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Stonbraker S, Sanabria G, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Rowell-Cunsolo T, Halpern M, Bakken S, Schnall R, George M. "If They Give Their Mind to HIV, They Don't Last as Long": An Explanatory Model of HIV Infection in a Limited-Resource Setting Informs Person-Centered Care. Glob Qual Nurs Res 2022; 9:23333936221097112. [PMID: 35719278 PMCID: PMC9203948 DOI: 10.1177/23333936221097112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
Explanatory models describe individuals’ perceptions of their illness experiences, which can guide culturally relevant care. We constructed an explanatory model of the experience of living with human immunodeficiency virus (HIV) in the Dominican Republic. Following qualitative descriptive methodology, we conducted interviews in Spanish using a semi-structured interview guide developed using Kleinman’s explanatory model framework. Two bilingual researchers coded interview transcripts following conventional content analysis. We used deductive codes from Kleinman’s framework and inductive codes external to the framework to construct the codebook. We arranged codes by shared meaning into categories and constructed themes that reflected shared findings from inductive categories and deductive codes. Twenty-six persons living with HIV participated. They provided rich descriptions of their experiences represented by four cross-cutting themes, which informed the explanatory model. By incorporating this in-depth understanding of patients’ illness experiences into care delivery, nurses can cultivate culturally meaningful and trusting patient-centered partnerships that improve health.
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Affiliation(s)
- Samantha Stonbraker
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, USA
| | | | | | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
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Okoboi S, Musaazi J, King R, Lippman SA, Kambugu A, Mujugira A, Izudi J, Parkes-Ratanshi R, Kiragga AN, Castelnuovo B. Adherence monitoring methods to measure virological failure in people living with HIV on long-term antiretroviral therapy in Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000569. [PMID: 36962730 PMCID: PMC10021796 DOI: 10.1371/journal.pgph.0000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
Appointment keeping and self-report within 7-day or and 30-days recall periods are non-objective measures of antiretroviral treatment (ART) adherence. We assessed incidence of virological failure (VF), predictive performance and associations of these adherence measures with VF among adults on long-term ART. Data for persons initiated on ART between April 2004 and April 2005, enrolled in a long-term ART cohort at 10-years on ART (baseline) and followed until December 2021 was analyzed. VF was defined as two consecutives viral loads ≥1000 copies/ml at least within 3-months after enhanced adherence counselling. We estimated VF incidence using Kaplan-Meier and Cox-proportional hazards regression for associations between each adherence measure (analyzed as time-dependent annual values) and VF. The predictive performance of appointment keeping and self-reporting for identifying VF was assessed using receiver operating characteristic curves and reported as area under the curve (AUC). We included 900 of 1,000 participants without VF at baseline: median age was 47 years (Interquartile range: 41-51), 60% were women and 88% were virally suppressed. ART adherence was ≥95% for all three adherence measures. Twenty-one VF cases were observed with an incidence rate of 4.37 per 1000 person-years and incidence risk of 2.4% (95% CI: 1.6%-3.7%) over the 5-years of follow-up. Only 30-day self-report measure was associated with lower risk of VF, adjusted hazard ratio (aHR) = 0.14, 95% CI:0.05-0.37). Baseline CD4 count ≥200cells/ml was associated with lower VF for all adherence measures. The 30-day self-report measure demonstrated the highest predictive performance for VF (AUC = 0.751) compared to appointment keeping (AUC = 0.674), and 7-day self-report (AUC = 0.687). The incidence of virological failure in this study cohort was low. Whilst 30- day self-report was predictive, appointment keeping and 7-day self-reported adherence measures had low predictive performance in identifying VF. Viral load monitoring remains the gold standard for adherence monitoring and confirming HIV treatment response.
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Affiliation(s)
- Stephen Okoboi
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rachel King
- Department of Global Health, University of California, San Francisco, San Francisco, CA, United States of America
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sheri A Lippman
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States of America
| | - Andrew Kambugu
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Mujugira
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Izudi
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Clinical School, University of Cambridge, London, United Kingdom
| | - Agnes N Kiragga
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Bor J, Onoya D, Richman B, Mayer KH. A Failure to Disseminate Transformative Science - HIV Treatment as Prevention, 10 Years On. N Engl J Med 2021; 385:2305-2307. [PMID: 34890175 PMCID: PMC9354720 DOI: 10.1056/nejmp2113118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jacob Bor
- From the Department of Global Health, Boston University School of Public Health (J.B.), and the Fenway Institute (K.H.M.) - both in Boston; the Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (D.O.); and the Prevention Access Campaign, New York (B.R.)
| | - Dorina Onoya
- From the Department of Global Health, Boston University School of Public Health (J.B.), and the Fenway Institute (K.H.M.) - both in Boston; the Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (D.O.); and the Prevention Access Campaign, New York (B.R.)
| | - Bruce Richman
- From the Department of Global Health, Boston University School of Public Health (J.B.), and the Fenway Institute (K.H.M.) - both in Boston; the Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (D.O.); and the Prevention Access Campaign, New York (B.R.)
| | - Kenneth H Mayer
- From the Department of Global Health, Boston University School of Public Health (J.B.), and the Fenway Institute (K.H.M.) - both in Boston; the Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (D.O.); and the Prevention Access Campaign, New York (B.R.)
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Smith PJ, Joseph Davey DL, Schmucker L, Bruns C, Bekker LG, Medina-Marino A, Thirumurthy H, Buttenheim AM. Participatory Prototyping of a Tailored Undetectable Equals Untransmittable Message to Increase HIV Testing Among Men in Western Cape, South Africa. AIDS Patient Care STDS 2021; 35:428-434. [PMID: 34739334 DOI: 10.1089/apc.2021.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Daily antiretroviral therapy (ART) suppresses viral replication, rendering HIV undetectable through viral load (VL) testing. People living with HIV (PLWH) who have an undetectable VL cannot transmit HIV to sexual partners or through giving birth, a message commonly referred to as U = U (undetectable equals untransmittable). To increase knowledge and understanding of U = U among men, who have poorer HIV testing and treatment outcomes than women, we engaged men from high HIV burden communities in Cape Town in two interactive human-centered design cocreation workshops to develop local U = U messaging for men. Two trained workshop facilitators, explained the U = U message to 39 adult men (in two separate workshops), and asked them how to effectively communicate U = U to other men in the local language (isiXhosa). Participant-designed messages sought to inform men about U = U to help assuage fears of testing HIV positive (by removing the stigma of living with HIV and being a vector of disease), and to explain that ART enables PLWH to live normal healthy lives, making HIV "untransmittable" to sex partners. Participants' messages emphasized that when virally suppressed, "I cannot spread HIV to the other person" and "(the pill) keeps on killing the virus so I can live a normal life for the rest of my life." Men cocreated simple local U = U messages to address fears of testing HIV positive and emphasizing ART's positive effects. Cocreated tailored messaging may reduce stigma associated with living with HIV and improve the uptake of HIV testing and treatment among South African men. This study was registered at clinicaltrials.gov under NCT04364165.
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Affiliation(s)
- Philip J Smith
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Dvora L Joseph Davey
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Laura Schmucker
- Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Incentives and Behavioral Economics, Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cal Bruns
- Matchboxology, Kalk Bay, Cape Town, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Andrew Medina-Marino
- Division of Men's Health, Desmond Tutu HIV Centre, University of Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harsha Thirumurthy
- Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Incentives and Behavioral Economics, Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison M Buttenheim
- Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Incentives and Behavioral Economics, Medical Ethics and Health Policy, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bor J, Musakwa N, Onoya D, Evans D. Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa. Sex Transm Infect 2021; 97:596-600. [PMID: 34510009 PMCID: PMC8606435 DOI: 10.1136/sextrans-2021-055031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Antiretroviral therapy (ART) nearly eliminates HIV transmission. Yet information on treatment as prevention (TasP) has been slow to diffuse in sub-Saharan Africa. We assessed TasP knowledge among university students in South Africa. Methods We conducted a cross-sectional survey of first-year university students at a large public university in Johannesburg, South Africa, all of whom would have recently completed secondary school HIV curricula. Respondents were asked to consider the likelihood of HIV transmission in a serodiscordant couple having condomless sex with and without virally suppressive ART. Beliefs were elicited using a 0–20 visual scale. Perceived TasP efficacy was computed as the relative reduction in risk associated with virally suppressive ART. We compared beliefs with estimates from the scientific literature and assessed associations with demographics, HIV testing history and qualitative measures of HIV knowledge and risk perception. Results The analysis included 365 university students ages 18-25 years (48% female, 56% from Gauteng Province). On average, perceived annual risk of HIV transmission with virally suppressive ART was 73%; the objective risk is <1%. On average, respondents perceived that virally suppressive ART reduced annual transmission risk by 17%; the objective reduction in risk is >96%. We observed no differences in perceived TasP efficacy by participant characteristics and testing history. Perceived TasP efficacy was correlated with the (correct) belief that HIV risk increases with sexual frequency. Conclusions University students in South Africa underestimated the prevention benefits of HIV treatment. Low knowledge of TasP could limit demand for HIV testing and treatment among young adults.
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Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA .,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
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Steward WT, Agnew E, de Kadt J, Ratlhagana MJ, Sumitani J, Gilmore HJ, Grignon J, Shade SB, Tumbo J, Barnhart S, Lippman SA. Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: results of a three-arm cluster randomized controlled trial. J Int AIDS Soc 2021; 24:e25774. [PMID: 34435440 PMCID: PMC8387209 DOI: 10.1002/jia2.25774] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Few interventions have demonstrated improved retention in care for people living with HIV (PLHIV) in sub-Saharan Africa. We tested the efficacy of two personal support interventions - one using text messaging (SMS-only) and the second pairing SMS with peer navigation (SMS+PN) - to improve HIV care retention over one year. METHODS In a cluster randomized control trial (NCT# 02417233) in North West Province, South Africa, we randomized 17 government clinics to three conditions: SMS-only (6), SMS+PN (7) or standard of care (SOC; 4). Participants at SMS-only clinics received appointment reminders, biweekly healthy living messages and twice monthly SMS check-ins. Participants at SMS+PN clinics received SMS appointment reminders and healthy living messages and spoke at least twice monthly with peer navigators (PLHIV receiving care) to address barriers to care. Outcomes were collected through biweekly clinical record extraction and surveys at baseline, six and 12 months. Retention in HIV care over one year was defined as clinic visits every three months for participants on antiretroviral therapy (ART) and CD4 screening every six months for pre-ART participants. We used generalized estimating equations, adjusting for clustering by clinic, to test for differences across conditions. RESULTS Between October 2014 and April 2015, we enrolled 752 adult clients recently diagnosed with HIV (SOC: 167; SMS-only: 289; SMS+PN: 296). Individuals in the SMS+PN arm had approximately two more clinic visits over a year than those in other arms (p < 0.01) and were more likely to be retained in care over one year than those in SOC clinics (54% vs. 38%; OR: 1.77, CI: 1.02, 3.10). Differences between SMS+PN and SOC conditions remained significant when restricting analyses to the 628 participants on ART (61% vs. 45% retained; OR: 1.78, CI: 1.08, 2.93). The SMS-only intervention did not improve retention relative to SOC (40% vs. 38%, OR: 1.12, CI: 0.63, 1.98). CONCLUSIONS A combination of SMS appointment reminders with personalized, peer-delivered support proved effective at enhancing retention in HIV care over one year. While some clients may only require appointment reminders, the SMS+PN approach offers increased flexibility and tailored, one-on-one support for patients struggling with more substantive challenges.
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Affiliation(s)
- Wayne T Steward
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Emily Agnew
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Julia de Kadt
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
| | - Mary Jane Ratlhagana
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
| | - Jeri Sumitani
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
| | - Hailey J Gilmore
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Jessica Grignon
- International Training and Education Center for Health (I‐TECH)PretoriaRepublic of South Africa
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Starley B Shade
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
- Institute for Global Health SciencesDepartment of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - John Tumbo
- Department of Family Medicine and Primary Health CareSefako Makgatho Health Sciences UniversityPretoriaRepublic of South Africa
| | - Scott Barnhart
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- International Training and Education Center for Health (I‐TECH) South AfricaPretoriaRepublic of South Africa
| | - Sheri A Lippman
- Division of Prevention ScienceDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
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Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158031. [PMID: 34360326 PMCID: PMC8345572 DOI: 10.3390/ijerph18158031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.
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