The study population includes PWH aged 18 or older followed at the National Institute of Infectious Diseases Evandro Chagas who were enrolled between 2004 and 2015. The primary outcome was early mortality, defined as deaths occurring within 1 year of inclusion in the cohort, considering two follow-up periods: 0 to 90 days (very early mortality) and 91 to 365 days (early mortality). Cox proportional hazards models were used to identify the variables associated with the hazard of very early and early mortality. Results Overall, 3879 participants contributed with 3616.4 person-years of follow-up. Of 220 deaths, 132 happened in the first 90 days and 88 between 91 and 365 days. Very early mortality rate ratios (MRR) show no statistically significant temporal differences between the periods 2004–2006 to 2013–2015. In contrast, for early mortality, a statistically significant decreasing trend was observed: mortality rates in the periods 2004–2006 (MR = 5.5; 95% CI 3.9–7.8) and 2007–2009 (MR = 3.9; 95% CI 2.7–5.7) were approximately four and three-fold higher when compared to 2013–2015 (MR = 1.4; 95% CI 0.7–2.7). Low CD4 count and prior AIDS-defining illness were strongly associated with higher hazard ratios of death, especially when considering very early mortality. Conclusions The present study shows an excess of mortality in the 1st year of follow-up with no changes in the mortality rates within 90 days among PWH from Rio de Janeiro. We note the significant impact of initiating treatment with immunosuppression, as evidenced by the increased risk of death among those with low CD4 cell count and with AIDS-defining illnesses.
... However, even though we have accomplished a lot in terms of HIV testing and ART provision, many HIV-infected persons still present late to care which puts them at risk of opportunistic infections. 2,3 Moreover, HIV late presenters are at the highest risk for IRIS 4 highlighting the importance of early HIV diagnosis. ...
... Late presentation to HIV care coupled with late treatment initiation in the course of HIV disease progression worsens the health outcomes for individuals and can compromise the fight against the HIV/AIDS epidemic. For people living with HIV, late treatment initiation is associated with clinical progression, increased AIDS and non-AIDS related morbidity and mortality, higher propensity for treatment related adverse events and lower chances of achieving viral suppression [8][9][10][11][12][13][14]. At the population level, late treatment initiation implies potential onward viral transmission from unsuppressed HIV viral load among those living with HIV [15]. ...
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Article
Background: Late antiretroviral treatment initiation for HIV disease worsens health outcomes and contributes to ongoing transmission. We investigated whether socioeconomic inequalities exist in access to treatment in a setting with universal access to care and treatment. Methods: This study investigated the association of educational level, used as a proxy for socioeconomic status, with late treatment initiation and treatment initiation with advanced disease. Study participants included adults (≥25 years) who started treatment from 2005 to 2018 at Instituto Nacional de Infectologia Evandro Chagas of Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil. Educational level was categorized following UNESCO's International Standard Classification of Education: incomplete basic education, basic education, secondary level, and tertiary level. We defined late treatment initiation as those initiating treatment with a CD4 < 350 cells/mL or an AIDS-defining event, and treatment initiation with advanced disease as those initiating treatment with a CD4 < 200 cells/mL or an AIDS-defining event. A directed acyclic graph (DAG) was constructed to represent the theoretical-operational model and to understand the involvement of covariates. Logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Multiple imputation using a chained equations approach was used to treat missing values and non-linear terms for continuous variables were tested. Results: In total, 3226 individuals composed the study population: 876 (27.4%) had incomplete basic education, 540 (16.9%) basic, 1251 (39.2%) secondary level, and 525 (16.4%) tertiary level. Late treatment initiation was observed for 2076 (64.4%) while treatment initiation with advanced disease was observed for 1423 (44.1%). Compared to tertiary level of education, incomplete basic, basic and secondary level increased the odds of late treatment initiation by 89% (aOR:1.89 95%CI:1.47-2.43), 61% (aOR:1.61 95%CI:1.23-2.10), and 35% (aOR:1.35 95%CI:1.09-1.67). Likewise, the odds of treatment initiation with advanced disease was 2.5-fold (aOR:2.53 95%CI:1.97-3.26), 2-fold (aOR:2.07 95%CI:1.59-2.71), 1.5-fold (aOR:1.51 95%CI:1.21-1.88) higher for those with incomplete basic, basic and secondary level education compared to tertiary level. Conclusion: Despite universal access to HIV care and antiretroviral treatment, late treatment initiation and social inequalities persist. Lower educational level significantly increased the odds of both outcomes, reinforcing the existence of barriers to "universal" antiretroviral treatment.
... Migrants are overrepresented with 42% of new diagnoses being persons born outside of Spain. Late presentation of HIV infection is a public health concern because of associated worse health outcomes [3][4][5] and the increased risk of transmission [6][7][8]. Worse survival rates have been observed in those who are diagnosed with advanced HIV disease compared to those diagnosed late [9]. ...
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Article
This study using the Catalan PISCIS cohort explores risk factors of migrants’ late presentation and the impact of late presentation on their health outcomes. We analyse 9590 new HIV diagnoses enrolled in the cohort between 2004 and 2016. Univariate and multivariate logistic regression models are used to identify risk factors associated with late presentation among migrants, giving crude and adjusted odds ratios and their 95% confidence intervals. Cox regression models are estimated to identify risk factors associated with AIDS/death, and crude and adjusted hazard ratios and 95% confidence intervals are reported. Late presentation is higher in migrants than non-migrants. Among migrants, region of origin is associated with late presentation and AIDS/death during follow-up. The results highlight persisting inequalities in HIV diagnosis and care among migrants in Catalonia. Targeted interventions addressed to specific subgroups in the migrant population are needed.
... These results are similar to the late presentation rate of 38% and the median CD4 count at diagnosis of 368 cells/lL reported by the investi- gators of several Western European cohorts [30]. Given the high levels of viraemia, which characterize undiagnosed HIV infection [31][32][33] and a higher risk of onward trans- mission [34,35], as well as a higher risk of mortality and treatment failure for late presenters [36,37], there is an urgent need to promote HIV testing in the at-risk popula- tion to identify individuals close to the time of HIV infec- tion and initiate cART. ...
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Objectives: Estonia has one the highest number of new HIV diagnoses in the European Union, mainly among injecting drug users and heterosexuals. Little is known of HIV incidence, which is crucial for limiting the epidemic. Using a recent HIV infection testing algorithm (RITA) assay, we aimed to estimate HIV incidence in 2013. Methods: All individuals aged ≥18 years newly-diagnosed with HIV in Estonia January- December 2013, except blood donors and those undergoing antenatal screening, were included. Demographic and clinical data were obtained from the Estonian Health Board and the Estonian HIV-positive patient database. Serum samples were tested for recent infection using the LAg-avidity EIA assay. HIV incidence was estimated based on previously published methods. Results: Of 69,115 tested subjects, 286 (0.41%) were newly-diagnosed with HIV with median age of 33 years (IQR: 28-42) and 65% male. Self-reported routes of HIV transmission were mostly heterosexual contact (n = 157, 53%) and injecting drug use (n = 62, 21%); 64 (22%) were with unknown risk group. Eighty two (36%) were assigned recent, resulting in estimated HIV incidence of 0.06%, corresponding to 642 new infections in 2013 among the non-screened population. Incidence was highest (1.48%) among people who inject drugs. Conclusions: These high HIV incidence estimates in Estonia call for urgent action of renewed targeted public health promotion and HIV testing campaigns.
... En los últimos 15 años, no obstante, el mecanismo de transmisión más frecuente es por vía sexual, fundamentalmente entre HSH (3) . La mortalidad por VIH/SIDA en España ha disminuido -y lo sigue haciendo --de forma muy marcada desde el año 1997 debido al impacto poblacional del TAR (83,84) . Como consecuencia, el número total de personas que viven con VIH/SIDA y que pueden transmitir la infección ha aumentado considerablemente, por lo que es necesario más que nunca mejorar el diagnóstico temprano y reforzar los mecanismos de prevención de la transmisión de la infección. ...
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Thesis
ADVERTIMENT. La consulta d'aquesta tesi queda condicionada a l'acceptació de les següents condicions d'ús: La difusió d'aquesta tesi per mitjà del servei TDX (www.tdx.cat) i a través del Dipòsit Digital de la UB (diposit.ub.edu) ha estat autoritzada pels titulars dels drets de propietat intel·lectual únicament per a usos privats emmarcats en activitats d'investigació i docència. No s'autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d'un lloc aliè al servei TDX ni al Dipòsit Digital de la UB. No s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora. ADVERTENCIA. La consulta de esta tesis queda condicionada a la aceptación de las siguientes condiciones de uso: La difusión de esta tesis por medio del servicio TDR (www.tdx.cat) y a través del Repositorio Digital de la UB (diposit.ub.edu) ha sido autorizada por los titulares de los derechos de propiedad intelectual únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro ni su difusión y puesta a disposición desde un sitio ajeno al servicio TDR o al Repositorio Digital de la UB. No se autoriza la presentación de su contenido en una ventana o marco ajeno a TDR o al Repositorio Digital de la UB (framing). Esta reserva de derechos afecta tanto al resumen de presentación de la tesis como a sus contenidos. En la utilización o cita de partes de la tesis es obligado indicar el nombre de la persona autora. WARNING. On having consulted this thesis you're accepting the following use conditions: Spreading this thesis by the TDX (www.tdx.cat) service and by the UB Digital Repository (diposit.ub.edu) has been authorized by the titular of the intellectual property rights only for private uses placed in investigation and teaching activities. Reproduction with lucrative aims is not authorized nor its spreading and availability from a site foreign to the TDX service or to the UB Digital Repository. Introducing its content in a window or frame foreign to the TDX service or to the UB Digital Repository is not authorized (framing). Those rights affect to the presentation summary of the thesis as well as to its contents. In the using or citation of parts of the thesis it's obliged to indicate the name of the author.
... These factors were reported in several studies as well that consistently show that late presentation is associated with adverse outcomes. (39) This study shades light in the progress the HIV care in the study sites took from the earlier periods to the very recent past. It also identifies key challenges that may require further investigation as the program evolves. ...
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Background The HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors. Methods This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression. Results 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality. Conclusion and recommendation Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.
... En los últimos 15 años, no obstante, el mecanismo de transmisión más frecuente es por vía sexual, fundamentalmente entre HSH (3) . La mortalidad por VIH/SIDA en España ha disminuido -y lo sigue haciendo --de forma muy marcada desde el año 1997 debido al impacto poblacional del TAR (83,84) . Como consecuencia, el número total de personas que viven con VIH/SIDA y que pueden transmitir la infección ha aumentado considerablemente, por lo que es necesario más que nunca mejorar el diagnóstico temprano y reforzar los mecanismos de prevención de la transmisión de la infección. ...
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Background: It has been estimated that 60,000 Iranians were infected with HIV/AIDS and only 36% of them are aware of their status. This study aimed to design, implement and evaluate a social marketing campaign to promote HIV testing in Boyer-Ahmad County, Kohgiluyeh, and Boyer-Ahmad Province, southwest of Iran. Materials and Methods: This study was a quasi-experimental pretest-posttest without a control group, developed based on a social marketing assessment and response tool. To design the intervention formative research was conducted, comprised of four focus group discussion sessions with 42 participants of the target community along with seven semi-structured interviews with health care providers involved in the HIV/AIDS Program. Data analysis was done manually using content analysis and the main content was formulated for the campaign. Afterward, the slogan and messages of the campaign were developed. The campaign’s materials including banners, posters, pamphlets, referral forms, and short messages were designed, pretested, and revised. Ultimately, the campaign was conducted for one month in October 2019. To determine the effectiveness of the campaign, the rate of referrals to the Center for Behavioral Health Counseling Services (CBHCS) for three months before and after the campaign was compared. Results: The findings of the qualitative study showed that the majority of the interviewees mentioned that the main reasons for the low rate of referrals to get tested for HIV were lack of awareness and information about HIV/AIDS and its diagnosis as well as the (CBHCS) including its free and confidential tests. Moreover, the stigma associated with HIV/AIDS was introduced as one other important reason for low referrals for testing. The rate of referrals for HIV testing in three months leading up to the campaign was 18, 32, and 23 people, and three months after the campaign was 64, 81, and 44 individuals; respectively. The results of the multivariate analysis demonstrated that the campaign had increased the rates of referrals for HIV testing through its significant influence on females, and individuals with academic degrees. Conclusion: It can be concluded that the social marketing campaign was successful in persuading people to get tested for HIV.
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Objective: to analyze the occurrence of late diagnosis of infection by the Human Immunodeficiency Virus and its associated factors. Method: this is an epidemiological, cross-sectional and analytical study, carried out with 369 people followed-up by Specialized Assistance Services, undergoing anti-retroviral treatment, and interviewed by means of a questionnaire. Univariate analysis was performed using Pearson’s chi-square test or Fisher’s exact test and Kruskall-Wallis test, and multivariate analysis using the ordinal logistic regression model of proportional odds. Results: the occurrence of 59.1% for late diagnosis of the infection was observed; the probability of later diagnosis is greater among people who have a steady partnership, when compared to those who do not; with increasing age, particularly above 35 years old; among those with lower schooling; for those who seek the health services to have an HIV test when they feel sick; and for those who test HIV less often or never do it after sex without a condom with a steady partner. Conclusion: the knowledge on the high proportion of late diagnosis and its associated factors verified in this study make the planning and implementation of new policies and strategies aimed at the timely diagnosis of the infection imperative.
Thesis
Acquired Immuno-Deficiency Syndrome (AIDS) is a disease caused by immunodeficiency viruses in human (HIV-1) and some animal species. The virus is a small enveloped particle that has a single-strand RNA genome and belongs to the lentivirus genus that belongs to the Retroviridae family. In human the virus infects and replicates mainly in cells that express the CD4 on their surface. Since its apparition in human in 1982 the virus has infected around 80 million individuals worldwide and caused the death of nearly half of them. No vaccine exists but life expectancy of near half of HIV-1-infected individuals has been now prolonged due to extensive highly active antiretroviral therapy (HAART). Because of the complexity of the host/pathogen interactions that are associated with HIV-1 infection in human and non-human primate models, a simple model system is strongly needed to ease the studies aiming at better understanding the underlying mechanisms of increased pathogenesis of HIV-1 in human. A chimeric virus CAL-HIV-R1 was created in our laboratory by exchanging the long terminal repeats (LTRs) of HIV with those of CAEV, a caprine lentivirus. Because these CAEV LTRs have a constitutive promoter, which is independent of the trans-activator of transcription, we expect that this chimeric virus should not undergo latency in memory CD4+ T cells. To increase the potency of this chimera, serial passages on cultured human cells were performed. Besides its primary receptor, CD4, HIV needs to interact with another molecule as a co-receptor. Several infectious molecular clones of HIV-1 isolates pDNAs containing the complete proviral genomes were received from the NIH AIDS Reagent Program Repository. Three of these, namely pNL4-3, p89.6 and WARO, were used to produce virus stocks following transfection in the human HEK-293T cell line and used to infect a variety of cell lines such as: 1) GHOST cells that were used to examine the tropism for the co-receptor that were X4, X4/R5 and R5 respectively; 2) M8166 a fusogenic indicator cell line to evaluate the replication competency, 3) TZM-bl to determine the infectivity titers of the viruses by scoring the blue cells enabled by infections. A vaccine based on a chimeric DNA vector, CAL-SHIV-IN-, has been developed in our laboratory and tested in macaques. A sero-neutralization assay was performed on sera of macaques, which had been vaccinated with this vector and challenged in parallel with control animals with a pathogenic virus. This assay was used to verify the presence of neutralizing antibodies, but, unfortunately none could be detected.
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