RESEARCH PAPER
HIV care cascade in Albania: analysis of newly diagnosed cases in 2016
1
Department and Service of Infectious Diseases, Faculty of Medicine, University Hospital Center, Tirana, Albania
2
Department of Infectious Diseases, Faculty of Medicine, Tirana, Albania
3
Institute of Public Health, Albania
4
Institute of Public Health, National HIV Program, Tirana, Albania
5
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University Izmir, Turkey
6
Royal Free Hospital, United Kingdom
Submission date: 2019-12-02
Acceptance date: 2020-08-20
Publication date: 2020-12-12
HIV & AIDS Review 2020;19(4):267-272
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Despite the fact that there has been a steady rise in new infections rate since the first reported case in 1993, Albania remains a low prevalence country. This was the first cascade study for Albania. The aim was to construct a cascade of care for newly human immunodeficiency virus (HIV)-diagnosed individuals in 2016 in Albania.
Material and methods:
This retrospective descriptive study was conducted at the HIV/AIDS Ambulatory Clinic, Infectious Disease Service, University Hospital Centre of Tirana. Medical records of patients diagnosed and enrolled in care in 2016 were retrospectively screened and data on gender, age, HIV clinical stage, CD4+ T cell count, viral load measurement, and treatment history, with antiretroviral treatment (ART) and adherence to treatment were collected.
Results:
Out of 127 new HIV cases reported, 100 (78.7%) entered care. The median age was 39 years (range, 20-75 years; male, 82%). Seventy one percent started ART within a median of 56 days (range, 1-317 days) from diagnosis, 34 (47.9%) patients received tenofovir disoproxil fumarate/emtricitabine + efavirenz (EFV), and 27 (38%) zidovudine + lamivudine + EFV. Among those who started ART, 19.7% were late presenters and 54.9% were very late presenters. Viral load after initiation of ART was assessed in 25 cases, with 56% of patients achieving an undetectable HIV-RNA.
Conclusions:
A large proportion of people living with HIV were lost at each step of the cascade. Efforts in Albania should be focused on scaling up HIV testing, promoting adherence to ART, improving access to diagnostics, and better ART regimens as well as proper monitoring of therapy.
Despite the fact that there has been a steady rise in new infections rate since the first reported case in 1993, Albania remains a low prevalence country. This was the first cascade study for Albania. The aim was to construct a cascade of care for newly human immunodeficiency virus (HIV)-diagnosed individuals in 2016 in Albania.
Material and methods:
This retrospective descriptive study was conducted at the HIV/AIDS Ambulatory Clinic, Infectious Disease Service, University Hospital Centre of Tirana. Medical records of patients diagnosed and enrolled in care in 2016 were retrospectively screened and data on gender, age, HIV clinical stage, CD4+ T cell count, viral load measurement, and treatment history, with antiretroviral treatment (ART) and adherence to treatment were collected.
Results:
Out of 127 new HIV cases reported, 100 (78.7%) entered care. The median age was 39 years (range, 20-75 years; male, 82%). Seventy one percent started ART within a median of 56 days (range, 1-317 days) from diagnosis, 34 (47.9%) patients received tenofovir disoproxil fumarate/emtricitabine + efavirenz (EFV), and 27 (38%) zidovudine + lamivudine + EFV. Among those who started ART, 19.7% were late presenters and 54.9% were very late presenters. Viral load after initiation of ART was assessed in 25 cases, with 56% of patients achieving an undetectable HIV-RNA.
Conclusions:
A large proportion of people living with HIV were lost at each step of the cascade. Efforts in Albania should be focused on scaling up HIV testing, promoting adherence to ART, improving access to diagnostics, and better ART regimens as well as proper monitoring of therapy.
REFERENCES (44)
1.
Greene W. A history of AIDS: looking back to see ahead. Eur J Immunol 2007; 37: S94-S102.
2.
Global HIV & AIDS statistics – 2018 fact sheet. Available at: https://www.unaids.org/en/reso... (Accessed: May 2019).
3.
UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014. Available at: https://www.unaids.org/en/reso... (Accessed: August 2019).
4.
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its Relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011; 52: 793-800.
5.
McNairy ML, Lamb MR, Abrams EJ, et al. Use of a comprehensive HIV care cascade for evaluating HIV program performance: findings from 4 sub-Saharan African countries. J Acquir Immune Defic Syndr 2015; 70: E44-51.
6.
Levi J, Raymond A, Pozniak A, Vernazza P, Kohler P, Hill A. Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades. BMJ Global Health 2016; 1: e000010.
7.
Ministry of Health. The National Strategy of Prevention and Control of HIV/AIDS in Albania 2010-2015. Tirane: Ministry of Health; 2019. Available at: http://ccm-albania.al/wp-conte....
8.
HIV in Albania: an epidemiological review – September 2014. Available at: http://www. euro.who.int/__data/assets/pdf_file/0006/.
10.
National Center for Infectious Diseases Division of HIV/AIDS; Castro KG, Ward JW, Slutsker L, et al. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992; 41: 1-19.
11.
Antinori A, Coenen T, Costagiola D, et al. Late presentation of HIV infection: a consensus definition. HIV Med 2011; 12: 61-64.
12.
WHO. 2015. Antiretroviral therapy (ARV) coverage. [ONLINE] Available at: http://www.who.int/healthinfo/... (Accessed: 1.05.2018).
13.
Gökengin D, Oprea C, Uysal S, Begovac J. The growing HIV epidemic in Central Europe: a neglected issue? J Virus Erad 2016; 2: 156-161.
14.
Late presenters working group in COHERE in EuroCoord; Amanda Mocroft 1, Jens Lundgren, Andrea Antinori, et al. Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013. Euro Surveill 2015; 20.
15.
Castilla J, Sobrino P, De La Fuente L, et al. Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence. AIDS 2002; 16: 1945-1951.
16.
Turan B, Hatcher AM, Weiser SD, et al. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health 2017; 107: 863-869.
17.
Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect 2003; 79: 442-447.
19.
Social stigma concerns and HIV medication adherence. AIDS Patient Care STDS 2006; 20: 359-368.
20.
Thapa S, Hannes K, Cargo M, et al. Effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries: a realist review protocol. Syst Rev 2015; 4: 142.
21.
Gesesew HA, Tesfay Gebremedhin A, Demissie TD, et al. Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: a systematic review and meta-analysis. PLoS One 2017; 12: e0173928. .
22.
Bozicevic I, Brown A, Delpech V, Dvoriak S. HIV in Albania: an epidemiological review. September 2014. Available at: http://www.euro.who.int/__data...-.
24.
Bino S, Rjepaj K, Harxhi A, et al. Albania Behavioral and Biological Surveillance Study Report. May 2006. Available at: http://ishp.gov.al/docs/DESiSH....
25.
Roshi E, Bino S, Burazeri G, et al. Albania Biological and Behavioural Surveillance Study Final Report. 2013. Available at: https://www.academia.edu/23029....
26.
Albania Demographic and Health Survey 2008-2009. Institute of Statistics, Institute of Public Health, ICF Macro, 2010. Available at: https://dhsprogram.com/pubs/pd... (Accessed: August 2019).
27.
Morrison SD, Banushi VH, Sarnquist C, et al. Levels of self-reported depression and anxiety among HIV-positive patients in Albania: a cross-sectional study. Croatian Medical Journal 2011; 52: 622-627.
28.
Rabkin JG. HIV and depression: 2008 review and update. Curr HIV/AIDS Rep 2008; 5: 163-171.
29.
Stober DR, Schwartz JA, McDaniel JS, Abrams RF. Depression and HIV disease: prevalence, correlates, and treatment. Psychiatr Ann 1997; 27: 372-377.
30.
Remien RH, Mellins CA. Long-term psychosocial challenges for people living with HIV: let’s not forget the individual in our global response to the pandemic. AIDS 2007; 21 (Suppl 5): S55-63.
31.
Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS 2006; 20: 1571-1582.
32.
Stout BD, Leon MP, Niccolai LM. Nonadherence to antiretroviral therapy in HIV-positive patients in Costa Rica. AIDS Patient Care STDS 2004; 18: 297-304.
33.
Yehia BR, Stewart L, Momplaisir F, et al. Barriers and facilitators to patient retention in HIV care. BMC Infect Dis 2015; 15: 246.
34.
Helbert M, Breuer J. Monitoring patients with HIV disease. J Clin Pathol 2000; 53: 266-273.
35.
INSIGHT START Study Group, Lundgren JD, Babiker AG, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015; 373: 795-807.
36.
World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2015. Available at: https://www.who.int/hiv/pub/gu... (Accessed: August 2019).
37.
Ryom L, Boesecke C, Gisler V et al. Essentials from the 2015 European AIDS Clinical Society (EACS) guidelines for the treatment of adult HIV‐positive persons. HIV Med 2016; 17: 83-88.
38.
European AIDS Clinical Society Guidelines. Version 9.1. (October 2018) Available at: http://www.eacsociety.org/file... (Accessed: August 2019).
39.
Gokengin D, Oprea C, Begovac J, et al. HIV care in Central and Eastern Europe: how close are we to the target? Int J Infect Dis 2018; 70: 121-130.
40.
Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in Sub-Saharan Africa and North America: a meta-analysis. JAMA 2006; 296: 679-690.
41.
Ye Ma, Zhihui Dou, Wei Guo, et al. The human immunodeficiency virus care continuum in China: 1985-2015. Clin Infect Dis 2018; 66: 833-839.
42.
Kowalska JD, Aebi‐Popp K, Loutfy M, et al. Promoting high standards of care for women living with HIV: position statement from the Women Against Viruses in Europe Working Group. HIV Med 2017; 19: 167-173.
43.
Kaplan JE, Hamm TE, Forhan S, et al. The impact of HIV care and support interventions on key outcomes in low and middle-income countries: a literature review. Introduction. J Acquir Immune Defic Syndr 2015; 68 (Suppl 3): S253-S256.
44.
World Health Organization Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach June 2013. Available at: https://www.who.int/hiv/pub/gu... (Accessed: August 2019).
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