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Pence BW, Darnell D, Ranna-Stewart M, Psaros C, Gaynes BN, Grimes L, Henderson S, Parman M, Filipowicz TR, Gaddis K, Dorsey S, Mugavero MJ. Provocative Findings From a Transdiagnostic Counseling Intervention to Improve Psychiatric Comorbidity and HIV Care Engagement Among People With HIV: A Pilot Randomized Clinical Trial. J Acquir Immune Defic Syndr 2024; 97:68-77. [PMID: 39116333 PMCID: PMC11315358 DOI: 10.1097/qai.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/19/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Depression, anxiety, post-traumatic stress, and alcohol/substance use disorders are prevalent among people with HIV (PWH), commonly co-occur, and predict worse HIV care outcomes. Transdiagnostic counseling approaches simultaneously address multiple co-occurring mental health disorders. METHODS We conducted a pilot individually randomized trial of the Common Elements Treatment Approach adapted for people with HIV (CETA-PWH), a transdiagnostic counseling intervention, compared with usual care at a large academic medical center in the southern United States. Participants were adults with HIV; at risk for HIV care disengagement; and with elevated symptoms of depression, anxiety, post-traumatic stress, and/or alcohol/substance use. Mental health and HIV care engagement were assessed at 4 and 9 months. RESULTS Among participants (n = 60), follow-up was high at 4 (92%) and 9 (85%) months. Intervention engagement was challenging: 93% attended ≥1 session, 43% attended ≥6 sessions in 3 months ("moderate dose"), and 30% completed treatment. Although not powered for effectiveness, mental health outcomes and HIV appointment attendance improved in CETA-PWH relative to usual care in intent-to-treat analyses; those receiving a moderate dose and completers showed progressively greater improvement. Viral load showed small differences between arms. The dose-response pattern was not explained by differences between those who did and did not complete treatment. CONCLUSIONS This pilot trial provides preliminary evidence for the potential of CETA-PWH to simultaneously address co-occurring mental health comorbidities and support HIV appointment attendance among PWH. Additional strategies may be an important part of ensuring that clients can engage in the full course of treatment and realize its full benefits.
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Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, the University of North Carolina at Chapel Hill
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, the University of Washington
| | | | | | - Bradley N. Gaynes
- Department of Epidemiology, the University of North Carolina at Chapel Hill
- Department of Psychiatry, the University of North Carolina at Chapel Hill
| | - LaKendra Grimes
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Savannah Henderson
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Mariel Parman
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | | | - Kathy Gaddis
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Shannon Dorsey
- Department of Global Health, the University of Washington
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Bizier A, Jones A, Businelle M, Kezbers K, Hoeppner BB, Giordano TP, Thai JM, Charles J, Montgomery A, Gallagher MW, Cheney MK, Zvolensky M, Garey L. An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52090. [PMID: 38657227 PMCID: PMC11079772 DOI: 10.2196/52090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. OBJECTIVE This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. METHODS This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). RESULTS Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. CONCLUSIONS The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52090.
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Affiliation(s)
- Andre Bizier
- University of Houston, Houston, TX, United States
| | | | - Michael Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Bettina B Hoeppner
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | | | | | - Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Matthew W Gallagher
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, United States
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Michael Zvolensky
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lorra Garey
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
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3
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Park JW, Wilson-Barthes MG, Dulin AJ, Hogan JW, Mugavero MJ, Napravnik S, Carey MP, Fava JL, Dale SK, Earnshaw VA, Johnson B, Dougherty-Sheff S, Agil D, Howe CJ. Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States. J Racial Ethn Health Disparities 2024; 11:313-325. [PMID: 37043167 PMCID: PMC10092932 DOI: 10.1007/s40615-023-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To assess overall and by neighborhood risk environments whether multilevel resilience resources were associated with HIV virologic suppression among African American/Black adults in the Southeastern United States. SETTING AND METHODS This clinical cohort sub-study included 436 African American/Black participants enrolled in two parent HIV clinical cohorts. Resilience was assessed using the Multilevel Resilience Resource Measure (MRM) for African American/Black adults living with HIV, where endorsement of a MRM statement indicated agreement that a resilience resource helped a participant continue HIV care despite challenges or was present in a participant's neighborhood. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) for virologic suppression as a function of categorical MRM scores, controlling for demographic, clinical, and behavioral characteristics at or prior to sub-study enrollment. We assessed for effect measure modification (EMM) by neighborhood risk environments. RESULTS Compared to participants with lesser endorsement of multilevel resilience resources, aPRs for virologic suppression among those with greater or moderate endorsement were 1.03 (95% confidence interval: 0.96-1.11) and 1.03 (0.96-1.11), respectively. Regarding multilevel resilience resource endorsement, there was no strong evidence for EMM by levels of neighborhood risk environments. CONCLUSIONS Modest positive associations between higher multilevel resilience resource endorsement and virologic suppression were at times most compatible with the data. However, null findings were also compatible. There was no strong evidence for EMM concerning multilevel resilience resource endorsement, which could have been due to random error. Prospective studies assessing EMM by levels of the neighborhood risk environment with larger sample sizes are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Marta G Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
| | - Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joseph W Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA.
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4
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Crockett KB, Schember CO, Bian A, Rebeiro PF, Keruly J, Mayer K, Mathews C, Moore RD, Crane H, Geng E, Napravnik S, Shepherd BE, Mugavero MJ, Turan B, Pettit AC. Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015. Clin Infect Dis 2023; 76:2163-2170. [PMID: 36757336 PMCID: PMC10273374 DOI: 10.1093/cid/ciad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. METHODS Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. RESULTS Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. CONCLUSIONS Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Mathews
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Disease, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Lopez CM, Baker NL, Moreland AD, Bisca E, Wilson T, Slick N, Danielson CK, Eckard AR, Madisetti M, Resick PA, Safren SA. Development and feasibility testing of an integrated PTSD and adherence intervention cognitive processing therapy-life steps (CPT-L) to improve HIV outcomes: Trial protocol. Contemp Clin Trials Commun 2023; 33:101150. [PMID: 37273831 PMCID: PMC10238849 DOI: 10.1016/j.conctc.2023.101150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023] Open
Abstract
Despite high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual models posit that avoidant behavior (hallmark symptom of PTSD) demonstrated by PLWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may address internalized stigma with targeted modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. This study will be the first pilot open-label randomized control trial (RCT) to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve PTSD symptoms, adherence to ART, and retention in HIV care. Primary aims are to (1) conduct theater testing of the CPT and Lifesteps research protocol and evaluate acceptability (n = 12) and (2) deliver a modified CPT protocol (CPT-Lifesteps, or CPT-L) in 60 PLWH/PTSD exploring impact of CPT-L on PTSD symptoms and HIV outcomes compared to a Lifesteps + Standard of Care condition. This innovative research extends PTSD treatment approaches as a paradigm to reduce barriers to ART adherence. Findings of this innovative study are significant because they support the Undetectable = Untransmittable (U[bond, double bond]U) campaign and can help prevent the transmission of HIV infection through increased viral suppression.
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Affiliation(s)
- Cristina M. Lopez
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Angela D. Moreland
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Bisca
- Medical University of South Carolina, USA
| | | | - Nathalie Slick
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla K. Danielson
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Allison R. Eckard
- Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
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7
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Recent Stressful Life Events, Lifetime Traumatic Events, Missed Visits, and Antiretroviral Adherence Among Black Women With HIV in the Southeastern United States: A Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:593-604. [PMID: 36094470 DOI: 10.1097/jnc.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Lifetime traumatic events are prevalent among people with HIV and consistently associated with deleterious HIV outcomes. Yet, little is known about the impact of recent stressful events on health outcomes among Black women with HIV (WWH). This cross-sectional study assessed the prevalence of recent stressful events and lifetime traumatic events and their association with HIV outcomes in Black WWH (n = 200) in the Southeastern United States. We evaluated the association between stressful events and HIV outcomes using chi-square tests and unadjusted and adjusted logistic regression analyses. In the unadjusted analyses, missed visits were associated with higher odds of recent stressful events (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04-1.16) and lifetime traumatic events (OR 1.15, 95% CI 1.05-1.26). In the adjusted analysis, exposure to recent stressful events was independently associated with missed visits (adjusted OR 1.08, 95% CI 1.01-1.15). Interventions addressing recent stressful events are warranted.
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8
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Alejos B, Díez C, Galindo MJ, López JC, Moreno-García E, Estrada V, Poveda E, Omar M, Jarrín I, Berenguer J. Progress in the quality of care for newly diagnosed people with HIV in Spain (2004-2019). Antivir Ther 2022; 27:13596535221112729. [PMID: 35802475 DOI: 10.1177/13596535221112729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We monitored the quality of care for newly diagnosed people with HIV (PWH) in Spain, including linkage to care within 1 month of HIV diagnosis (LC-1Mo) and viral suppression within 3 months of HIV diagnosis (VS-3Mo). METHODS Longitudinal study based on The Cohort of the Spanish AIDS Research Network (CoRIS). We used logistic regression stratified by year of HIV diagnosis (2004-2013 and 2014-2019) to assess differences by sex, country of origin, HIV risk group, age, prior AIDS, HIV Viral Load, and CD4 cell count. RESULTS The final analysis included 13,632 PWH: males 85%, men having sex with men (MSM) 61%, median age 35 years. LC-1Mo increased from 42% (95% CI, 38%-46%) in 2004 to 80% (95% CI, 77%-83%) in 2019 (P < 0.001). Median CD4+ cell counts at ART initiation increased from <250/mm3 in 2004-2005 to >350/mm3 since 2012 (P < 0.001). The percentage of initial regimens based on integrase strand transfer inhibitors (INSTI) increased from 3% in 2004 to >70% from 2016 onwards (P < 0.001). VS-3Mo increased from 6% (95% CI, 4%-8%) in 2004 to 45% (95% CI, 41%-49%) in 2019 (P < 0.001). Worst results for LC-1Mo were found among PWH acquiring HIV by injection drug use and those born in Latin American Countries across all the study period. CONCLUSION Care indicators have improved among newly diagnosed PWH in Spain over the last 15 years. Removal of CD4 cell counts limitations, and probably the increasing use of INSTI-based regimens was decisive for the progress made.
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Affiliation(s)
- Belén Alejos
- Centro Nacional de Epidemiología, 38176Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Díez
- Infectious Diseases, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María J Galindo
- Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan C López
- Infectious Diseases, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Vicente Estrada
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.,Infectious Diseases, 16267Hospital Clínico de San Carlos, Madrid, Spain
| | - Eva Poveda
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Mohamed Omar
- Infectious Diseases, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, 38176Instituto de Salud Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Berenguer
- Infectious Diseases, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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9
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Jemal A, Caliste S. Work-in-progress: Focus groups evaluate and inform revisions of a socio-behavioral health intervention. EVALUATION AND PROGRAM PLANNING 2022; 93:102079. [PMID: 35751913 PMCID: PMC10148963 DOI: 10.1016/j.evalprogplan.2022.102079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/24/2021] [Accepted: 03/13/2022] [Indexed: 05/03/2023]
Abstract
African American men and women are disproportionately impacted by HIV/STI risk. Particularly, African American women are more likely to be infected with HIV from heterosexual sex. Yet, much of the intervention research has focused on men who have sex with men. This article describes the development and feasibility study of a six-session socio-behavioral health intervention that utilized sociodrama to reduce substance use and HIV/STI risk among heterosexual, African American men and women who have multiple sex partners. The intervention was developed based on theories and models of critical consciousness, social scripts, and group work practice. Content and delivery were informed by qualitative data collection with a range of stakeholders including service providers and members of the target population. The resulting intervention was six group sessions, delivered by two licensed social workers, with one of the facilitators trained in sociodrama. The results of the qualitative study explored the feasibility of conducting this six-week intervention and evaluated a trial run of the intervention. The data was obtained through focus group interviews and observations. Findings revealed that the intervention could be delivered with fidelity and was acceptable to participants and indicated that the intervention's innovative components of sociodrama and critical consciousness resonated with the participants and has potential to reduce HIV/STI risk and substance use. Reported barriers and suggested revisions need to be examined further and addressed to develop and implement a sustainable program that can be delivered in community-based settings. A future randomized control trial of the revised intervention will evaluate the intervention's efficacy.
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Lesko CR, Mugavero MJ, Shen NM, Fojo AT, Moore RD, Keruly JC, Cachay ER, Napravnik S, Mayer KH, Christopoulos KA, Jacobson JM, Rebeiro PF, Chander G. Exploring definitions of retention in care for people living with HIV in the United States in the modern treatment era. AIDS 2022; 36:1181-1189. [PMID: 35796732 PMCID: PMC9273016 DOI: 10.1097/qad.0000000000003232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe retention in HIV care based on various definitions of retention in the modern treatment era. DESIGN A cohort study of people enrolled in care at seven mostly urban HIV clinics across the United States, 2010-2018. METHODS We estimated retention based on missed visits, kept visits, kept encounters (clinical visits, CD4 counts, and viral loads), and HIV labs. We contrasted risk factors for retention by different definitions and estimated odds ratios for of viral suppression and hazard ratios for mortality in 2 years immediately following the year in which retention was defined (the study year). RESULTS Across 108 171 person-years (N = 21 481 people), in 71% of years people kept ≥75% of scheduled visits; in 78%, people kept ≥2 visits >90 days apart; in 74%, people had ≥2 HIV labs >90 days apart; and in 47%, people had no gaps >6 months in clinic visits. Missing >25% of scheduled visits despite attending ≥2 visits >90 days apart was associated with nonwhite non-Hispanic race/ethnicity, history of injection drug use, and prior AIDS diagnosis. In contrast, attending ≥75% of scheduled visits while not attending ≥2 visits >90 days apart was associated with male sex, white race, no injection drug use history, and no prior AIDS diagnosis. Subsequent viral nonsuppression was more strongly associated with missed- than kept-visit measures of retention; 2-year mortality was only associated with failure to be retained by missed-visit measures. DISCUSSION Missed and kept-visit definitions of retention capture different constructs. Missed-visit measures are more strongly associated with poor HIV outcomes.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael J Mugavero
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anthony T Fojo
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Richard D Moore
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jeanne C Keruly
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts
| | - Katerina A Christopoulos
- Division of Infectious Diseases, HIV, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Peter F Rebeiro
- Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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11
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Predictors of loss to follow-up from HIV antiretroviral therapy in Namibia. PLoS One 2022; 17:e0266438. [PMID: 35421126 PMCID: PMC9009635 DOI: 10.1371/journal.pone.0266438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Despite progress on population-level HIV viral suppression, unknown outcomes amongst people who have initiated antiretroviral therapy (ART) in low- and middle-income countries, commonly referred to as loss to follow-up (LTFU), remains a barrier. The mean global estimate of LTFU is 20%, exceeding the World Health Organization target of <15%. Pervasive predictors associated with LTFU include younger age, low body mass index, low CD4 count, advanced HIV clinical stage and certain ART regimens. In Namibia, ART use by eligible individuals exceeds 85%, surpassing the global average. Nonetheless, LTFU remains a barrier to achieving viral suppression and requires research to elucidate context-specific factors. An observational cohort study was conducted in Namibia in 2012 by administering surveys to individuals who presented for HIV care and initiated ART for the first time. Additional data were collected from routine medical data monitoring systems. Participants classified as LTFU at 12 months were traced to confirm their status. Predictors of LTFU were analyzed using multivariable logistic regression. Of those who presented consecutively to initiate ART, 524 were identified as eligible to enroll in the study, 497 enrolled, and 474 completed the baseline questionnaire. The cohort had mean age 36 years, 39% were male, mean CD4 cell count 222 cells/mm3, 17% were WHO HIV clinical stage III-IV, and 14% started efavirenz-based regimens. Tracing participants classified as LTFU yielded a re-categorization from 27.8% (n = 132) to 14.3% (n = 68) LTFU. In the final multivariable model, factors associated with confirmed LTFU status were: younger age (OR 0.97, 95% CI 1.00–1.06, p = 0.02); male sex (OR 2.34, CI 1.34–4.06, p = 0.003); difficulty leaving work or home to attend clinic (OR 2.55, CI 1.40–4.65, p = 0.002); and baseline efavirenz-based regimen (OR 2.35, CI 1.22–4.51, p = 0.01). Interventions to reduce LTFU should therefore target young men, particularly those who report difficulty leaving work or home to attend clinic and are on an efavirenz-based regimen.
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Linthwaite B, Kronfli N, Marbaniang I, Ruppenthal L, Lessard D, Engler K, Lebouché B, Cox J. Increased reengagement of out-of-care HIV patients using Lost & Found, a clinic-based intervention. AIDS 2022; 36:551-560. [PMID: 34897240 PMCID: PMC8876436 DOI: 10.1097/qad.0000000000003147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative health outcomes associated with being out of HIV care (OOC) warrant reengagement strategies. We aimed to assess effectiveness of Lost & Found, a clinic-based intervention to identify and reengage OOC patients. METHODS Developed and delivered using implementation science, Lost & Found consists of two core elements: identification, operationalized through nurse validation of a real-time list of possible OOC patients; and contact, via nurse-led phone calls. It was implemented over a 12-month period (2018-2019) at the Chronic Viral Illness Service, McGill University Health Centre (CVIS-MUHC) during a type-II implementation-effectiveness hybrid pilot study. Descriptive outcomes of interest were identification as possibly OOC, OOC confirmation, contact, and successful reengagement. We present results from a pre-post analysis comparing overall reengagement to the year prior, using robust Poisson regression controlled for sex, age, and Canadian birth. Time to reengagement is reported using a Cox proportional hazards model. RESULTS Over half (56%; 1312 of 2354) of CVIS-MUHC patients were identified as possibly OOC. Among these, 44% (n = 578) were followed elsewhere, 19% (n = 249) engaged in care, 3% (n = 33) deceased, 2% (n = 29) otherwise not followed, and 32% (n = 423) OOC. Of OOC patients contacted (85%; 359/423), 250 (70%) reengaged and 40 (11%) had upcoming appointments; the remainder were unreachable, declined care, or missed given appointments. Pre-post results indicate people who received Lost & Found were 1.18 [95% confidence interval (CI) 1.02-1.36] times more likely to reengage, and reengaged a median 55 days (95% CI 14-98) sooner. CONCLUSION Lost & Found may be a viable clinic-based reengagement intervention for OOC patients. More robust evaluations are needed.
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Affiliation(s)
- Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - Ivan Marbaniang
- Department of Epidemiology, Biostatistics, and Occupational Health
| | - Luciana Ruppenthal
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
| | - David Lessard
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Kim Engler
- Research Institute of the McGill University Health Centre (RI-MUHC)
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre (RI-MUHC)
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine
- Department of Epidemiology, Biostatistics, and Occupational Health
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Kalomo EN, Shamrova D, Jun JS, Kaddu MN, Kalb A. Risk and protective factors for depressive symptoms among the youth living with HIV in Namibia. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:65-76. [PMID: 35361060 DOI: 10.2989/16085906.2022.2041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/01/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND : Namibia has one of the highest HIV prevalence rates among young people living with HIV and AIDS. The study of mental well-being among this vulnerable population is emerging as an important area of public health research. METHODS : This study examined how gender, social support, food insecurity, HIV-related stigma, HIV treatment adherence and HIV transmission knowledge are related to depressive symptoms among young people living with HIV in rural northern Namibia. Data were collected from 188 participants from the Zambezi region. RESULTS : The hierarchical regression analysis revealed that being a female infected with HIV, having perceived food insecurity, experiencing more HIV-related stigma and having low levels of social support can exacerbate the severity of depressive symptoms in this sample of Namibian youth. DISCUSSION : Our findings point to the need to expand social support interventions, enhance socio-economic programmes and reduce HIV-related stigma among young people living with HIV, especially those residing in rural, HIV endemic, resource-limited communities in developing countries.
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Affiliation(s)
| | - Dasha Shamrova
- School of Social Work, Wichita State University, Wichita, USA
| | - Jung Sim Jun
- Department of Sociology, Anthropology, and Social Work, Kansas State University, Manhattan, USA
| | | | - Amy Kalb
- School of Social Work, Wichita State University, Wichita, USA
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Fontil V, Pacca L, Bellows BK, Khoong E, McCulloch CE, Pletcher M, Bibbins-Domingo K. Association of Differences in Treatment Intensification, Missed Visits, and Scheduled Follow-up Interval With Racial or Ethnic Disparities in Blood Pressure Control. JAMA Cardiol 2022; 7:204-212. [PMID: 34878499 PMCID: PMC8655666 DOI: 10.1001/jamacardio.2021.4996] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/15/2021] [Indexed: 11/14/2022]
Abstract
Importance Black patients with hypertension often have the lowest rates of blood pressure (BP) control in clinical settings. It is unknown to what extent variation in health care processes explains this disparity. Objective To assess whether and to what extent treatment intensification, scheduled follow-up interval, and missed visits are associated with racial and ethnic disparities in BP control. Design, Setting, and Participants In this cohort study, nested logistic regression models were used to estimate the likelihood of BP control (defined as a systolic BP [SBP] level <140 mm Hg) by race and ethnicity, and a structural equation model was used to assess the association of treatment intensification, scheduled follow-up interval, and missed visits with racial and ethnic disparities in BP control. The study included 16 114 adults aged 20 years or older with hypertension and elevated BP (defined as an SBP level ≥140 mm Hg) during at least 1 clinic visit between January 1, 2015, and November 15, 2017. A total of 11 safety-net clinics within the San Francisco Health Network participated in the study. Data were analyzed from November 2019 to October 2020. Main Outcomes and Measures Blood pressure control was assessed using the patient's most recent BP measurement as of November 15, 2017. Treatment intensification was calculated using the standard-based method, scored on a scale from -1.0 to 1.0, with -1.0 being the least amount of intensification and 1.0 being the most. Scheduled follow-up interval was defined as the mean number of days to the next scheduled visit after an elevated BP measurement. Missed visits measured the number of patients who did not show up for visits during the 4 weeks after an elevated BP measurement. Results Among 16 114 adults with hypertension, the mean (SD) age was 58.6 (12.1) years, and 8098 patients (50.3%) were female. A total of 4658 patients (28.9%) were Asian, 3743 (23.2%) were Black, 3694 (22.9%) were Latinx, 2906 (18.0%) were White, and 1113 (6.9%) were of other races or ethnicities (including American Indian or Alaska Native [77 patients (0.4%)], Native Hawaiian or Pacific Islander [217 patients (1.3%)], and unknown [819 patients (5.1%)]). Compared with patients from all racial and ethnic groups, Black patients had lower treatment intensification scores (mean [SD], -0.33 [0.26] vs -0.29 [0.25]; β = -0.03, P < .001) and missed more visits (mean [SD], 0.8 [1.5] visits vs 0.4 [1.1] visits; β = 0.35; P < .001). In contrast, Asian patients had higher treatment intensification scores (mean [SD], -0.26 [0.23]; β = 0.02; P < .001) and fewer missed visits (mean [SD], 0.2 [0.7] visits; β = -0.20; P < .001). Black patients were less likely (odds ratio [OR], 0.82; 95% CI, 0.75-0.89; P < .001) and Asian patients were more likely (OR, 1.13; 95% CI, 1.02-1.25; P < .001) to achieve BP control than patients from all racial or ethnic groups. Treatment intensification and missed visits accounted for 21% and 14%, respectively, of the total difference in BP control among Black patients and 26% and 13% of the difference among Asian patients. Conclusions and Relevance This study's findings suggest that racial and ethnic inequities in treatment intensification may be associated with more than 20% of observed racial or ethnic disparities in BP control, and racial and ethnic differences in visit attendance may also play a role. Ensuring more equitable provision of treatment intensification could be a beneficial health care strategy to reduce racial and ethnic disparities in BP control.
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Affiliation(s)
- Valy Fontil
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Lucia Pacca
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Brandon K. Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Elaine Khoong
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Mark Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Kirsten Bibbins-Domingo
- Division of General Internal Medicine, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
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15
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The Mediating Role of Social Support and Resilience Between HIV-Related Stigmas and Patient Activation Among Young Black Women Living With HIV in the Southern United States: A Cross-sectional Study. J Assoc Nurses AIDS Care 2021; 33:78-88. [PMID: 34939990 DOI: 10.1097/jnc.0000000000000312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Little is known about the construct of patient activation for engaging in favorable self-management behaviors in people with HIV. We conducted a cross-sectional study among young Black women with HIV (n = 84) to examine the association between stigma and patient activation and the mediating role of social support and resilience. Social support mediated the relationship between the following dimensions of stigma and patient activation: internalized (β = -0.20, SE = 0.08, CI [-0.369 to -0.071]) and anticipated in health care settings (β = -0.06, SE = 0.04, CI [-0.177 to -0.001]). Resilience mediated the relationship between the following dimensions of stigma and patient activation: anticipated in health care (β = -0.20, SE = 0.08, CI [-0.387 to -0.057]) and community settings (β = -0.15, SE = 0.08, CI [-0.318 to -0.017]), and enacted in community settings (β = -0.14, SE = 0.09, CI [-0.332 to -0.001]). Our findings suggest intrapersonal and interpersonal mechanisms by which various dimensions of stigma contribute to patient activation, thus identifying social support, resilience, and patient activation as potential intervention targets.
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Pettit AC, Bian A, Schember CO, Rebeiro PF, Keruly JC, Mayer KH, Mathews WC, Moore RD, Crane HM, Geng E, Napravnik S, Shepherd BE, Mugavero MJ. Development and Validation of a Multivariable Prediction Model for Missed HIV Health Care Provider Visits in a Large US Clinical Cohort. Open Forum Infect Dis 2021; 8:ofab130. [PMID: 34327249 PMCID: PMC8314944 DOI: 10.1093/ofid/ofab130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual level. Methods We developed prediction models for missed visits among people with HIV (PWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010 to 2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site–level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed using random forests with 10-fold cross-validation; candidate models with the highest area under the curve (AUC) were identified. Results Data from 382 432 visits among 20 807 PWH followed for a median of 3.8 years were included; the median age was 44 years, 81% were male, 37% were Black, 15% reported injection drug use, and 57% reported male-to-male sexual contact. The highest AUC was 0.76, and the strongest predictors were at the individual level (prior visit adherence, age, CD4+ count) and community level (proportion living in poverty, unemployed, and of Black race). A simplified model, including readily accessible variables available in a web-based calculator, had a slightly lower AUC of .700. Conclusions Prediction models validated using multilevel data had a similar AUC to previous models developed using only individual-level data. The strongest predictors were individual-level variables, particularly prior visit adherence, though community-level variables were also predictive. Absent additional data, PWH with previous missed visits should be prioritized by interventions to improve visit adherence.
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Affiliation(s)
- April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Fenway Health and Harvard Medical School, Boston, Massachusetts, USA
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heidi M Crane
- Division of Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Shade SB, Marseille E, Kirby V, Chakravarty D, Steward WT, Koester KK, Cajina A, Myers JJ. Health information technology interventions and engagement in HIV care and achievement of viral suppression in publicly funded settings in the US: A cost-effectiveness analysis. PLoS Med 2021; 18:e1003389. [PMID: 33826617 PMCID: PMC8059802 DOI: 10.1371/journal.pmed.1003389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 04/21/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The US National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined cost-effectiveness from the health system perspective of 6 health information technology (HIT) interventions implemented during 2008 to 2012 in a Ryan White HIV/AIDS Program (RWHAP) Special Projects of National Significance (SPNS) Program demonstration project. METHODS/FINDINGS HIT interventions were implemented at 6 sites: Bronx, New York; Durham, North Carolina; Long Beach, California; New Orleans, Louisiana; New York, New York (2 sites); and Paterson, New Jersey. These interventions included: (1) use of HIV surveillance data to identify out-of-care individuals; (2) extension of access to electronic health records (EHRs) to support service providers; (3) use of electronic laboratory ordering and prescribing; and (4) development of a patient portal. We employed standard microcosting techniques to estimate costs (in 2018 US dollars) associated with intervention implementation. Data from a sample of electronic patient records from each demonstration site were analyzed to compare prescription of antiretroviral therapy (ART), CD4 cell counts, and suppression of viral load, before and after implementation of interventions. Markov models were used to estimate additional healthcare costs and quality-adjusted life-years saved as a result of each intervention. Overall, demonstration site interventions cost $3,913,313 (range = $287,682 to $998,201) among 3,110 individuals (range = 258 to 1,181) over 3 years. Changes in the proportion of patients prescribed ART ranged from a decrease from 87.0% to 72.7% at Site 4 to an increase from 74.6% to 94.2% at Site 6; changes in the proportion of patients with 0 to 200 CD4 cells/mm3 ranged from a decrease from 20.2% to 11.0% in Site 6 to an increase from 16.7% to 30.2% in Site 2; and changes in the proportion of patients with undetectable viral load ranged from a decrease from 84.6% to 46.0% in Site 1 to an increase from 67.0% to 69.9% in Site 5. Four of the 6 interventions-including use of HIV surveillance data to identify out-of-care individuals, use of electronic laboratory ordering and prescribing, and development of a patient portal-were not only cost-effective but also cost saving ($6.87 to $14.91 saved per dollar invested). In contrast, the 2 interventions that extended access to EHRs to support service providers were not effective and, therefore, not cost-effective. Most interventions remained either cost-saving or not cost-effective under all sensitivity analysis scenarios. The intervention that used HIV surveillance data to identify out-of-care individuals was no longer cost-saving when the effect of HIV on an individual's health status was reduced and when the natural progression of HIV was increased. The results of this study are limited in that we did not have contemporaneous controls for each intervention; thus, we are only able to assess sites against themselves at baseline and not against standard of care during the same time period. CONCLUSIONS These results provide additional support for the use of HIT as a tool to enhance rapid and effective treatment of HIV to achieve sustained viral suppression. HIT has the potential to increase utilization of services, improve health outcomes, and reduce subsequent transmission of HIV.
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Affiliation(s)
- Starley B. Shade
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
- * E-mail:
| | | | - Valerie Kirby
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Wayne T. Steward
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Kimberly K. Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Adan Cajina
- Demonstration and Evaluation Branch, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Janet J. Myers
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
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Hensing WL, Poplack SP, Herman CR, Sutcliffe S, Colditz GA, Ademuyiwa FO. Racial differences in no-show rates for screening mammography. Cancer 2021; 127:1857-1863. [PMID: 33792894 DOI: 10.1002/cncr.33435] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Differences in utilization of screening mammography partly explain the increased breast cancer mortality observed in African American (AA) women compared with non-Hispanic White women. However, the contribution of noncompliance from women who do not come for their scheduled screening mammography appointment (ie, no-shows) is unknown. The purpose of this study was to investigate racial differences in no-show rates for screening mammography. METHODS Women scheduled for routine screening mammograms between January 2018 and March 2018 were identified from the Joanne Knight Breast Health Center at Siteman Cancer Center in St. Louis, Missouri. Using a case-control design, this study retrospectively identified patients who no-showed for their mammograms (cases) and randomly sampled an equal number of patients who completed their mammograms (controls). These participants were compared by race. The main outcome measure was whether AA race was associated with no-shows for screening mammography. RESULTS During the study period, 5060 women were scheduled for screening mammography, and 316 (6.2%) did not keep their appointment (ie, they no-showed). Women who no-showed were more likely to be AA than women who kept their appointment (odds ratio, 2.64; 95% confidence interval, 1.90-3.67). Even after adjustments for marital status, insurance type, and place of residence, AA race was still significantly associated with no-shows for screening mammography. CONCLUSIONS This study identified a no-show rate of 6.2% for screening mammography at the authors' institution. Women who no-showed were more likely to be AA than women who completed their mammogram even after adjustments for multiple factors. These data can be leveraged for future studies aimed at improving mammography attendance rates among AA women.
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Affiliation(s)
- Whitney L Hensing
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Steven P Poplack
- Breast Imaging Section, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Cheryl R Herman
- Breast Imaging Section, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Foluso O Ademuyiwa
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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19
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Kohli M, Pasipanodya EC, Montoya JL, Marquine M, Hoenigl M, Serrano V, Cushman C, Garcia R, Kua J, Gant V, Rojas S, Moore DJ. A Culturally Adapted SMS Text Messaging Intervention to Promote Antiretroviral Therapy Adherence Among African Americans: Protocol for a Single-Arm Trial. JMIR Res Protoc 2020; 9:e21592. [PMID: 33300885 PMCID: PMC7759437 DOI: 10.2196/21592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background African Americans are disproportionally affected by HIV and have poorer rates of antiretroviral therapy (ART) adherence compared to other racial or ethnic groups in the United States. Factors associated with poor HIV disease outcomes are commonly associated with sociostructural barriers that prevent engagement with and retention in HIV care. SMS text messaging interventions to promote ART adherence among predominantly non-Hispanic White persons with HIV (PWH) have been shown to be efficacious; however, limited research has been devoted to culturally tailoring interventions for underrepresented racial/ethnic groups. Considering African Americans show poorer engagement along the HIV care continuum, we developed an individualized and culturally tailored two-way SMS text messaging intervention to improve ART adherence and associated virologic suppression among African American PWH. Objective In this paper we describe the protocol of a culturally tailored individualized Texting for Adherence Building (iTAB) intervention in a 24- to 48-week, single-arm study. Methods We developed a culturally tailored iTAB intervention, which we are implementing in a 24- to 48-week, single-arm study. Participants were recruited from the Family Health Centers of San Diego (FHCSD), a federally qualified health center. Patient inclusion criteria were (1) receiving care at the FHCSD, (2) living with HIV, (3) self-identification as Black, African American, or of African ancestry, (4) English speaking, (5) age 18 or older, (6) currently on ART, and (7) able to provide informed consent. Study enrollment began in November 2017 and closed in July 2019. A total of 90 participants from the FHCSD enrolled in the iTAB intervention, and we anticipate completing data collection in July 2020. Participants were assisted in individualizing and customizing their SMS text message preferences at the baseline study visit. Self-assessment measures are collected at baseline, interim, and final study visits. Problems related to sending/receiving SMS text messages and barriers to ART adherence are assessed at each interim study visit. The FHCSD staff monitors and tracks participants’ daily SMS text message responses to ART adherence reminders using a clinical dashboard. Results We hypothesize that the proportion of individuals achieving HIV virologic suppression (viral load <40 copies/mL) will be greater at the end of the intervention period compared to the proportion prior to study implementation. Additionally, we anticipate that rates of virologic suppression at the end of the intervention among participants receiving iTAB will be comparable to those among the general FHCSD non-African American population who did not receive iTAB. Finally, we anticipate a high response rate to iTAB SMS text messages as well as positive participant feedback at the end of the intervention with regard to the acceptability of, satisfaction with, and perceived efficacy of iTAB. Conclusions The iTAB intervention is a novel individualized two-way SMS text messaging intervention that has been culturally tailored for use among African Americans with HIV. We anticipate that iTAB will demonstrate efficacy in future randomized control trials and will be supportive of medication adherence among other populations facing health disparities. International Registered Report Identifier (IRRID) DERR1-10.2196/21592
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Affiliation(s)
- Maulika Kohli
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Elizabeth C Pasipanodya
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jessica L Montoya
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| | - Maria Marquine
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| | - Martin Hoenigl
- University of California San Diego, San Diego, CA, United States
| | - Vanessa Serrano
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,San Diego State University, San Diego, CA, United States
| | - Clint Cushman
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| | - Rogelio Garcia
- Family Health Centers of San Diego, San Diego, CA, United States
| | - John Kua
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Verna Gant
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Sarah Rojas
- San Diego State University, San Diego, CA, United States.,Family Health Centers of San Diego, San Diego, CA, United States
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
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20
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Sims OT, Wang K, Chandler R, Melton PA, Truong DN. A descriptive analysis of concurrent alcohol and substance use among patients living with HIV/HCV co-infection. SOCIAL WORK IN HEALTH CARE 2020; 59:525-541. [PMID: 32873213 PMCID: PMC9494867 DOI: 10.1080/00981389.2020.1814938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The objectives of this study were to estimate the prevalence of concurrent alcohol and substance use among patients living with HIV/HCV co-infection and to compare demographic and clinical characteristics of those with concurrent alcohol and substance to those with alcohol or substance use, and to those who were abstinent. We conducted an analysis of patient reported outcomes data of patients living with HIV/HCV co-infection (n = 327) who transitioned from primary care to sub-specialty care for evaluation of candidacy for HCV treatment at a university-affiliated HIV Clinic. The prevalence of self-reported concurrent alcohol and substance use was 33%. A higher proportion of those with concurrent alcohol and substance use were currently smoking tobacco, and those who were abstinent had higher ratings of health-related quality of life compared to those with alcohol or substance use. To reduce patients' risk for progression to advanced stages of HIV, HCV, and liver-related disease due to continued alcohol and substance and tobacco use, social workers and other health care professionals are encouraged to develop and implement intervention strategies to assist patients living with HIV/HCV co-infection in efforts to achieve behavioral change.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham , Birmingham, AL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
- Integrative Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco , San Francisco, CA, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
- Department of Mathematics and Statistics, College of Arts and Sciences, Georgia State University , Atlanta, GA, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco , San Francisco, CA, USA
- School of Nursing, Emory University , Atlanta, GA, USA
| | - Pamela A Melton
- School of Social Work, Tulane University , New Orleans, LA, USA
| | - Duong N Truong
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
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21
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Jemal A, Urmey LS, Caliste S. From Sculpting an Intervention to Healing in Action. SOCIAL WORK WITH GROUPS 2020; 44:226-243. [PMID: 34483402 PMCID: PMC8411875 DOI: 10.1080/01609513.2020.1757923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Blacks/African Americans have the most severe and disproportionate burden of HIV of all racial/ethnic groups in the United States. Oppression (i.e., socio-structural (macro), institutional (exo), community (meso), and interpersonal (micro)), operates as four interrelated prongs that perpetuate the HIV epidemic in Black/ African American communities. Oppressive (i.e., racist and sexist) cultural scripts transferred to individuals through community, family and interpersonal relationships may play a role in HIV/STI risk. However, socio-behavioral health interventions or behavioral risk reduction interventions have traditionally focused solely on individual-level health risk behaviors allowing invisible, inequitable socio-structural factors to continue unchallenged. A new intervention, Black Men and Women: Empowering Self, Relationships and Community, was sculpted from two existing interventions Community Wise and Men of African American Legacy Empowering Self (MAALES) to develop awareness of oppressive cultural scripts operating on interpersonal and intrapersonal levels and to take action against these oppressive messages to reclaim identity, restore relationships, and build community. This paper summarizes the theory and selected sociodramatic components of the intervention that promote healing in action to reduce HIV/STI risk among heterosexually identified, low-income African American men and women with multiple sex partners. Lessons learned in theory, research and practice are also discussed.
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Affiliation(s)
- Alexis Jemal
- Silberman School of Social Work at Hunter College
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22
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Sims OT, Chiu CY, Chandler R, Melton P, Wang K, Richey C, Odlum M. Alcohol Use and Ethnicity Independently Predict Antiretroviral Therapy Nonadherence Among Patients Living with HIV/HCV Coinfection. J Racial Ethn Health Disparities 2020; 7:28-35. [PMID: 31435855 PMCID: PMC6980421 DOI: 10.1007/s40615-019-00630-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is important to counter synergistic effects of HIV and hepatitis C (HCV) in patients living with coinfection. Predictors of ART nonadherence among patients living with HIV/HCV coinfection are not well established. This knowledge would be advantageous for clinicians and behavioral health specialists who provide care to patients living with HIV/HCV coinfection. OBJECTIVES The purpose of this study was to assess prevalence and predictors of ART nonadherence in a sample of patients living with HIV/HCV coinfection who were actively in HIV clinical care. METHOD A sample of patients living with HIV/HCV coinfection who received care at a university-affiliated HIV clinic (n = 137) between January 2013 and July 2017 were included in the study. Computerized patient-reported data or outcomes (PROs) and electronic medical record data of these respective patients were collected and analyzed. Binomial logistic regression was used to examine predictors of ART nonadherence. RESULTS The prevalence of ART nonadherence was 31%. In multivariate analysis, African American ethnicity (OR = 3.28, CI 1.241-8.653, p = 0.017) and a higher number of alcoholic drinks per drinking day (OR = 1.31, CI 1.054-1.639, p = 0.015) were positively associated with ART nonadherence. CONCLUSIONS Behavioral health providers are encouraged to incorporate alcohol use reduce interventions in HIV clinical settings to reduce ART nonadherence among patients living with HIV/HCV coinfection. Additionally, public health professionals and researchers, and clinicians are encouraged to use inductive methods to discover why ART nonadherence disproportionately impacts African American patients living with HIV/HCV coinfection and to develop approaches that are sensitive to those respective barriers.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA.
- The University of Alabama at Birmingham, Univesity Hall 3137, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Chia-Ying Chiu
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Pamela Melton
- Department of Social Work, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, 104 Bibb Graves Hall, Normal, AL, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Richey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Odlum
- School of Nursing, Columbia University, 560 West 168th Street, New York, 10032, USA
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23
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Cressman AE, Howe CJ, Nunn AS, Adimora AA, Williams DR, Kempf MC, Chandran A, Wentz EL, Blackstock OJ, Kassaye SG, Cohen J, Cohen MH, Wingood GM, Metsch LR, Wilson TE. The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV. AIDS Behav 2020; 24:151-164. [PMID: 31049811 DOI: 10.1007/s10461-019-02522-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Receiving regular HIV care is crucial for maintaining good health among persons with HIV. However, racial and gender disparities in HIV care receipt exist. Discrimination and its impact may vary by race/ethnicity and gender, contributing to disparities. Data from 1578 women in the Women's Interagency HIV Study ascertained from 10/1/2012 to 9/30/2016 were used to: (1) estimate the relationship between discrimination and missing any scheduled HIV care appointments and (2) assess whether this relationship is effect measure modified by race/ethnicity. Self-reported measures captured discrimination and the primary outcome of missing any HIV care appointments in the last 6 months. Log-binomial models accounting for measured sources of confounding and selection bias were fit. For the primary outcome analyses, women experiencing discrimination typically had a higher prevalence of missing an HIV care appointment. Moreover, there was no statistically significant evidence for effect measure modification by race/ethnicity. Interventions to minimize discrimination or its impact may improve HIV care engagement among women.
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Affiliation(s)
- Andrew E Cressman
- Department of Epidemiology, Centers for Epidemiology and Environmental Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Chanelle J Howe
- Department of Epidemiology, Centers for Epidemiology and Environmental Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapelhill, NC, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aruna Chandran
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eryka L Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Oni J Blackstock
- Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Seble G Kassaye
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital and Rush University, Chicago, IL, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Lerner Center for Public Health Promotion, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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24
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Ye Y, Shrestha S, Burkholder G, Bansal A, Erdmann N, Wiener H, Tang J. Rates and Correlates of Incident Type 2 Diabetes Mellitus Among Persons Living With HIV-1 Infection. Front Endocrinol (Lausanne) 2020; 11:555401. [PMID: 33329379 PMCID: PMC7719801 DOI: 10.3389/fendo.2020.555401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence of various comorbidities continue to rise in aging persons living with HIV-1 infection (PLWH), and our study here aimed to assess the rates and correlates of incident type 2 diabetes mellitus (T2DM) in PLWH from a retrospective, southeastern U.S. cohort. Based on electronic health records, we examined patient demographics, body mass index (BMI), HIV-1-related outcomes, hepatitis C virus co-infection, common comorbidities (e.g. shingles and asthma), usage of protease inhibitors, and usage of statins as potential correlates for T2DM occurrence. Among 3,975 PLWH with ≥12 months of follow-up between January 1999 and March 2018, the overall rate of incident T2DM was 135 per 10,000 person-years, almost 2-fold higher than the rate reported for the general U.S. population. In multivariable models (354 T2DM patients and 3,617 control subjects), sex, BMI, nadir CD4+ T-cell count, HIV-1 viral load (VL) and duration of statin use were independent correlates of incident T2DM (adjusted P <0.05 for all), with clear consistency in several sensitivity analyses. The strongest associations (adjusted odds ratio/OR >2.0 and P <0.0001) were noted for: i) statin use for ≥6 months (OR = 10.2), ii) BMI ≥30 kg/m2 (OR = 3.4), and iii) plasma VL ≥200 copies/ml (OR = 2.2). Their collective predictive value was substantial: the C-statistic for area under the receiver operating characteristics curve was 0.87 (95% CI = 0.84-0.91), showing close similarity between two major racial groups (C-statistic = 0.87 for African Americans and 0.91 for European Americans). Overall, these findings not only establish a promising algorithm for predicting incident T2DM in PLWH but also suggest that patients who are obese and use statins should require special consideration for T2DM diagnosis and prevention.
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Affiliation(s)
- Yuanfan Ye
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nathaniel Erdmann
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Howard Wiener
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jianming Tang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Jianming Tang,
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25
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Carroll JK, Tobin JN, Luque A, Farah S, Sanders M, Cassells A, Fine SM, Cross W, Boyd M, Holder T, Thomas M, Overa CC, Fiscella K. "Get Ready and Empowered About Treatment" (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV. J Gen Intern Med 2019; 34:1782-1789. [PMID: 31240605 PMCID: PMC6712153 DOI: 10.1007/s11606-019-05102-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/10/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Little is known about strategies to improve patient activation, particularly among persons living with HIV (PLWH). OBJECTIVE To assess the impact of a group intervention and individual coaching on patient activation for PLWH. DESIGN Pragmatic randomized controlled trial. SITES Eight practices in New York and two in New Jersey serving PLWH. PARTICIPANTS Three hundred sixty PLWH who received care at participating practices and had at least limited English proficiency and basic literacy. INTERVENTION Six 90-min group training sessions covering use of an ePersonal Health Record loaded onto a handheld mobile device and a single 20-30 min individual pre-visit coaching session. MAIN MEASURES The primary outcome was change in Patient Activation Measure (PAM). Secondary outcomes were changes in eHealth literacy (eHEALS), Decision Self-efficacy (DSES), Perceived Involvement in Care Scale (PICS), health (SF-12), receipt of HIV-related care, and change in HIV viral load (VL). KEY RESULTS The intervention group showed significantly greater improvement than the control group in the primary outcome, the PAM (difference 2.82: 95% confidence interval [CI] 0.32-5.32). Effects were largest among participants with lowest quartile PAM at baseline (p < 0.05). The intervention doubled the odds of improving one level on the PAM (odds ratio 1.96; 95% CI 1.16-3.31). The intervention group also had significantly greater improvement in eHEALS (difference 2.67: 95% CI 1.38-3.9) and PICS (1.27: 95% CI 0.41-2.13) than the control group. Intervention effects were similar by race/ethnicity and low education with the exception of eHealth literacy where effects were stronger for minority participants. No statistically significant effects were observed for decision self-efficacy, health status, adherence, receipt of HIV relevant care, or HIV viral load. CONCLUSIONS The patient activation intervention modestly improved several domains related to patient empowerment; effects on patient activation were largest among those with the lowest levels of baseline patient activation. TRIAL REGISTRATION This study is registered at Clinical Trials.Gov (NCT02165735).
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Affiliation(s)
| | | | - Amneris Luque
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Subrina Farah
- Department of Family Medicine, Family Medicine Research Programs, University of Rochester, Rochester, NY, USA
| | - Mechelle Sanders
- Department of Family Medicine, Family Medicine Research Programs, University of Rochester, Rochester, NY, USA
| | | | - Steven M Fine
- Department of Family Medicine, University of Rochester, Rochester, NY, USA
| | - Wendi Cross
- Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Michele Boyd
- Department of Family Medicine, Family Medicine Research Programs, University of Rochester, Rochester, NY, USA
| | - Tameir Holder
- Clinical Directors Network, Inc. (CDN), New York, NY, USA
| | - Marie Thomas
- Department of Family Medicine, Family Medicine Research Programs, University of Rochester, Rochester, NY, USA
| | | | - Kevin Fiscella
- Department of Family Medicine, Family Medicine Research Programs, University of Rochester, Rochester, NY, USA. .,Department of Family Medicine, University of Rochester, Rochester, NY, USA.
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26
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Awh K, Venuti MA, Gleason LP, Rogers R, Denduluri S, Kim YY. Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:726-734. [DOI: 10.1111/chd.12784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Katherine Awh
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Morgan A. Venuti
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Lacey P. Gleason
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Rachel Rogers
- Biostatistics and Data Management Core The Children's Hospital of Philadelphia Research Institute Philadelphia Pennsylvania
| | - Srinivas Denduluri
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
- Division of Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
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27
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Mannes ZL, Hearn LE, Zhou Z, Janelle JW, Cook RL, Ennis N. The association between symptoms of generalized anxiety disorder and appointment adherence, overnight hospitalization, and emergency department/urgent care visits among adults living with HIV enrolled in care. J Behav Med 2019; 42:330-341. [PMID: 30387009 PMCID: PMC6447438 DOI: 10.1007/s10865-018-9988-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022]
Abstract
This study examined the association between generalized anxiety disorder (GAD) symptoms and healthcare utilization (HCU) among 801 people living with HIV (PLWH). Participants recruited from community health centers in Florida completed questionnaires assessing demographics, substance use, symptoms of GAD and depression, and HCU. Adjusted binary and multinomial logistic regressions assessed the association between moderate-severe GAD symptoms and past 6-month missed HIV-care appointments, overnight hospitalization, and emergency department (ED)/urgent care visits. Participants reporting moderate-severe GAD symptoms had a greater odds of missing an HIV-care appointment (AOR 2.03, 95% CI 1.28-3.24, p = 0.003), spending 2 (AOR 4.35, 95% CI 2.18-8.69, p < 0.001) or 3+ (AOR 2.79, 95% CI 1.20-6.45, p = 0.016) nights in the hospital, and visiting an ED/urgent care facility 2 (AOR 2.63, 95% CI 1.39-4.96, p = 0.003) or 3+ (AOR 2.59, 95% CI 1.27-5.26 p = 0.008) times compared to participants reporting none-mild anxiety. Depression was associated with fewer ED/urgent care visits and overnight hospitalizations, while no association was found with missed primary care appointments. The role of anxiety in illness management remains understudied among PLWH. Anxiety identification and the development of interventions for anxiety among PLWH may have important consequences for healthcare cost saving, patient retention in care, and HIV-disease management.
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Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL, 32610-0165, USA.
| | - Lauren E Hearn
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, 4237 S Pipkin Road, Bldg 2, Lakeland, FL, 33811, USA
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Jennifer W Janelle
- Department of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100289, Gainesville, FL, 32610, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL, 32610-0165, USA
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Clemenzi-Allen A, Neuhaus J, Geng E, Sachdev D, Buchbinder S, Havlir D, Gandhi M, Christopoulos K. Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort. Open Forum Infect Dis 2019; 6:ofz148. [PMID: 31139668 PMCID: PMC6534280 DOI: 10.1093/ofid/ofz148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) who experience homelessness and unstable housing (HUH) often have fragmented health care. Research that incorporates granular assessments of housing status and primary care visit adherence to understand patterns of acute care utilization can help pinpoint areas for intervention. Methods We collected self-reported living situation, categorized as stable (rent/own, hotel/single room occupancy), unstable (treatment/transitional program, staying with friends), or homeless (homeless shelter, outdoors/in vehicle) at an urban safety-net HIV clinic between February and August 2017 and abstracted demographic and clinical information from the medical record. Regression models evaluated the association of housing status on the frequency of acute care visits—urgent care (UC) visits, emergency department (ED) visits, and hospitalizations—and whether suboptimal primary care visit adherence (<75%) interacted with housing status on acute care visits. Results Among 1198 patients, 25% experienced HUH. In adjusted models, unstable housing resulted in a statistically significant increase in the incidence rate ratio for UC visits (incidence rate ratio [IRR], 1.35; 95% confidence interval [CI], 1.10 to 1.66; P < .001), ED visits (IRR, 2.12; 95% CI, 1.44 to 3.13; P < .001), and hospitalizations (IRR, 1.75; 95% CI, 1.10 to 2.77; P = 0.018). Homelessness led to even greater increases in UC visits (IRR, 1.75; 95% CI, 1.29 to 2.39; P < .001), ED visits (IRR, 4.18; 95% CI, 2.77 to 6.30; P < .001), and hospitalizations (IRR, 3.18; 95% CI, 2.03 to 4.97; P < .001). Suboptimal visit adherence differentially impacted UC and ED visits by housing status, suggesting interaction. Conclusions Increased acute care visit frequency among HUH-PLWH suggests that interventions at these visits may create opportunities to improve care.
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Affiliation(s)
- Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Elvin Geng
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - Darpun Sachdev
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital.,San Francisco Department of Public Health, San Francisco, California
| | - Susan Buchbinder
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,San Francisco Department of Public Health, San Francisco, California
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - Katerina Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
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29
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Gamarel KE, Chakravarty D, Neilands TB, Hoff CC, Lykens J, Darbes LA. Composite Risk for HIV: A New Approach Towards Integrating Biomedical and Behavioral Strategies in Couples-Based HIV Prevention Research. AIDS Behav 2019; 23:283-288. [PMID: 30003506 PMCID: PMC6368473 DOI: 10.1007/s10461-018-2229-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A substantial number of new HIV infections among gay, bisexual, and other men who have sex with men and transgender women occurs in the context of primary partnerships. Given the diversity of risk reduction needs and various approaches available for reducing risk within couples, condomless sex is no longer the gold standard HIV outcome. We present a novel, comprehensive, and flexible Composite Risk for HIV (CR-HIV) approach for integrating evolving biomedical and behavioral HIV prevention strategies into couples-based HIV prevention intervention and survey research. We provide illustrative examples of the utility of the CR-HIV approach based on couples' HIV status.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - James Lykens
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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30
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Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada. J Acquir Immune Defic Syndr 2018; 77:144-153. [PMID: 29135650 PMCID: PMC5770113 DOI: 10.1097/qai.0000000000001589] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Associations between HIV-related stigma and reduced antiretroviral therapy (ART) adherence are widely established, yet the mechanisms accounting for this relationship are underexplored. There has been less attention to HIV-related stigma and its associations with ART initiation and current ART use. We examined pathways from HIV-related stigma to ART initiation, current ART use, and ART adherence among women living with HIV in Canada. METHODS We used baseline survey data from a national cohort of women living with HIV in Canada (n = 1425). Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of HIV-related stigma dimensions (personalized, negative self-image, and public attitudes) on ART initiation, current ART use, and 90% ART adherence, and indirect effects through depression and HIV disclosure concerns, adjusting for sociodemographic factors. RESULTS In the final model, the direct paths from personalized stigma to ART initiation (β = -0.104, P < 0.05) and current ART use (β = -0.142, P < 0.01), and negative self-image to ART initiation (β = -0.113, P < 0.01) were significant, accounting for the mediation effects of depression and HIV disclosure concerns. Depression mediated the pathways from personalized stigma to ART adherence, and negative self-image to current ART use and ART adherence. Final model fit indices suggest that the model fit the data well [χ(25) = 90.251, P < 0.001; comparative fit index = 0.945; root-mean-square error of approximation = 0.044]. CONCLUSIONS HIV-related stigma is associated with reduced likelihood of ART initiation and current ART use, and suboptimal ART adherence. To optimize the benefit of ART among women living with HIV, interventions should reduce HIV-related stigma and address depression.
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Kimmel AD, Masiano SP, Bono RS, Martin EG, Belgrave FZ, Adimora AA, Dahman B, Galadima H, Sabik LM. Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South. AIDS Care 2018. [DOI: http://doi.org.10.1080/09540121.2018.1476656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Steven P. Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Erika G. Martin
- Nelson A. Rockefeller Institute of Government, Albany, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs & Policy, University at Albany, Albany, USA
| | - Faye Z. Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adaora A. Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Hadiza Galadima
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, USA
| | - Lindsay M. Sabik
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
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32
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Kimmel AD, Masiano SP, Bono RS, Martin EG, Belgrave FZ, Adimora AA, Dahman B, Galadima H, Sabik LM. Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South. AIDS Care 2018; 30:1459-1468. [PMID: 29845878 PMCID: PMC6150812 DOI: 10.1080/09540121.2018.1476656] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Structural barriers to HIV care are particularly challenging in the US South, which has higher HIV diagnosis rates, poverty, uninsurance, HIV stigma, and rurality, and fewer comprehensive public health programs versus other US regions. Focusing on one structural barrier, we examined geographic accessibility to comprehensive, coordinated HIV care (HIVCCC) in the US South. We integrated publicly available data to study travel time to HIVCCC in 16 Southern states and District of Columbia. We geocoded HIVCCC service locations and estimated drive time between the population-weighted county centroid and closest HIVCCC facility. We evaluated drive time in aggregate, and by county-level HIV prevalence quintile, urbanicity, and race/ethnicity. Optimal drive time was ≤30 min, a common primary care accessibility threshold. We identified 228 service locations providing HIVCCC across 1422 Southern counties, with median drive time to care of 70 min (IQR 64 min). For 368 counties in the top HIV prevalence quintile, median drive time is 50 min (IQR 61 min), exceeding 60 min in over one-third of these counties. Among counties in the top HIV prevalence quintile, drive time to care is six-folder higher for rural versus super-urban counties. Counties in the top HIV prevalence quintiles for non-Hispanic Blacks and for Hispanics have >50% longer drive time to care versus for non-Hispanic Whites. Including another potential care source-publicly-funded health centers serving low-income populations-could double the number of high-HIV burden counties with drive time ≤30 min, representing nearly 35,000 additional people living with HIV with accessible HIVCCC. Geographic accessibility to HIVCCC is inadequate in the US South, even in high HIV burden areas, and geographic and racial/ethnic disparities exist. Structural factors, such as geographic accessibility to care, may drive disparities in health outcomes. Further research on programmatic policies, and evidence-based alternative HIV care delivery models improving access to care, is critical.
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Affiliation(s)
- April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Steven P. Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Erika G. Martin
- Nelson A. Rockefeller Institute of Government, Albany, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs & Policy, University at Albany, Albany, USA
| | - Faye Z. Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adaora A. Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Hadiza Galadima
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, USA
| | - Lindsay M. Sabik
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
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Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders. Community Ment Health J 2018; 54:1146-1153. [PMID: 29752639 PMCID: PMC6230497 DOI: 10.1007/s10597-018-0284-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/05/2018] [Indexed: 02/05/2023]
Abstract
A consistently suppressed viral load enables HIV (+) patients to live longer, healthier lives and reduces the probability of transmitting the virus. Since the prevalence of HIV is four times higher among those with psychiatric disorders than in the general population, it is likely that this group would also have greater difficulty remaining in care and achieving viral suppression. A secondary data analysis utilizing screening data from the Preventing AIDS Through Health (PATH) for Triples (PFT) Study were examined to assess HIV load suppression among 254 psychiatric inpatients with comorbid substance use disorders in Philadelphia. Viral load results from the past 12 months were obtained from medical records for 63 inpatients identified as HIV (+). The sample was predominately African American (76%), male (56%), and the average age was 43 years. Psychiatric disorders included depression (64%), schizophrenia (21%), and bipolar disorder (13%) with patients reporting use of alcohol (73%), cocaine (64%), cannabis (29%) and opioids (16%) prior to admission. Among this high risk sample of HIV (+) patients, about one-half (52%) achieved viral suppression, with recent opioid users six times more likely to have a detectable viral load than non-opioid users (OR 6.0; CI 1.1-31.7, p = .035). The 52% viral load suppression rate among psychiatric inpatient was higher than expected, given that the CDC's national suppression rate among those diagnosed with HIV in the general population is 58%. However, individuals with mental illness and substance use disorders require constant surveillance, monitoring, and supportive services to achieve viral suppression. Many of those who were virally suppressed were engaged in Philadelphia's extensive treatment network, whereas those who were detectable and enrolled in the PFT intervention were often homeless with unstable psychiatric symptoms and current substance use disorders, particularly opioid abuse.
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34
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Kang CR, Bang JH, Cho SI. Factors Contributing to Missed Visits for Medical Care among Human Immunodeficiency Virus-Infected Adults in Seoul, Korea. J Korean Med Sci 2018; 33:e261. [PMID: 30310363 PMCID: PMC6179983 DOI: 10.3346/jkms.2018.33.e261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is important that patients with human immunodeficiency virus (HIV) remain under medical care to improve their health and to reduce the potential for HIV transmission. We explored factors associated with missed visits for HIV medical care according to age group. METHODS Data were derived from a city-wide, cross-sectional survey of 812 HIV-infected adults in Seoul. Multiple logistic analyses were used to explore predictors of missed visits. RESULTS Of the 775 subjects, 99.3% were treated with antiretroviral therapy (ART) and 12.5% had missed a scheduled appointment for HIV medical care during the past 12 months. Compared with the group aged ≥ 50 years, the 20-34-years and 35-49-years groups were strongly associated with missed visits (adjusted odds ratio [aOR], 5.0 and 2.2, respectively). When divided by age group, lower education level (aOR, 3.0) in subjects aged 20-34 years, low income (aOR, 3.5), National Medical Aid beneficiary (aOR, 0.3), and treatment interruption due to side effects of ART (aOR, 3.4) in subjects aged 35-49 years, and National Medical Aid beneficiary (aOR, 7.1) in subjects aged ≥ 50 years were associated with missed visits. CONCLUSION In conclusion, younger age was a strong predictor of missed visits for HIV medical care. However, the risk factors differed according to age group, and the strongest predictor in each age group was related to socioeconomic status.
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Affiliation(s)
- Cho Ryok Kang
- Environmental Health Division, Seoul Metropolitan Government, Seoul, Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
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35
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Corado K, Jain S, Morris S, Dube MP, Daar ES, He F, Aldous JL, Sitapati A, Haubrich R, Milam J, Karris MY. Randomized Trial of a Health Coaching Intervention to Enhance Retention in Care: California Collaborative Treatment Group 594. AIDS Behav 2018; 22:2698-2710. [PMID: 29725790 DOI: 10.1007/s10461-018-2132-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poor linkage, engagement and retention remain significant barriers in achieving HIV treatment goals in the US. HIV-infected persons entering or re-entering care across three Southern California academic HIV clinics, were randomized (1:1) to an Active, Linkage, Engagement, Retention and Treatment (ALERT) specialist for outreach and health coaching, or standard of care (SOC). The primary outcome of time to loss to follow up (LTFU) was compared using Cox proportional hazards regression modeling. No differences in the median time to LTFU (81.7 for ALERT versus 93.6 weeks for SOC; HR 1.27; p = 0.40), or time to ART initiation was observed (N = 116). Although, ALERT participants demonstrated worsening depressive symptomatology from baseline to week 48 compared to SOC (p = 0.02). The ALERT intervention did not improve engagement and retention in HIV care over SOC. Further studies are needed to determine how best to apply resources to improve retention and engagement.
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Affiliation(s)
- Katya Corado
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, 1124 West Carson Street, Building CDCRC, Box 496, Torrance, CA, 90502, USA.
| | - Sonia Jain
- Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA
| | - Sheldon Morris
- Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA
| | - Michael P Dube
- Department of Medicine, Keck School of Medicine of the University Southern California, Los Angeles, CA, USA
| | - Eric S Daar
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, 1124 West Carson Street, Building CDCRC, Box 496, Torrance, CA, 90502, USA
| | - Feng He
- Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA
| | | | - Amy Sitapati
- Deparment of Medicine, University California San Diego, San Diego, CA, USA
| | | | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine of the University Southern California, Los Angeles, CA, USA
| | - Maile Young Karris
- Deparment of Medicine, University California San Diego, San Diego, CA, USA
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Urada LA, Smith LR, Yore J, Triplett DP, Hucks-Ortiz C, Raj A. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav 2018; 22:2553-2563. [PMID: 29748844 PMCID: PMC6443569 DOI: 10.1007/s10461-018-2131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.
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Affiliation(s)
- Lianne A Urada
- School of Social Work, San Diego State University, Hepner Hall #119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.
| | - Laramie R Smith
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Daniel P Triplett
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | | | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
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Modi R, Amico KR, Knudson A, Westfall AO, Keruly J, Crane HM, Quinlivan EB, Golin C, Willig J, Zinski A, Moore R, Napravnik S, Bryan L, Saag MS, Mugavero MJ. Assessing effects of behavioral intervention on treatment outcomes among patients initiating HIV care: Rationale and design of iENGAGE intervention trial. Contemp Clin Trials 2018; 69:48-54. [PMID: 29526609 DOI: 10.1016/j.cct.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
During the initial year of HIV diagnosis, while patients are often overwhelmed adjusting to this life changing diagnosis, they must develop self-care behaviors for attending regular medical care visits and antiretroviral therapy (ART) adherence to achieve and sustain viral suppression (VS). Maintaining "HIV adherence" and integrating it into one's daily life is required to sustain VS over time. The HIV care continuum or "treatment cascade," an epidemiological snapshot of the national epidemic in the United States (US), indicates that a minority of persons living with HIV (PLWH) have achieved VS. Little evidence exists regarding the effects of interventions focusing on PLWH newly initiating outpatient HIV care. An intervention that focuses on both retention in care and ART adherence skills delivered during the pivotal first year of HIV care is lacking. To address this, we developed a theory-based intervention evaluated in the Integrating Engagement and Adherence Goals upon Entry (iENGAGE) study, a National Institute of Allergy and Infectious Diseases (NIAID) funded randomized behavioral intervention trial. Here we present the study objectives, design and rationale, as well as the intervention components, targeting rapid and sustained VS through retention in HIV care and ART adherence during participants' first year of HIV care. The primary outcome of the study is 48-week VS (<200 c/mL). The secondary outcomes are retention in care, including HIV visit adherence and visit constancy, as well as ART adherence.
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Affiliation(s)
- R Modi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - K R Amico
- University of Michigan, Ann Arbor, MI, USA
| | - A Knudson
- University of Michigan, Ann Arbor, MI, USA
| | - A O Westfall
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Keruly
- Johns Hopkins University, Baltimore, MD, USA
| | - H M Crane
- University of Washington, Seattle, WA, USA
| | - E B Quinlivan
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - C Golin
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - J Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - A Zinski
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - R Moore
- Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - L Bryan
- Johns Hopkins University, Baltimore, MD, USA
| | - M S Saag
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- University of Alabama at Birmingham, Birmingham, AL, USA.
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38
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Santos MA, Guimarães MDC, Helena ETS, Basso CR, Vale FC, Carvalho WMDES, Alves AM, Rocha GM, Acurcio FDA, Ceccato MDGB, do Prado RR, Menezes PR, Nemes MIB. Monitoring self-reported adherence to antiretroviral therapy in public HIV care facilities in Brazil: A national cross-sectional study. Medicine (Baltimore) 2018; 97:S38-S45. [PMID: 29912815 PMCID: PMC5991539 DOI: 10.1097/md.0000000000009015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient adherence to antiretroviral therapy (ART) is critical for HIV treatment success. Monitoring rates of adherence in public HIV outpatient care facilities can improve outcomes in Brazil where ART is universally available. METHODS We conducted a national cross-sectional survey of ART adherence in 2010. Participants were selected using a multistage probability sample. First, HIV outpatient care facilities were stratified according to 7 Organizational Quality Classification (OQC) groups and regions. Second, 1 or 2 facilities were selected per region for each OQC group. Finally, patients were randomly selected at each facility. In a first component, patients were invited to answer to a web-based questionnaire (WebAd-Q), a validated self-reported tool that includes 3 questions on adherence to ART in the past 7 days (time scheduling-timing, drug regimen-medication, and pill counts-dose), herein named indicators of potential nonadherence (IPN). In addition, a subsample of participants were interviewed in order to obtain further data on sociodemographic and clinical characteristics (second component). The proportion of each IPN was estimated using weighted data to account for the sampling design with 95% confidence interval (CI) and descriptive analysis was carried out. RESULTS Fifty-five facilities were chosen and 2424 patients completed the WebAd-Q in the first component of the study, while 598 patients were interviewed for the second component. The weighted proportions of the IPN were 50.9%, 31.8%, and 19.5%, for timing, medication, and dose, respectively, while11.7% had all 3 indicators, varying from 5.9% in the Southeast and 21.9% in the Northeast regions. Overall, 61.1% of the patients had at least 1 IPN (95% CI: 58.5-63.7%). Patients reporting depression symptoms, illicit drug use and those who missed medical appointments had worse nonadherence outcomes. CONCLUSIONS Overall, there was a high proportion of all indicators IPN and timing was the main component associated with low adherence. Although these indicators may not necessarily indicate individual nonadherence, they represent a worrisome scenario in the public Brazilian HIV care facilities. On a routine basis, these facilities can identify gaps in providing counseling and ART orientation to their clientele and develop innovative strategies to prevent nonadherence.
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Affiliation(s)
- Maria Altenfelder Santos
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | - Cáritas Relva Basso
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | - Felipe Campos Vale
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | - Ana Maroso Alves
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | | | | | - Paulo Rossi Menezes
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
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Okeke NL, Clement ME, McKellar MS, Stout JE. Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis. Open Forum Infect Dis 2018; 5:ofy088. [PMID: 29876365 PMCID: PMC5961009 DOI: 10.1093/ofid/ofy088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The traditional definition of engagement in HIV care in terms of only clinic attendance and viral suppression provides a limited understanding of how persons living with HIV (PLWH) interact with the health care system. Methods We conducted a retrospective analysis of patients with ≥1 HIV clinic visits at the Duke Adult Infectious Diseases Clinic between 2008 and 2013. Health care utilization was characterized by 4 indicators: clinic attendance in each half of the year (yes/no), number of emergency department (ED) visits/year (0, 1, or 2+), inpatient admissions/year (0, 1, 2+), and viral suppression (never, intermittent, always). Health care engagement patterns were modeled using latent class/latent transition analysis. Results A total of 2288 patients (median age, 46.4 years; 59% black, 71% male) were included in the analysis. Three care engagement classes were derived from the latent class model: "adherent" "nonadherent," and "sick." Patients age ≤40 years were more likely to be in the nonadherent class (odds ratio, 2.64; 95% confidence interval, 1.38-5.04) than other cohort members. Whites and males were more likely to transition from nonadherent to adherent the following year. Nonadherent patients were significantly more likely to disengage from care the subsequent year than adherent patients (23.6 vs 0.2%, P < .001). Conclusions A broader definition of health care engagement revealed distinct and dynamic patterns among PLWH that would have been hidden had only previous HIV clinic attendance had been considered. These patterns may be useful for designing engagement-targeted interventions.
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Affiliation(s)
- Nwora Lance Okeke
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Meredith E Clement
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mehri S McKellar
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jason E Stout
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Erdmann NB, Prentice HA, Bansal A, Wiener HW, Burkholder G, Shrestha S, Tang J. Herpes Zoster in Persons Living with HIV-1 Infection: Viremia and Immunological Defects Are Strong Risk Factors in the Era of Combination Antiretroviral Therapy. Front Public Health 2018; 6:70. [PMID: 29594092 PMCID: PMC5857573 DOI: 10.3389/fpubh.2018.00070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/20/2018] [Indexed: 12/30/2022] Open
Abstract
In a cohort of 4,225 persons living with human immunodeficiency virus type 1 (HIV-1) infection (PLWH) enrolled at a southeastern US clinic, the overall rate of incident herpes zoster (HZ) was 101 per 10,000 person-years (PY) between January 1999 and 2017, which nearly quadruples the rate reported for the general US population. In the same cohort, the median age of HZ diagnosis was 39.5 years [interquartile range (IQR) 31.5-49.2] in African American (AA) and 39.1 years (IQR 34.9-45.2) in European American (EA) PLWH, with the highest incidence seen in PLWH who were over 50 years old (144 and 93 per 10,000 PY in AA and EA, respectively, P = 0.18), showing no bias between men (100 per 10,000 PY) and women (101 per 10,000 PY). In multivariable models that were applicable to 245 HZ cases and 3,713 controls, age, nadir CD4+ T-cell (CD4) count, plasma viral load (VL), and duration of combination antiretroviral therapy were independent correlates of incident HZ (adjusted P ≤ 0.006 for all). Regardless of other factors, viremic PLWH (VL > 50 copies/mL) was at the highest risk of HZ [adjusted odds ratio (OR) > 3.0, P < 0.0001]. PLWH with a nadir CD4 count of ≥500 cells/μL showed a relatively low risk (adjusted OR = 0.48, P = 0.003). By contrast, similar risk estimates were observed with three advancing age groups (30-39, 40-49, and ≥50) when compared with age <30 (adjusted OR = 1.86-2.17, P ≤ 0.010). These findings indicate that efforts for HZ diagnosis and prophylaxis should target viremic PLWH who are over 30 years old and with CD4 count <500 cells/μL.
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Affiliation(s)
- Nathaniel B. Erdmann
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Heather A. Prentice
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Howard W. Wiener
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jianming Tang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Vaughan Sarrazin MS, Ohl ME, Richardson KK, Asch SM, Gifford AL, Bokhour BG. Patient and Facility Correlates of Racial Differences in Viral Control for Black and White Veterans with HIV Infection in the Veterans Administration. AIDS Patient Care STDS 2018; 32:84-91. [PMID: 29620926 DOI: 10.1089/apc.2017.0213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Black persons with HIV are less likely than white persons to experience viral control even while in treatment. We sought to understand whether patient characteristics and site of care explain these differences using a cross-sectional analysis of medical records. Our cohort included 8779 black and 7836 white patients in the Veterans Administration (VA) health system with HIV who received antiretroviral medication during 2013. Our primary outcome, viral control, was defined as HIV serum RNA <200 copies/mL. We examined the degree to which racial differences in viral control are related to site of care, patient characteristics (demographics, HIV treatment history, comorbid conditions, time in care, and medication adherence), retention in care, and combination antiretroviral therapy (cART) adherence, using multi-variable logistic regression models. Compared to whites, blacks were younger and had lower CD4 counts, more comorbidities, lower retention in care, and poorer medication adherence. The odds of uncontrolled viral load were 2.02 (p < 0.001) for black relative to white patients without risk adjustment (15% vs. 8% uncontrolled viral load, respectively). The odds decreased to 1.83 (p < 0.001), 1.65 (p < 0.001), 1.62 (p < 0.001), and 1.24 (p = 0.01) in models that sequentially controlled for site of care, age and clinical characteristics, care retention, and cART adherence, respectively. Overall, 51% of the viral control difference between blacks and whites was accounted for by adherence; 26% by site of care. We conclude that differences in the site of HIV care and cART adherence account for most of the difference in viral control between black and white persons receiving HIV care, although the exact pathway by which this relationship occurs is unknown. Targeting poorer performing sites for quality improvement and focusing on improving antiretroviral adherence in black patients may help alleviate disparities in viral control.
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Affiliation(s)
- Mary S. Vaughan Sarrazin
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Michael E. Ohl
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Kelly K. Richardson
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
| | - Steven M. Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
| | - Allen L. Gifford
- VA Center for Healthcare Organization and Implementation Research (CHOIR) at ENRM Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Barbara G. Bokhour
- VA Center for Healthcare Organization and Implementation Research (CHOIR) at ENRM Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
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Tan JY, Pollack L, Rebchook G, Peterson J, Huebner D, Eke A, Johnson W, Kegeles S. The Role of the Primary Romantic Relationship in HIV Care Engagement Outcomes Among Young HIV-Positive Black Men Who Have Sex with Men. AIDS Behav 2018; 22:774-790. [PMID: 27844296 PMCID: PMC5839634 DOI: 10.1007/s10461-016-1601-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV.
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Affiliation(s)
- Judy Y Tan
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA.
| | - Lance Pollack
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| | - Greg Rebchook
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
| | - John Peterson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - David Huebner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Agatha Eke
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Kegeles
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, 0886, San Francisco, CA, 94158-2549, USA
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Jaiswal J, Singer SN, Griffin Tomas M, Lekas HM. Conspiracy Beliefs Are Not Necessarily a Barrier to Engagement in HIV Care Among Urban, Low-Income People of Color Living with HIV. J Racial Ethn Health Disparities 2018; 5:1192-1201. [PMID: 29488174 DOI: 10.1007/s40615-018-0466-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/17/2018] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND HIV-related "conspiracy beliefs" include ideas about the genocidal origin of HIV to target minority people, and the notion that a cure for HIV is being deliberately withheld. Previous literature suggests that these beliefs may negatively affect engagement in HIV care and ART adherence, but little is known about how people who are disengaged from care may think about these ideas. METHODS Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV in NYC who were currently disengaged from, or recently re-engaged in, HIV care. FINDINGS The data suggest that HIV-related "conspiracy beliefs" are not necessarily a barrier to care. Regardless of whether or not people endorsed these ideas, participants were largely dismissive, and prioritized focusing on managing their HIV and overall health and life challenges. RECOMMENDATIONS Interventions aiming to improve ART adherence and retention in HIV care should focus on building trust between clinicians and populations that have experienced historical, as well as ongoing, marginalization. HIV care providers should ask patients open-ended questions specifically about their beliefs about HIV and ART in order to address potential suspicion. Moving away from the phrase "conspiracy beliefs" in favor of more neutral language, such as "HIV-related beliefs," can enable us to better understand these ideas in the context of people's daily lives. CONCLUSIONS Further research is needed to better understand how structural inequality may shape how people experience mistrust, and how mistrust may factor into the constellation of barriers to consistent engagement in HIV care.
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Affiliation(s)
- J Jaiswal
- Center for Health Identity, Behavior and Prevention Studies, New York University, 665 Broadway, Ste 800, New York, NY, 10012, USA. .,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - S N Singer
- Center for Health Identity, Behavior and Prevention Studies, New York University, 665 Broadway, Ste 800, New York, NY, 10012, USA
| | - M Griffin Tomas
- Center for Health Identity, Behavior and Prevention Studies, New York University, 665 Broadway, Ste 800, New York, NY, 10012, USA
| | - H-M Lekas
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, State of New York Office of Mental Health, Orangeburg, NY, USA
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The State of Adherence to HIV Care in Black Women. J Assoc Nurses AIDS Care 2018; 29:487-503. [PMID: 29764715 DOI: 10.1016/j.jana.2018.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
Abstract
The purpose of this systematic review was to assess the state of adherence to HIV care such as HIV medication and appointment adherence among Black women in the United States. After a systematic search of CINAHL, PubMed, EMBASE, and clinicialtrials.gov, 26 studies and two ongoing trials met inclusion criteria. Psychosocial factors such as intersectional stigmas and depression were among the salient factors associated with adherence-to-care behaviors in women living with HIV (WLWH). In addition, interpersonal factors such as social support and the patient-provider relationship were frequently associated with adherence-to-care behaviors. No culturally relevant interventions for Black WLWH were found in the literature, but one ongoing trial that was developed specifically for Black WLWH seemed promising. Considering the dearth of tailored interventions, more gender-specific and culturally relevant interventions are urgently needed to improve adherence-to-care behaviors and optimize health outcomes for Black WLWH.
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Howe CJ, Dulin-Keita A, Cole SR, Hogan JW, Lau B, Moore RD, Mathews WC, Crane HM, Drozd DR, Geng E, Boswell SL, Napravnik S, Eron JJ, Mugavero MJ. Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework. Am J Epidemiol 2018; 187:316-325. [PMID: 28992096 DOI: 10.1093/aje/kwx247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 06/08/2017] [Indexed: 01/10/2023] Open
Abstract
Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data.
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Affiliation(s)
- Chanelle J Howe
- Centers for Epidemiology and Environmental Health, Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Akilah Dulin-Keita
- Center for Health Equity Research, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph W Hogan
- Center for Statistical Sciences, Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Richard D Moore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Daniel R Drozd
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Elvin Geng
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | | | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph J Eron
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Smith LR, Amico KR, Fisher JD, Cunningham CO. 60 Minutes for health: examining the feasibility and acceptability of a low-resource behavioral intervention designed to promote retention in HIV care. AIDS Care 2018; 30:255-265. [PMID: 28657333 PMCID: PMC5836545 DOI: 10.1080/09540121.2017.1344184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sustained retention in HIV medical care is a key health behavior for the long-term health of people living with HIV (PLWH). Approximately 60% of PLWH in the U.S. are poorly retained in HIV care, yet to date, the few available evidence-based retention-promoting interventions are resource and time intensive to implement. The current study describes the feasibility and acceptability of a theory-based retention-promoting intervention designed to meet the needs of a busy clinical care setting. 60 Minutes for Health reflects a low-resource single-session intervention, implemented by a health educator, to PLWH who have had a recent gap in care (≥6-months) in the past 18-months. Intervention content was informed by a situated application of the Information Motivation Behavioral Skills Model and delivered using a Motivational Interviewing-based format. The intervention uses a workbook to guide a series of activities that: (1) Identify and reduce misinformation guiding HIV care attendance. (2) Enhance motivation to maintain care via personal health goals. (3) Build skills for coping with emotional distress related to living with HIV. (4) Increase self-efficacy for navigating the logistics of maintaining care amidst competing priorities. A small feasibility pilot of this intervention protocol was conducted to assess its potential to improve retention in care and to obtain estimates for a larger-scale efficacy trial. Participants were randomized to the 60-minute intervention session (n = 8), or a theory-based time-and-attention control session focused on diet and nutrition (n = 8). Medical records were abstracted to evaluate changes in participants' retention in care status at 12- and 24-months post-intervention. Findings suggest the intervention is both feasible and acceptable to implement with poorly retained PLWH in a clinic setting. Post-intervention a larger proportion of intervention participants were retained in care (12-months: 87.5%, 24-months: 62.5%), compared control participants (12-months: 50.0%, 24-months: 25.0%). Future work should aim to evaluate a larger-scale efficacy trial.
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Affiliation(s)
- Laramie R Smith
- a Division of Global Public Health, Department of Medicine , University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - K Rivet Amico
- b Department of Health Behavior and Health Education , School of Public Health, University of Michigan , Ann Harbor , MI , USA
| | - Jeffrey D Fisher
- c Institute for Collaboration on Health, Intervention, and Policy , University of Connecticut , Storrs , CT , USA
| | - Chinazo O Cunningham
- d Division of General Internal Medicine , Albert Einstein College of Medicine , Bronx , NY , USA
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Falade-Nwulia O, Sutcliffe C, Moon J, Chander G, Wansom T, Keruly J, Katzianer J, Nathanson A, Marks J, Mehta S, Thomas D, Moore R, Sulkowski M. High hepatitis C cure rates among black and nonblack human immunodeficiency virus-infected adults in an urban center. Hepatology 2017; 66:1402-1412. [PMID: 28608973 PMCID: PMC5650518 DOI: 10.1002/hep.29308] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/18/2017] [Accepted: 06/06/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) cure rates have been similar in patients with and without human immunodeficiency virus (HIV) coinfection; however, in the ION-4 study, black patients treated with ledipasvir/sofosbuvir (LDV/SOF) were significantly less likely to achieve cure (90%) compared to nonblack patients (99%). There are limited real-world data on the effectiveness of oral direct-acting antivirals (DAAs) in predominantly minority HIV/HCV coinfected populations. We analyzed HCV treatment outcomes among 255 HCV coinfected patients initiating DAAs between February 2014 and March 2016 in an urban clinic in Baltimore, Maryland. To facilitate adherence, patients received standardized HIV nurse/pharmacist support, which included nurse visits and telephone calls. Median age was 43 years, 88% were black, 73% male, 69% had a history of injection drug use, 45% a history of hazardous alcohol use, and 57% a comorbid psychiatric diagnosis. Median CD4 count was 577 (interquartile range, 397-820) cells/mm3 ; most (97%) were on antiretroviral therapy, had HIV RNA <20 copies/mL (87%), and were infected with HCV genotype 1 (98%). Over 60% had significant fibrosis (Fibrosis-4 Index score 1.45-3.25 [44%] and >3.25 [17%, cirrhosis]) and 30% were HCV treatment experienced. The majority of patients received LDV/SOF with or without ribavirin (91%) and were treated for 12 weeks. Overall, the sustained virological response rate was 97% (95% confidence interval [CI], 93-98) and did not vary by race (black, 96% [95% CI, 93-98]; nonblack, 97%, [95% CI, 83-99]), history of injection drug use, alcohol use, or psychiatric diagnosis. CONCLUSION HCV treatment was highly effective among HIV-infected patients who received care within an integrated nurse/pharmacist adherence support program. These results suggest that race and psychosocial comorbidity may not be barriers to HCV elimination. (Hepatology 2017;66:1402-1412).
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Affiliation(s)
| | - Catherine Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Juhi Moon
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tanyaporn Wansom
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeanne Keruly
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Katzianer
- Johns Hopkins Pharmaquip, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Amy Nathanson
- Johns Hopkins Pharmaquip, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jillian Marks
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shruti Mehta
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - David Thomas
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard Moore
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Sulkowski
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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Christopoulos KA, Cunningham WE, Beckwith CG, Kuo I, Golin CE, Knight K, Flynn PM, Spaulding AC, Coffin LS, Kruszka B, Kurth A, Young JD, Mannheimer S, Crane HM, Kahana SY. Lessons Learned From the Implementation of Seek, Test, Treat, Retain Interventions Using Mobile Phones and Text Messaging to Improve Engagement in HIV Care for Vulnerable Populations in the United States. AIDS Behav 2017; 21:3182-3193. [PMID: 28578543 DOI: 10.1007/s10461-017-1804-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the United States, little is known about interventions that rely on mobile phones and/or text messaging to improve engagement in HIV care for vulnerable populations. Domestic studies using these technologies as part of the National Institute on Drug Abuse "Seek, Test, Treat, Retain" research initiative were queried regarding intervention components, implementation issues, participant characteristics, and descriptive statistics of mobile phone service delivery. Across five studies with 1,135 predominantly male, minority participants, implementation challenges occurred in three categories: (1) service interruptions; (2) billing/overage issues, and; (3) the participant user experience. Response rules for automated text messages frequently frustrated participants. The inability to reload minutes/texting capacity remotely was a significant barrier to intervention delivery. No study encountered confidentiality breaches. Service interruption was common, even if studies provided mobile phones and plans. Future studies should attend to the type of mobile phone and service, the participant user experience, and human subjects concerns.
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Affiliation(s)
- Katerina A Christopoulos
- Division of HIV, ID and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, 4th Floor, San Francisco, CA, 94110, USA.
| | - William E Cunningham
- Departments of Medicine and Health Policy and Management, UCLA Schools of Medicine and Public Health, Los Angeles, CA, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Carol E Golin
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kevin Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA
| | - Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA
| | - Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lara S Coffin
- Division of HIV, ID and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, 4th Floor, San Francisco, CA, 94110, USA
| | - Bridget Kruszka
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA, USA
| | - Ann Kurth
- School of Nursing, Yale University, New Haven, CT, USA
| | - Jeremy D Young
- Division of Infectious Disease, University of Illinois at Chicago, Chicago, IL, USA
| | - Sharon Mannheimer
- Departments of Medicine and Epidemiology, Columbia University, New York, NY, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Shoshana Y Kahana
- Services Research Branch, National Institute on Drug Abuse, Bethesda, MD, USA
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Hightow-Weidman L, LeGrand S, Choi SK, Egger J, Hurt CB, Muessig KE. Exploring the HIV continuum of care among young black MSM. PLoS One 2017; 12:e0179688. [PMID: 28662170 PMCID: PMC5491033 DOI: 10.1371/journal.pone.0179688] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts young, black men who have sex with men (YBMSM) who experience disparities across the HIV care continuum. A more nuanced understanding of facilitators and barriers to engagement in care, missed visits, antiretroviral uptake, adherence and viral suppression could improve care and intervention design. METHODS A randomized controlled trial of an online intervention, healthMpowerment, enrolled 465 YBMSM (18-30 years); 193 identified as HIV-positive. Bivariable and multivariable analyses of baseline data explored predictors of: engagement in care, missed visits, antiretroviral uptake, self-reported adherence, and viral suppression. RESULTS Mean age was 24.9 years; most identified as gay (71.0%) and were receiving HIV care (89.1%). Among those in care, 52.1% reported no missed visits in the past 12 months, 41 (24.6%) reported one missed visit, and 39 (23.4%) reported two or more. Having insurance (prevalence odds ratio [POR] 4.5; 95% CI: 1.3, 15.8) and provider self-efficacy (POR 20.1; 95% CI: 6.1, 64.1) were associated with being in care. Those with a college degree (POR 9.1; 95% CI: 1.9, 45.2) and no recent marijuana (POR 2.6; 95% CI: 1.2, 5.6) or methamphetamine use (POR 5.4; 95% CI: 1.0, 28.5) were less likely to miss visits. Most (n = 153, 84.1%) had been prescribed antiretroviral therapy. A majority of participants (70.8%) reported ≥90% adherence; those with depressive symptoms had 4.7 times the odds of reporting adherence <90% (95% CI: 1.65, 13.37). Of participants who reported viral load testing in the past six months, 65% (n = 102) reported an undetectable viral load. Disclosure to sex partners was associated with viral suppression (POR 6.0; 95% CI: 1.6, 22.4). CONCLUSIONS Multi-level facilitators and barriers to engagement across the continuum of care were identified in this sample of YBMSM. Understanding the distinct needs of YBMSM at each stage of the continuum and addressing them through tailored approaches is critical for long term success in care.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Seul Ki Choi
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Christopher B. Hurt
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Bean MC, Scott L, Kilby JM, Richey LE. Use of an Outreach Coordinator to Reengage and Retain Patients with HIV in Care. AIDS Patient Care STDS 2017; 31:222-226. [PMID: 28488904 DOI: 10.1089/apc.2016.0318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
It is well established that retention in high-quality care and regular visits with an HIV/AIDS provider improve outcomes for people living with HIV/AIDS (PLWHA). However, nationally and regionally in South Carolina, retention rates remain low. We piloted an outreach program focused on characterizing out of care (OOC) patients to identify PLWHA who were lost to care and attempt reengagement through phone call, letter, and home visit interventions. Primary outcomes were reengagement, defined as attendance to a clinic appointment, and retention in care, defined by the Health Resources and Services Administration (HRSA) definition (two visits at least 90 days apart in 2015). There were 1242 adult clinic patients in 2014. A total of 233 patients were included in the OOC cohort, according to the inclusion criteria. Of these 233, the outreach coordinator found that a majority of patients, 119 (51%), were lost to care. Reengagement was seen in 52 (44%) patients lost to care, and among those who reengaged, 26 (50%) were retained in care in 2015. This report represents one of few interventions that target reengagement for patients who are lost to care. The use of an outreach coordinator was successful in reengaging and retaining patients in care. It represents an uncomplicated intervention, functional within the current clinic design and available funding structure of the Ryan White grant. Poor engagement and retention in care continue to be significant problems among PLWHA with resultant poor clinical outcomes. Continued focus on new interventions to improve retention in care is necessary to improve clinical outcomes.
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Affiliation(s)
- Madelyne C. Bean
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina
| | - Linda Scott
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina
| | - J. Michael Kilby
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina
| | - Lauren E. Richey
- Division of Infectious Disease, Medical University of South Carolina, Charleston, South Carolina
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