Early HIV diagnosis enhances quality-adjusted life expectancy of men who have sex with men living with HIV: A population-based cohort study in Taiwan.

BACKGROUND: Whether early HIV diagnosis is beneficial for HIV patients themselves remains uncertain, given the stigma and social discrimination associated with an HIV diagnosis. This study aimed to measure the impact of early HIV diagnosis on quality-adjusted life expectancy (QALE) in comparison with late HIV diagnosis, from real-world data in Taiwan under universal access to antiretroviral therapy (ART). METHODS: This population-based cohort study included 14,570 men who have sex with men (MSM) in the national HIV registry and a quasi-random sample (n = 127) of MSM patients to measure quality of life using the EQ-5D health utility instrument. We integrated quality of life data into the extrapolated cohort survival curve to estimate the QALE in patients with early versus late HIV diagnosis (≤30 days before AIDS diagnosis). Loss-of-QALE were estimated by comparing the cohort with age-, sex-, and calendar-year-matched referents simulated from vital statistics. Difference-in-differences was estimated to quantify the effect of early HIV diagnosis. RESULTS: Early HIV diagnosis is associated with a loss-of-life expectancy of 3.11 years, with an average health utility of 0.95, in contrast to those diagnosed late (loss-of-life expectancy 8.47 years, with an average health utility of 0.86). After integration of survival and life quality, early HIV diagnosis results in a reduction of loss-of-QALE by 8.28 quality-adjusted life years among MSM living with HIV. CONCLUSIONS: Under universal access to ART, early HIV diagnosis is highly beneficial for people living with HIV themselves, with a net gain of 8.28 healthy life years compared with those diagnosed late.

Mother-to-child transmission of HIV: An 11-year experience in a single center and HIV prevention effectiveness in Taiwan.

BACKGROUND: Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) has become an essential global health issue and its elimination is a crucial target. A prenatal "opt-out" HIV screening program was initiated in 2005 in Taiwan. In recent 3 years, approximate screening and MTCT rates were 99% and 2.27% (1/44), respectively. Here, we describe the clinical management of mothers infected with HIV and MTCT rate at National Taiwan University Hospital (NTUH), Taipei, Taiwan, in the years after the program was initiated. METHODS: We retrospectively reviewed charts of pregnant women infected with HIV, who were managed at NTUH between January 2005 and December 2016. HIV infection status of 39 infants born to mothers infected with HIV was available. RESULTS: Between 2005 and December 2016, 50 pregnant women infected with HIV, with 57 parities were managed at NTUH, and 57 live infants were born. We excluded 18 parities because of missing data. Maternal antiviral treatment was administered in 37 of 39 infants. Only one infant tested positive for an HIV antibody test at 18 months, but showed definitive HIV exclusion at 20 months after a series of tests without administration of antiviral treatment. MTCT rate was 0%. CONCLUSION: Successful implementation of available perinatal HIV intervention dramatically reduced vertical transmission rate of HIV. MTCT rate was 0% in NTUH after the program. However, as NTUH is an HIV referral center, additional efforts are needed to achieve the World Health Organization criteria of lowering the vertical transmission rate of HIV to <2% in Taiwan.

Stress, needs, and quality of life of people living with human immunodeficiency virus/AIDS in Taiwan.

Human immunodeficiency virus (HIV)/AIDS is a manageable infectious disease by the effectiveness of highly active antiretroviral therapy. AIDS-related stigma and conflict may create distress and deteriorate quality of life (QoL) of people living with HIV/AIDS (PLWHA). This cross-sectional, descriptive, correlational study using structural questionnaires aimed to explore the stress, needs, QoL, and associated factors of PLWHA in Taiwan. A total of 200 PLWHA participating in this study needed most on treatment of HIV and prevention of AIDS, and health maintenance. They had worse QoL in physical, psychological, and social domains (all p < 0.001) than the general population. Stress was the most significant predictor (ß = -0.25 to -0.54, p < 0.01) for all four domains of QoL. Needs was not significantly associated with QoL. The QoL of PLWHA can be explained by demographics, self-perception on health, needs, and stress for 25.3-40.7% of variances. No association existed between CD4(+) counts and QoL in Taiwanese PLWHA. It is important to recognize the perception of PLWHA on their health status, which is significantly associated with their QoL, besides monitoring their physical indicators of health (CD4(+) counts). To recognize the stress and needs that PLWHA experience and to develop intervention programs targeting strategies on HIV disclosure, prevention and health maintenance are crucial for PLWHA's QoL.

[HIV/AIDS: an exploration of the knowledge, attitude, infection risk perceptions, and willingness to care of nurses].

BACKGROUND: The number of people infected with HIV/AIDS continues to increase across the world. The awareness of HIV/AIDS and attitudes toward this disease among nurses and their willingness to care for those infected directly impacts upon the quality of HIV/AIDS-patient care. PURPOSE: This study explores the knowledge, attitudes, infection-risk perceptions, and willingness to care for HIV/AIDS patients among nurses and the correlations among these variables. METHODS: This study used a descriptive, correlational design. Scales on HIV/AIDS-related knowledge, attitudes, perceived risk of infection, and willingness to care were used to collect data from 219 nurses who attended the course series on HIV/AIDS held by the Nurses AIDS Prevention Foundation in 2010. RESULTS: The mean score for HIV/AIDS knowledge was 79.6%, with knowledge related to disease transmission pathways earning the highest score and knowledge related to HIV/AIDS protective measures earning the lowest. Participating nurses with higher knowledge scores held a more positive attitude toward HIV/AIDS (p < .001), a lower perceived risk of HIV/AIDS infection (p < .001), and a higher willingness to care for HIV/AIDS-positive patients (p = .001). In addition, those participants who had received in-service HIV/AIDS education training earned higher willingness-to-care scores (p = .046). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study underscore the importance of HIV/AIDS education and may be referenced by health authorities and hospitals for promoting HIV/AIDS education. Further, the results suggest that nurses with a greater knowledge of HIV/AIDS protection and of prophylaxis after occupational exposure are more willing to care for HIV/AIDS patients.

[The experience of nurses caring for HIV-positive injection drug users].

Taiwan has experienced a clear upswing in HIV infection among injection drug users (IDUs) since 2004. Unsafe drug injection behavior has led to complicated infections including HIV and hepatitis C virus infection among IDUs. Nurses face challenges and threats in caring for this group due to the widespread criminal and behavioral problems related to drug use. The purpose of this phenomenological study was to explore nurses' experiences in caring for HIV positive IDUs. Purposive sampling was used to recruit 7 nurses with experience working with HIV positive IDUs. In-depth semi-structured interviews were conducted 1~2 times with each nurse. The length of interviews ranged from 1.5~3 hours. Interviews were tape recorded and transcribed verbatim. Data was analyzed using the Colaizzi method for phenomenology. Nurse experiences reflected low achievement level, difficulty in establishing rapport with IDUs, fear of drug use incidences during hospitalization, insufficiency and complications with family caregivers, fear of being threatened, and lack of support from other medical disciplines. Nurses used strategies that included being supportive of one another, learning appropriate communication skills, positive thinking, and anticipating substantial compensation from administrators. The results of this study provide essential information for in-service education and healthcare policy reform on IDU care. Interventions to ease nurse anxieties and feelings of insecurity in order to increase safe care should be developed and implemented. Positive feedback from IDUs with HIV infection enhances nurses' professional and personal growth.