51
|
Klein PW, Geiger T, Chavis NS, Cohen SM, Ofori AB, Umali KT, Hauck H. The Health Resources and Services Administration's Ryan White HIV/AIDS Program in rural areas of the United States: Geographic distribution, provider characteristics, and clinical outcomes. PLoS One 2020; 15:e0230121. [PMID: 32203556 PMCID: PMC7089565 DOI: 10.1371/journal.pone.0230121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration’s Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas. Methods and findings Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service (“RWHAP providers”) were categorized as rural or non-rural according to the HRSA FORHP’s definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as “visited only rural providers,” “visited only non-rural providers,” or “visited rural and non-rural providers.” In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1–99 clients, while 29.6% of non-rural providers served 1–99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers. Conclusions RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.
Collapse
Affiliation(s)
- Pamela W. Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
- * E-mail:
| | - Tanya Geiger
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Alexa B. Ofori
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Kathryn T. Umali
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Heather Hauck
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| |
Collapse
|
52
|
Owens C, Hubach RD, Williams D, Lester J, Reece M, Dodge B. Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:51-66. [PMID: 32073310 DOI: 10.1521/aeap.2020.32.1.51] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non-primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas.
Collapse
Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio State University, Athens, Ohio
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| |
Collapse
|
53
|
Feng I, Brondani M, Bedos C, Donnelly L. Access to oral health care for people living with HIV/AIDS attending a community-based program. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2020; 54:7-15. [PMID: 33240359 PMCID: PMC7533800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE People living with HIV/AIDS (PLWHA) have difficulty accessing oral health services primarily due to HIV-related stigma and discrimination. In 2011, the University of British Columbia (UBC) Dental Hygiene Degree Program implemented a preventive oral health services program at the Positive Living Society of British Columbia (PLSBC), a non-profit organization supporting PLWHA. This study aims to assess the perception of how this type of service delivery influenced access to oral health care for members of PLSBC. METHODS Personal interviews with 10 members and one focus group comprising 12 staff were conducted. Audiorecordings were transcribed verbatim and coded thematically. Emerging themes were identified using the interpretative phenomenology approach following Penchansky and Thomas' theory of access. RESULTS The program helped members maximize their dental coverage to receive other types of dental services. Members who were influenced by past traumatic experiences appreciated that services were delivered in a safe manner and in a stigma-free setting. Members valued the opportunity to educate future dental professionals to reduce HIV-related stigma. However, dental needs that could not be addressed by the program remained untreated for some members who continued to face barriers to care at referral clinics. CONCLUSION This community-based preventive dental program provided affordable dental care, a stigma-free setting, care delivered in a safe manner, an educational opportunity, and accessible location, which all seemed to have a positive influence on access to oral health care for members of PLSBC. However, the limited availability of the program prevented many members from accessing comprehensive oral health care and is a factor that should be addressed.
Collapse
Affiliation(s)
- Iris Feng
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Mario Brondani
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | | | - Leeann Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
54
|
Gesesew H, Lyon P, Ward P, Woldemichael K, Mwanri L. "Our Tradition Our Enemy": A Qualitative Study of Barriers to Women's HIV Care in Jimma, Southwest Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030833. [PMID: 32013114 PMCID: PMC7036873 DOI: 10.3390/ijerph17030833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 01/08/2023]
Abstract
Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers from 10 institutions using an in-depth interview guide designed to probe barriers to HIV care at individual, community, healthcare provider, and government policy levels. To systematically analyze the data, we applied a thematic framework analysis using NVivo. In total, 35 participants were involved in the study and provided the following interrelated barriers: (i) Availability— most women living in rural areas who accessed HIV cared less often than men; (ii) free antiretroviral therapy (ART) is expensive—most women who have low income and who live in urban areas sold ART drugs illegally to cover ART associated costs; (iii) fear of being seen by others—negative consequences of HIV related stigma was higher in women than men; (iv) the role of tradition—the dominance of patriarchy was found to be the primary barrier to women’s HIV care and treatment outcomes. In conclusion, barriers related to culture or tradition constrain women’s access to HIV care. Therefore, policies and strategies should focus on these contextual constrains.
Collapse
Affiliation(s)
- Hailay Gesesew
- Public Health, Flinders University, Adelaide 5042, Australia; (H.G.); (L.M.)
- Epidemiology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Pamela Lyon
- Southgate Institute for Health, Society ad Equity, College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia;
| | - Paul Ward
- Public Health, Flinders University, Adelaide 5042, Australia; (H.G.); (L.M.)
- Correspondence: ; Tel.: +61-8-7221-8415
| | | | - Lillian Mwanri
- Public Health, Flinders University, Adelaide 5042, Australia; (H.G.); (L.M.)
| |
Collapse
|
55
|
Butkus R, Rapp K, Cooney TG, Engel LS. Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health. Ann Intern Med 2020; 172:S50-S59. [PMID: 31958803 DOI: 10.7326/m19-2410] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Reductions in nonfinancial barriers to care and improvements in social determinants of health are also necessary. This ACP position paper calls for ending discrimination based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. The ACP calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems in order to achieve ACP's vision for a better U.S. health care system.
Collapse
Affiliation(s)
- Renee Butkus
- American College of Physicians, Washington, DC (R.B., K.R.)
| | - Katherine Rapp
- American College of Physicians, Washington, DC (R.B., K.R.)
| | - Thomas G Cooney
- Oregon Health & Science University and Portland Veterans Affairs Medical Center, Portland, Oregon (T.G.C.)
| | - Lee S Engel
- Louisiana State University Health Sciences Center, New Orleans, Louisiana (L.S.E.)
| | | |
Collapse
|
56
|
Burde A, O'Connor S, Hachey D. Community Pharmacy Enhanced Dispensing Model to Improve Medication Access for Rural Patients Living with HIV. Innov Pharm 2019; 10. [PMID: 34007597 PMCID: PMC8051905 DOI: 10.24926/iip.v10i4.2264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To demonstrate the utility of a community pharmacy-centric workflow for improving access to medications for high-risk, rural persons living with HIV (PLWH) in partnership with a Federally Qualified Health Center (FQHC). Setting: University-sponsored independent community pharmacy and rural FQHC providing care to PLWH. Practice Description: Patient-centered Pharmacy Program is a service designed to improve access to HIV medications for PLWH in rural Idaho. The service is delivered in partnership with a 340B-covered entity (FQHC). Practice innovation: The workflow for the service in the community pharmacy is described in detail, including time assessments and descriptions of tools and forms developed for rollout. Evaluation: Quality improvement initiatives over three years are described. Results: This service ensures medication access for rural PLWH and is sustainable for the community pharmacy. Expansion of services is feasible for the future. Conclusion: This partnership may be one that could be implemented at other rural, independent community pharmacies seeking to have outreach to rural patients with chronic medication needs.
Collapse
Affiliation(s)
- Anushka Burde
- Department of Pharmacy Practice and Administrative Sciences, Idaho State University
| | - Shanna O'Connor
- Department of Pharmacy Practice and Administrative Sciences, Idaho State University
| | - David Hachey
- Department of Family Medicine, Idaho State University
| |
Collapse
|
57
|
Pinto RM, Lacombe-Duncan A, Kay ES, Berringer KR. Expanding Knowledge About Implementation of Pre-exposure Prophylaxis (PrEP): A Methodological Review. AIDS Behav 2019; 23:2761-2778. [PMID: 31292825 PMCID: PMC6789046 DOI: 10.1007/s10461-019-02577-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Methodological limitations in PrEP implementation studies may explain why PrEP implementation is lagging. This methodological review provides a description and critique of the methods used to identify barriers to PrEP implementation in the United States (2007-18). For each selected article, we provide: (1) research questions; (2) measures; (3) design; (4) sample (size and type); and (5) theoretical orientation. Among 79 articles which identified knowledge, attitudes, and behavioral and social/structural barriers to PrEP implementation, 51 (65%) were quantitative; 25 (32%) qualitative; and 3 (4%) were mixed-methods; overall, just one-half described a conceptual approach. About two-thirds of articles were conducted with patients and one-third with healthcare providers. Our review reveals a paucity of longitudinal, mixed-methods, and ethnographic/observational research and guiding theoretical frameworks; thus, the applicability of results are limited. We recommend that interventions aimed at PrEP implementation address barriers situated at multiple ecological domains, and thus improve PrEP access, uptake, and adherence.
Collapse
Affiliation(s)
- Rogério M Pinto
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA.
| | - Ashley Lacombe-Duncan
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA
| | - Emma Sophia Kay
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA
| | - Kathryn R Berringer
- University of Michigan, School of Social Work, Office 2850, 1080 South University, Ann Arbor, MI, 48109, USA
- University of Michigan, Anthropology, Ann Arbor, MI, USA
| |
Collapse
|
58
|
Kalichman S, Shkembi B, Hernandez D, Katner H, Thorson KR. Income Inequality, HIV Stigma, and Preventing HIV Disease Progression in Rural Communities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1066-1073. [PMID: 30955136 PMCID: PMC7000177 DOI: 10.1007/s11121-019-01013-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Antiretroviral therapies (ART) suppress HIV replication, thereby preventing HIV disease progression and potentially preventing HIV transmission. However, there remain significant health disparities among people living with HIV, particularly for women living in impoverished rural areas. A significant contributing factor to HIV-related disparities is a stigma. And yet, the relative contributions of stigma, gender, socio-economics, and geography in relation to health outcomes are understudied. We examined the associations of internalized stigma and enacted stigma with community-level income inequality and HIV viral suppression-the hallmark of successful ART-among 124 men and 74 women receiving care from a publicly funded HIV clinic serving rural areas with high-HIV prevalence in the southeastern US. Participants provided informed consent, completed computerized interviews, and provided access to their medical records. Gini index was collected at the census tract level to estimate community-level income inequality. Individual-level and multilevel models controlled for point distance that patients lived from the clinic and quality of life, and included participant gender as a moderator. We found that for women, income inequality, internalized stigma, and enacted stigma were significantly associated with HIV suppression. For men, there were no significant associations between viral suppression and model variables. The null findings for men are consistent with gender-based health disparities and suggest the need for gender-tailored prevention interventions to improve the health of people living with HIV in rural areas. Results confirm and help to explain previous research on the impact of HIV stigma and income inequality among people living with HIV in rural settings.
Collapse
Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Bruno Shkembi
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Dominica Hernandez
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | | | | |
Collapse
|
59
|
Wise JM, Ott C, Azuero A, Lanzi RG, Davies S, Gardner A, Vance DE, Kempf MC. Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South. AIDS Behav 2019; 23:1062-1072. [PMID: 30607759 DOI: 10.1007/s10461-018-02385-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although CDC guidelines call for universal, "opt-out" HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of "opt-out" HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N = 250) and qualitative data from providers (N = 10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of "opt-out" HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.
Collapse
|
60
|
Laurence C, Wispelwey E, Flickinger TE, Grabowski M, Waldman AL, Plews-Ogan E, Debolt C, Reynolds G, Cohn W, Ingersoll K, Dillingham R. Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV. JMIR Form Res 2019; 3:e11578. [PMID: 30892269 PMCID: PMC6446157 DOI: 10.2196/11578] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/01/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). Objective This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. Methods App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. Results A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. Conclusions The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV.
Collapse
Affiliation(s)
- Colleen Laurence
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Erin Wispelwey
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Marika Grabowski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Ava Lena Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Erin Plews-Ogan
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Claire Debolt
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| |
Collapse
|
61
|
Teti M, Schulhoff AM, Koegler E, Saffran L, Bauerband LA, Shaffer V. Exploring the Use of Photo-Stories and Fiction Writing to Address HIV Stigma Among Health Professions Students. QUALITATIVE HEALTH RESEARCH 2019; 29:260-269. [PMID: 30095044 DOI: 10.1177/1049732318790939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
HIV/AIDS stigma exists in healthcare and is harmful to people living with HIV (PLWH). Few anti-stigma interventions target undergraduate health professions students, although evidence supports reaching providers early in their training. We developed two different arts-based interventions based on Intergroup Contact Theory: a Photovoice intervention in which they viewed photo-stories of PLWH and a fiction writing intervention in which they developed characters with HIV. We present the results of a qualitative analysis of the post-intervention interviews, to elaborate on what and how students learned from both interventions. Via theme analysis, we identified three similar patterns among both sets of intervention participants. Interventions helped students to understand PLWH as "people first," experience emotional responses to PLWH, and complicated their understanding of who was living with HIV. All three themes illustrate how Photovoice and fiction writing interrupted stereotypes about PLWH and humanized PLWH to health professions students.
Collapse
Affiliation(s)
| | | | | | - Lise Saffran
- 1 University of Missouri, Columbia, Missouri, USA
| | | | | |
Collapse
|
62
|
Kempf MC, Ott C, Wise JM, Footman AP, Araya BY, Hardy CM, Walker C, Latham C, Stockett R, Daniels G, Alexander M, Lanzi RG. Universal Screening for HIV and Hepatitis C Infection: A Community-Based Pilot Project. Am J Prev Med 2018; 55:S112-S121. [PMID: 30670196 PMCID: PMC6548448 DOI: 10.1016/j.amepre.2018.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Black men in the Deep South have been disproportionally affected by high HIV and hepatitis C virus infection rates. Conventional clinic-based screening approaches have had limited success in reaching those with undiagnosed HIV or hepatitis C virus infection. The purpose of this study was to evaluate the acceptability, feasibility, and best practices of an integrated HIV and hepatitis C virus community-based health screening approach. METHODS The study used a mixed methods approach: focus group discussion, individual interviews, and surveys that assessed perceptions, perspectives, and HIV and hepatitis C virus awareness among six communities across Alabama and Mississippi. Data were collected and analyzed in 2014-2017. RESULTS Although HIV and hepatitis C virus knowledge was limited among community members surveyed, the results of this study suggest that (1) using an integrated, community-based HIV and hepatitis C virus testing approach is acceptable and feasible; (2) formation of a community advisory board is a key element of successful community mobilization; (3) education and training of community members on disease-specific topics and overcoming stigma are essential; and (4) focus on and inclusion of young community members will be critical for the sustainability of screening efforts. CONCLUSIONS Including and engaging communities at risk for HIV and hepatitis C virus infection in prevention research is a promising strategy to overcome existing barriers of stigma and discrimination. Integration of HIV and hepatitis C virus testing in universal health screening efforts utilizing a Community Health Advisors model encourages unbiased communication with a focus on overall community health. Community health advisors are recognized as important agents in this effort. SUPPLEMENT INFORMATION This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
Collapse
Affiliation(s)
- Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama; School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; School of Medicine, University of Alabama at Birmingham, Alabama.
| | - Corilyn Ott
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jenni M Wise
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alison P Footman
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brook Y Araya
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Claudia M Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cordia Walker
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Robin G Lanzi
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
63
|
Abstract
The Southern United States has been disproportionately affected by HIV diagnoses and mortality. To inform efforts to effectively address HIV in the South, this manuscript synthesizes recent data on HIV epidemiology, care financing, and current research literature on factors that predispose this region to experience a greater impact of HIV. The manuscript focuses on a specific Southern region, the Deep South, which has been particularly affected by HIV. Epidemiologic data from the Centers from Disease Control and Prevention indicate that the Deep South had the highest HIV diagnosis rate and the highest number of individuals diagnosed with HIV (18,087) in 2014. The percentage of new HIV diagnoses that were female has decreased over time (2008-2014) while increasing among minority MSM. The Deep South also had the highest death rates with HIV as an underlying cause of any US region in 2014. Despite higher diagnosis and death rates, the Deep South received less federal government and private foundation funding per person living with HIV than the US overall. Factors that have been identified as contributors to the disproportionate effects of HIV in the Deep South include pervasive HIV-related stigma, poverty, higher levels of sexually transmitted infections, racial inequality and bias, and laws that further HIV-related stigma and fear. Interventions that address and abate the contributors to the spread of HIV disease and the poorer HIV-related outcomes in the Deep South are warranted. Funding inequalities by region must also be examined and addressed to reduce the regional disparities in HIV incidence and mortality.
Collapse
Affiliation(s)
- Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA. .,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Donna Safley
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | | | - Elena Wilson
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA.,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
| |
Collapse
|
64
|
Prevalence and correlates of HIV testing and HIV-positive status in the US: Results from the National Epidemiological Survey on Alcohol and Related Conditions III (NESARC-III). J Psychiatr Res 2018; 105:1-8. [PMID: 30118996 PMCID: PMC7551804 DOI: 10.1016/j.jpsychires.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022]
Abstract
We used the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a nationally representative sample of US adults (n = 34,653), to estimate the prevalence and correlates of HIV testing and HIV status. The diagnostic interview used was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version. We found that in 2012-2013, the prevalence of a history of HIV testing was 53.0% among females and 47.0% among males. Among individuals tested, the prevalence of HIV was 1.06%, resulting in a known estimated prevalence of 0.54% in the full sample. In adjusted results, being non-white, aged 30-44, having college, being non-heterosexual, having history of unprotected sex or history of childhood sexual abuse and lower mental health-related quality of life increased the odds of having been tested, whereas being foreign-born, 45 years or older, family income ≥$20,000, being unemployed or a student, living in a rural setting and older age at first sex lowered those odds. Among those tested, being 30-64, being non-heterosexual, having history of unprotected sex or having a sexually transmitted disease in the last year was associated with greater odds of being HIV+. Having some college decreased those odds. In the adjusted results all psychiatric disorders were associated with increased rates of HIV testing, but only a lifetime history of drug use disorder and antisocial personality disorders were associated with HIV status among those tested. Despite CDC recommendations, only about half of US adults have ever been tested for HIV, interfering with efforts to eradicate HIV infection.
Collapse
|
65
|
Wood BR, Bell C, Carr J, Aleshire R, Behrens CB, Dunaway SB, Shah JA, Barnabas RV, Green ML, Ramers CB, Fina PL, Kim HN, Harrington RD. Washington state satellite HIV clinic program: a model for delivering highly effective decentralized care in under-resourced communities. AIDS Care 2018; 30:1120-1127. [PMID: 29852744 DOI: 10.1080/09540121.2018.1481194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
To improve access to high-quality HIV care in underserved regions of Western Washington (WA) State, we collaborated with the WA State Department of Health (DOH) and community partners to launch four satellite HIV clinics. Here, we describe this innovative clinical care model, present an estimate of costs, and evaluate patient care outcomes, including virologic suppression rates. To accomplish this, we assessed virologic suppression rates 12 months before and 12 months after the satellite clinics opened, comparing people living with HIV (PLWH) who enrolled in the satellite clinics versus all PLWH in the same regions who did not. We also determined virologic suppression rates in 2015 comparing satellite clinic versus non-satellite clinic patients and compared care quality indicators between the satellite clinics and the parent academic clinic. Results demonstrate that the change in virologic suppression rate 12 months before to 12 months after the satellite clinics opened was higher for patients who enrolled in the satellite clinics compared to all those in the same region who did not (18% versus 6%, p < 0.001). Virologic suppression in 2015 was significantly higher for satellite clinic than non-satellite clinic patients at three of four sites. Care quality indicators were met at a high level at the satellite clinics, comparable to the parent academic clinic. Overall, through community partnerships and WA DOH support, the satellite clinic program increased access to best practice HIV care and improved virologic suppression rates in difficult-to-reach areas. This model could be expanded to other regions with inadequate access to HIV practitioners, though financial support is necessary.
Collapse
Affiliation(s)
- Brian R Wood
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Christopher Bell
- b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Jason Carr
- c Infectious Disease Assessment Unit , Washington State Department of Health , Olympia , WA , USA
| | - Richard Aleshire
- c Infectious Disease Assessment Unit , Washington State Department of Health , Olympia , WA , USA
| | - Christopher B Behrens
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Shelia B Dunaway
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Javeed A Shah
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Ruanne V Barnabas
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Margaret L Green
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Christian B Ramers
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Pegi L Fina
- b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - H Nina Kim
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Robert D Harrington
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| |
Collapse
|
66
|
Kalichman S, Katner H, Banas E, Kalichman M. Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:517-525. [PMID: 28190136 DOI: 10.1007/s11121-017-0761-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.
Collapse
Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | | | - Ellen Banas
- Mercer University Medical School, Macon, GA, USA
| | - Moira Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| |
Collapse
|
67
|
A Mixed-Methods Exploration of the Needs of People Living with HIV (PLWH) Enrolled in Access to Care, a National HIV Linkage, Retention and Re-Engagement in Medical Care Program. AIDS Behav 2018; 22:819-828. [PMID: 28550379 DOI: 10.1007/s10461-017-1809-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Competing needs pose barriers to engagement in HIV medical care. Mixed methods were used to explore and describe the needs of participants enrolled in Access to Care, a national HIV linkage, retention and re-engagement in care (LRC) program that served people living with HIV who knew their status but were not engaged in care. When asked to prioritize their most urgent needs, participants reported housing or shelter (31%), HIV medical services (24%), and employment (8%). When we assessed the HIV continuum of care by needs status, we found no significant differences in linkage, retention, or viral suppression between participants with and without basic needs. Qualitative interviews with program staff contextualized the barriers to HIV medical care faced by participants and explored the strategies used by LRC programs to address participant needs. Study findings will be of use to future programs and have implications for HIV policy, in particular the implementation of the National HIV/AIDS Strategy (2015-2020).
Collapse
|
68
|
Hoots BE, Finlayson TJ, Wejnert C, Paz-Bailey G. Updated Data on Linkage to Human Immunodeficiency Virus Care and Antiretroviral Treatment Among Men Who Have Sex With Men-20 Cities, United States. J Infect Dis 2017; 216:808-812. [PMID: 28368493 DOI: 10.1093/infdis/jix007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/10/2017] [Indexed: 11/14/2022] Open
Abstract
We examined differences in prevalence of linkage to care and antiretroviral (ARV) treatment among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) between 2008 and 2014 in National HIV Behavioral Surveillance. Prevalence of linkage to care increased from 79% in 2008 to 87% in 2014 (prevalence ratio [PR], 1.05; 95% confidence interval [CI], 1.03-1.07). ARV treatment increased from 69% in 2008 to 88% in 2014 (adjusted PR, 1.15; 95% CI, 1.12-1.18). Despite these increases, a large disparity in ARV treatment between white and black MSM remains. Increased resources are needed to support immediate referrals for ARV treatment for all MSM newly diagnosed with HIV.
Collapse
Affiliation(s)
- Brooke E Hoots
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa J Finlayson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
69
|
The North Carolina HIV Bridge Counselor Program: Outcomes From a Statewide Level Intervention to Link and Reengage HIV-Infected Persons in Care in the South. J Acquir Immune Defic Syndr 2017; 76:e7-e14. [PMID: 28394820 DOI: 10.1097/qai.0000000000001389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To improve the HIV continuum of care, a team of field service interventionists (State Bridge Counselors, SBC) was developed through a state public health system and provided brief (1-2) contacts for linkage of newly diagnosed persons with HIV and reengagement of persons living with HIV (PLWH) who were not in care. SETTING North Carolina, United States. METHODS Service data from January 2013 to June 2015 were analyzed to determine characteristics of clients referred to SBCs, proportions linked or reengaged in care, and/or achieved viral load suppression (VLs). We evaluated associations between client characteristics and outcomes using multivariable analyses and estimated odds ratios (OR) with 95% confidence intervals (CI). RESULTS SBCs provided linkage services to 299 newly diagnosed individuals and reengagement services to 606 PLWH throughout North Carolina. Among persons who received linkage services, 189 (63%) had evidence of care within 90 days of referral and 205 (69%) had VLs within a year. Among PLWH who received reengagement services, 278 (46%) had care within 90 days and 308 (51%) had VLs within a year. Persons aged 30-39 years (OR, 2.1; 95% CI, 1.1 to 3.9) and 40-49 years had an increased likelihood (OR, 2.4; 95% CI, 1.1 to 5.2) of linkage within 90 days compared with persons aged 18-29 years. Non-white PLWH had an increased OR of 1.7; (95% CI, 1.2 to 2.5) of reengagement compared with whites. CONCLUSIONS Our SBC program successfully implemented a "low-touch" approach to provision of linkage and reengagement services, demonstrating that public health resources can be used to address the HIV care continuum on a statewide level.
Collapse
|
70
|
Bosh KA, Shi J, Chen M. Survival After HIV Infection Stage 3 (AIDS) Diagnosis, by Population Density Areas, United States, 2005-2010. Public Health Rep 2017; 132:570-578. [PMID: 28800284 DOI: 10.1177/0033354917722143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We examined the survival rates after diagnosis of HIV infection stage 3 (AIDS) in the United States by population density area of residence at diagnosis. METHODS We used data from the National HIV Surveillance System to calculate survival rates among people aged ≥13 with HIV infection stage 3 (AIDS) diagnosed from 2005 through 2010. We determined survival rates for more than 12, 24, and 36 months after diagnosis; overall and by demographic characteristics; and across 3 population density area categories (large metropolitan statistical areas [MSAs, ≥500 000 people], small-to-medium MSAs [50 000 to 499 999 people], and nonmetropolitan areas [<50 000 people]). RESULTS The survival rates for more than 12, 24, and 36 months after diagnosis were highest among people residing in large MSAs (90.2%, 87.2%, and 84.9%, respectively) and lowest among people residing in nonmetropolitan areas (87.3%, 84.1%, and 81.4%, respectively). With a few exceptions, survival rates were lower in those residing in nonmetropolitan areas than those residing in large MSAs and small-to-medium MSAs across most subgroups by age at diagnosis, race/ethnicity, sex, transmission category, region of residence, and year of diagnosis. Between 2005 and 2010, significant year-to-year increases occurred in the proportion of people surviving more than 36 months after diagnosis across all 3 population density area categories (estimated annual percentage change: large MSAs [0.88; 95% confidence interval (CI), 0.56-1.20]; small-to-medium MSAs [0.94; 95% CI, 0.06-1.83]; and nonmetropolitan areas [1.26; 95% CI, 0.07-2.46]). CONCLUSIONS Although survival rates for those with HIV infection stage 3 (AIDS) improved in all 3 population density area categories, efforts to remove barriers to care and promote treatment adherence in nonmetropolitan areas will be necessary to eliminate survival disparities.
Collapse
Affiliation(s)
- Karin A Bosh
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mi Chen
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
71
|
Hubach RD, Currin JM, Sanders CA, Durham AR, Kavanaugh KE, Wheeler DL, Croff JM. Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:315-329. [PMID: 28825858 DOI: 10.1521/aeap.2017.29.4.315] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.
Collapse
Affiliation(s)
- Randolph D Hubach
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Joseph M Currin
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Carissa A Sanders
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - André R Durham
- School of Educational Foundations, Leadership, and Aviation, Oklahoma State University
| | - Katherine E Kavanaugh
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Julie M Croff
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| |
Collapse
|
72
|
Schafer KR, Albrecht H, Dillingham R, Hogg RS, Jaworsky D, Kasper K, Loutfy M, MacKenzie LJ, McManus KA, Oursler KAK, Rhodes SD, Samji H, Skinner S, Sun CJ, Weissman S, Ohl ME. The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions. J Acquir Immune Defic Syndr 2017; 75:35-44. [PMID: 28225437 PMCID: PMC6169533 DOI: 10.1097/qai.0000000000001329] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural-urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.
Collapse
Affiliation(s)
- Katherine R Schafer
- *Section on Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, NC; †Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine; ‡Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA; §Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; ‖BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; ¶Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada; #Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada; **Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada; ††CIHR Canadian HIV Trials Network, Vancouver, BC, Canada; ‡‡Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada; §§Carver College of Medicine, University of Iowa, Iowa City, IA; ‖‖Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Salem, VA; ¶¶Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC; ##British Columbia Centre for Disease Control, Vancouver, BC, Canada; ***University of Saskatchewan, Saskatoon, SK, Canada; and †††Oregon Health & Science University-Portland State University School of Public Health, Portland, OR
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
73
|
Koirala S, Deuba K, Nampaisan O, Marrone G, Ekström AM. Facilitators and barriers for retention in HIV care between testing and treatment in Asia-A study in Bangladesh, Indonesia, Lao, Nepal, Pakistan, Philippines and Vietnam. PLoS One 2017; 12:e0176914. [PMID: 28459881 PMCID: PMC5411091 DOI: 10.1371/journal.pone.0176914] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/06/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction The need for efficient retention in HIV care is more evident than ever because of the expansion of earlier ART initiation and the shift towards ‘Test and Treat’. This study assesses factors affecting participation in the HIV care cascade among people living with HIV (PLHIV) in the Asia-Pacific Region. Methods A total of 7843 PLHIV aged 18–50 years were recruited using targeted and venue-based sampling between October 1, 2012, and May 31, 2013, across 59 sites in 7 countries (Bangladesh, Indonesia, Lao People's Democratic Republic (Lao PDR), Nepal, Pakistan, Philippines and Vietnam). Statistically significant associations between demographic and health system determinants, and various steps in the HIV care cascade were computed using a generalized structural equation model. Results A high proportion of PLHIV (40–51%) presented late for HIV care and delayed linkage to care in all seven countries. However, once PLHIV enrolled in care, retention in the various steps of the care cascade including adherence to antiretroviral treatment (ART) was satisfactory. The proportion still engaged in HIV care at 36 months post HIV diagnosis, varied from 78% in Nepal to >90% in Lao PDR. Similarly, the proportion of ART initiation who also were adherent to ART ranged from 91% in Bangladesh to >95% in Philippines/ Vietnam and from 70% in Lao PDR to 89% in the Philippines respectively. The following factors enhanced the likelihood of ART initiation and high adherence to HIV care and ART: good client-provider communication, high HIV treatment literacy, a referral from a health worker and TB/HIV co-infection. The following barriers were identified: young age, sex work, imprisonment, transgender identity, illiteracy, rural residence, alcohol/ injecting drug use, perceived poor health status, lack of health insurance, fear of confidentiality breach, self-referral for HIV testing, and public hospital as the place of HIV diagnosis. Conclusions HIV programme planners should ensure easy access to HIV testing and earlier linkage to HIV care among PLHIV. In addition, multiple socio-economic and health systems barriers need to be addressed along the HIV care cascade to reach the UNAIDS 90-90-90 target in the Asia-Pacific region.
Collapse
Affiliation(s)
- Sushil Koirala
- Asia Pacific Network of People Living with HIV/AIDS, Bangkok, Thailand
| | - Keshab Deuba
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Oranuch Nampaisan
- Asia Pacific Network of People Living with HIV/AIDS, Bangkok, Thailand
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
74
|
Rhodes CM, Chang Y, Regan S, Singer DE, Triant VA. Human Immunodeficiency Virus (HIV) Quality Indicators Are Similar Across HIV Care Delivery Models. Open Forum Infect Dis 2017; 4:ofw240. [PMID: 28480238 DOI: 10.1093/ofid/ofw240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are limited data on human immunodeficiency virus (HIV) quality indicators according to model of HIV care delivery. Comparing HIV quality indicators by HIV care model could help inform best practices because patients achieving higher levels of quality indicators may have a mortality benefit. METHODS Using the Partners HIV Cohort, we categorized 1565 patients into 3 HIV care models: infectious disease provider only (ID), generalist only (generalist), or infectious disease provider and generalist (ID plus generalist). We examined 12 HIV quality indicators used by 5 major medical and quality associations and grouped them into 4 domains: process, screening, immunization, and HIV management. We used generalized estimating equations to account for most common provider and multivariable analyses adjusted for prespecified covariates to compare composite rates of HIV quality indicator completion. RESULTS We found significant differences between HIV care models, with the ID plus generalists group achieving significantly higher quality measures than the ID group in HIV management (94.4% vs 91.7%, P = .03) and higher quality measures than generalists in immunization (87.8% vs 80.6%, P = .03) in multivariable adjusted analyses. All models achieved rates that equaled or surpassed previously reported quality indicator rates. The absolute differences between groups were small and ranged from 2% to 7%. CONCLUSIONS Our results suggest that multiple HIV care models are effective with respect to HIV quality metrics. Factors to consider when determining HIV care model include healthcare setting, feasibility, and physician and patient preference.
Collapse
Affiliation(s)
- Corinne M Rhodes
- University of Pennsylvania, Division of General Internal Medicine, Philadelphia, Pennsylvania; Massachusetts General Hospital, Divisions of
| | - Yuchiao Chang
- General Internal Medicine.,Harvard Medical School, Boston, Massachusetts
| | - Susan Regan
- General Internal Medicine.,Harvard Medical School, Boston, Massachusetts
| | - Daniel E Singer
- General Internal Medicine.,Harvard Medical School, Boston, Massachusetts
| | - Virginia A Triant
- General Internal Medicine.,Infectious Diseases, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
75
|
Rhodes CM, Chang Y, Regan S, Triant VA. Non-Communicable Disease Preventive Screening by HIV Care Model. PLoS One 2017; 12:e0169246. [PMID: 28060868 PMCID: PMC5218477 DOI: 10.1371/journal.pone.0169246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/14/2016] [Indexed: 12/30/2022] Open
Abstract
Importance The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population. Objective The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates. Design Prospective observational cohort study. Setting Partners HealthCare System (PHS) encompassing Brigham & Women’s Hospital, Massachusetts General Hospital, and affiliated community health centers. Participants PLWHA age >18 engaged in active primary care at PHS. Exposure HIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers. Main Outcome(s) and Measures(s) Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer. Results In a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models. Conclusions There were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.
Collapse
Affiliation(s)
- Corinne M. Rhodes
- Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Susan Regan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Virginia A. Triant
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
76
|
Nelson JA, Kinder A, Johnson AS, Hall HI, Hu X, Sweet D, Guido A, Katner H, Janelle J, Gonzalez M, Paz NM, Ledonne C, Henry J, Bramel T, Harris J. Differences in Selected HIV Care Continuum Outcomes Among People Residing in Rural, Urban, and Metropolitan Areas-28 US Jurisdictions. J Rural Health 2016; 34:63-70. [PMID: 27620836 DOI: 10.1111/jrh.12208] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/24/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. METHODS We analyzed the Centers for Disease Control and Prevention's National HIV Surveillance System data on adults and adolescents (≥13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (≥1 CD4 or viral load test ≤3 months of diagnosis), retention in care (≥2 CD4 and/or viral load tests ≥3 months apart), and viral suppression (viral load <200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (<50,000 population), urban (50,000-499,999 population), and metropolitan (≥500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. FINDINGS Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). CONCLUSIONS Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States.
Collapse
Affiliation(s)
- John A Nelson
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Anna Kinder
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Casper Natrona County Health Department, Casper, Wyoming
| | - Anna Satcher Johnson
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - H Irene Hall
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Xiaohong Hu
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Donna Sweet
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Medicine, University of Kansas, Wichita, Kansas
| | - Alyssa Guido
- College of Medicine, University of Arizona, Tucson, Arizona
| | - Harold Katner
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Medicine, Mercer University, Macon, Georgia
| | - Jennifer Janelle
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Department of Medicine, University of Florida, Gainesville, Florida
| | - Maribel Gonzalez
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Florida Department of Health, LaBelle, Florida
| | - Natalia Martínez Paz
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,School of Medicine, University of Washington, Seattle, Washington
| | - Charlotte Ledonne
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,San Luis Valley Area Health Education Center, Alamosa, Colorado
| | - Jason Henry
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Northeast/Caribbean AIDS Education and Training Center, St. Croix, US Virgin Islands
| | - Theresa Bramel
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Jeanne Harris
- Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey.,College of Medicine, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
77
|
Chakraborty H, Weissman S, Duffus WA, Hossain A, Varma Samantapudi A, Iyer M, Albrecht H. HIV community viral load trends in South Carolina. Int J STD AIDS 2016; 28:265-276. [PMID: 27037110 DOI: 10.1177/0956462416642349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community viral load is an aggregate measure of HIV viral load in a particular geographic location, community, or subgroup. Community viral load provides a measure of disease burden in a community and community transmission risk. This study aims to examine community viral load trend in South Carolina and identify differences in community viral load trends between selected population subgroups using a state-wide surveillance dataset that maintains electronic records of all HIV viral load measurements reported to the state health department. Community viral load trends were examined using random mixed effects models, adjusting for age, race, gender, residence, CD4 counts, HIV risk group, and initial antiretroviral regimen during the study period, and time. The community viral load gradually decreased from 2004 to 2013 ( p < 0.0001). The number of new infections also decreased ( p = 0.0001) over time. A faster rate of decrease was seen among men compared to women ( p < 0.0001), men who have sex with men ( p = 0.0001) compared to heterosexuals, patients diagnosed in urban areas compared to that in rural areas ( p = 0.0004), and patients prescribed single-tablet regimen compared to multiple-tablet regimen ( p < 0.0001). While the state-wide community viral load decreased over time, the decline was not uniform among residence at diagnosis, HIV risk group, and single-tablet regimen versus multiple-tablet regimen subgroups. Slower declines in community viral load among females, those in rural areas, and heterosexuals suggest possible disparities in care that require further exploration. The association between using single-tablet regimen and faster community viral load decline is noteworthy.
Collapse
Affiliation(s)
- Hrishikesh Chakraborty
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sharon Weissman
- 2 Division of Infectious Disease, Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Wayne A Duffus
- 2 Division of Infectious Disease, Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Akhtar Hossain
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ashok Varma Samantapudi
- 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Medha Iyer
- 3 Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Helmut Albrecht
- 2 Division of Infectious Disease, Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| |
Collapse
|
78
|
Hargreaves JR, Stangl A, Bond V, Hoddinott G, Krishnaratne S, Mathema H, Moyo M, Viljoen L, Brady L, Sievwright K, Horn L, Sabapathy K, Ayles H, Beyers N, Bock P, Fidler S, Griffith S, Seeley J, Hayes R. HIV-related stigma and universal testing and treatment for HIV prevention and care: design of an implementation science evaluation nested in the HPTN 071 (PopART) cluster-randomized trial in Zambia and South Africa. Health Policy Plan 2016; 31:1342-1354. [PMID: 27375126 DOI: 10.1093/heapol/czw071] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Stigma and discrimination related to HIV and key populations at high risk of HIV have the potential to impede the implementation of effective HIV prevention and treatment programmes at scale. Studies measuring the impact of stigma on these programmes are rare. We are conducting an implementation science study of HIV-related stigma in communities and health settings within a large, pragmatic cluster-randomized trial of a universal testing and treatment intervention for HIV prevention in Zambia and South Africa and will assess how stigma affects, and is affected by, implementation of this intervention. METHODS/DESIGN A mixed-method evaluation will be nested within HIV prevention trials network (HPTN) 071/PopART (Clinical Trials registration number NCT01900977), a three-arm trial comparing universal door-to-door delivery of HIV testing and referral to prevention and treatment services, accompanied by either an immediate offer of anti-retroviral treatment to people living with HIV regardless of clinical status, or an offer of treatment in-line with national guidelines, with a standard-of-care control arm. The primary outcome of HPTN 071/PopART is HIV incidence measured among a cohort of 52 500 individuals in 21 study clusters. Our evaluation will include integrated quantitative and qualitative data collection and analysis in all trial sites. We will collect quantitative data on indicators of HIV-related stigma over 3 years from large probability samples of community members, health workers and people living with HIV. We will collect qualitative data, including in-depth interviews and observations from members of these same groups sampled purposively. In analysis, we will: (1) compare HIV-related stigma measures between study arms, (2) link data on stigma to measures of the success of implementation of the PopART intervention and (3) explore changes in the dominant drivers and manifestations of stigma in study communities and the health system. DISCUSSION HIV-related stigma may impede the successful implementation of HIV prevention and treatment programmes. Using a novel study-design nested within a large, community randomized trial we will evaluate the extent to which HIV-related stigma affects and is affected by the implementation of a comprehensive combination HIV prevention intervention including a universal test and treatment approach.
Collapse
Affiliation(s)
- James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Anne Stangl
- International Center for Research on Women, 1120 20th St NW, Suite 500 North, Washington, DC 20036, USA
| | - Virginia Bond
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Lower Level Clinical Building, Fransie Van Zyl Street, Parow Valley, Cape Town, 7500, South Africa
| | - Shari Krishnaratne
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hlengani Mathema
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Lower Level Clinical Building, Fransie Van Zyl Street, Parow Valley, Cape Town, 7500, South Africa
| | - Maureen Moyo
- Zambart, ZAMBART House, Ridgeway Campus, Lusaka, Zambia
| | - Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Lower Level Clinical Building, Fransie Van Zyl Street, Parow Valley, Cape Town, 7500, South Africa
| | - Laura Brady
- International Center for Research on Women, 1120 20th St NW, Suite 500 North, Washington, DC 20036, USA
| | - Kirsty Sievwright
- International Center for Research on Women, 1120 20th St NW, Suite 500 North, Washington, DC 20036, USA
| | - Lyn Horn
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Lower Level Clinical Building, Fransie Van Zyl Street, Parow Valley, Cape Town, 7500, South Africa
| | - Kalpana Sabapathy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Helen Ayles
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,Zambart, ZAMBART House, Ridgeway Campus, Lusaka, Zambia
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Lower Level Clinical Building, Fransie Van Zyl Street, Parow Valley, Cape Town, 7500, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Lower Level Clinical Building, Fransie Van Zyl Street, Parow Valley, Cape Town, 7500, South Africa
| | - Sarah Fidler
- 7Department of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Sam Griffith
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | |
Collapse
|
79
|
Wood BR, Unruh KT, Martinez-Paz N, Annese M, Ramers CB, Harrington RD, Dhanireddy S, Kimmerly L, Scott JD, Spach DH. Impact of a Telehealth Program That Delivers Remote Consultation and Longitudinal Mentorship to Community HIV Providers. Open Forum Infect Dis 2016; 3:ofw123. [PMID: 27703991 PMCID: PMC5047402 DOI: 10.1093/ofid/ofw123] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 01/09/2023] Open
Abstract
Background. To increase human immunodeficiency virus (HIV) care capacity in our region, we designed a distance mentorship and consultation program based on the Project ECHO (Extension for Community Healthcare Outcomes) model, which uses real-time interactive video to regularly connect community providers with a multidisciplinary team of academic specialists. This analysis will (1) describe key components of our program, (2) report types of clinical problems for which providers requested remote consultation over the first 3.5 years of the program, and (3) evaluate changes in participants' self-assessed HIV care confidence and knowledge over the study period. Methods. We prospectively tracked types of clinical problems for which providers sought consultation. At baseline and regular intervals, providers completed self-efficacy assessments. We compared means using paired-samples t test and examined the statistical relationship between each survey item and level of participation using analysis of variance. Results. Providers most frequently sought consultation for changing antiretroviral therapy, evaluating acute symptomatology, and managing mental health issues. Forty-five clinicians completed a baseline and at least 1 repeat assessment. Results demonstrated significant increase (P < .05) in participants' self-reported confidence to provide a number of essential elements of HIV care. Significant increases were also reported in feeling part of an HIV community of practice and feeling professionally connected to academic faculty, which correlated with level of program engagement. Conclusions. Community HIV practitioners frequently sought support on clinical issues for which no strict guidelines exist. Telehealth innovation increased providers' self-efficacy and knowledge while decreasing professional isolation. The ECHO model creates a virtual network for peer-to-peer support and longitudinal mentorship, thus strengthening capacity of the HIV workforce.
Collapse
Affiliation(s)
- Brian R Wood
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Kenton T Unruh
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Natalia Martinez-Paz
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | - Mary Annese
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| | | | | | | | | | | | - David H Spach
- University of Washington,; Mountain West AIDS Education and Training Center, Seattle, Washington
| |
Collapse
|
80
|
Abstract
A group of nine states in the Southern United States, hereafter referred to as the targeted states, has experienced particularly high HIV diagnosis and case fatality rates. To provide additional information about the HIV burden in this region, we used CDC HIV surveillance data to examine characteristics of individuals diagnosed with HIV in the targeted states (2011), 5-year HIV and AIDS survival, and deaths among persons living with HIV (2010). We used multivariable analyses to explore the influence of residing in the targeted states at diagnosis on deaths among persons living with HIV after adjustment for demographics and transmission risk. In 2011, the targeted states had a higher HIV diagnosis rate (24.5/100,000 population) than the US overall (18.0/100,000) and higher proportions than other regions of individuals diagnosed with HIV who were black, female, younger, and living in suburban and rural areas. Furthermore, the targeted states had lower HIV and AIDS survival proportions (0.85, 0.73, respectively) than the US overall (0.86, 0.77, respectively) and the highest death rate among persons living with HIV of any US region. Regional differences in demographics and transmission risk did not explain the higher death rate among persons living with HIV in the targeted states indicating that other factors contribute to this disparity. Differences in characteristics and outcomes of individuals with HIV in the targeted states are critical to consider when creating strategies to address HIV in the region, as are other factors identified in previous research to be prominent in the region including poverty and stigma.
Collapse
|
81
|
Berger MB, Sullivan KA, Parnell HE, Keller J, Pollard A, Cox ME, Clymore JM, Quinlivan EB. Barriers and Facilitators to Retaining and Reengaging HIV Clients in Care: A Case Study of North Carolina. J Int Assoc Provid AIDS Care 2015; 15:486-493. [PMID: 26567224 DOI: 10.1177/2325957415616491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Retention in HIV care is critical to decrease disease-related mortality and morbidity and achieve national benchmarks. However, a myriad of barriers and facilitators impact retention in care; these can be understood within the social-ecological model. To elucidate the unique factors that impact consistent HIV care engagement, a qualitative case study was conducted in North Carolina to examine the barriers and facilitators to retain and reengage HIV clients in care. HIV professionals (n = 21) from a variety of health care settings across the state participated in interviews that were transcribed and analyzed for emergent themes. Respondents described barriers to care at all levels within the HIV prevention and care system including intrapersonal, interpersonal, institutional, community, and public policy. Participants also described recent statewide initiatives with the potential to improve care engagement. Results from this study may assist other states with similar challenges to identify needed programs and priorities to optimize client retention in HIV care.
Collapse
Affiliation(s)
- Miriam B Berger
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kristen A Sullivan
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Heather E Parnell
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jennifer Keller
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alice Pollard
- North Carolina Community Health Center Association, Raleigh, NC, USA
| | - Mary E Cox
- Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Jacquelyn M Clymore
- Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Evelyn Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
82
|
Lima VD, Goldberg N, Lourenço L, Chau W, Hogg RS, Guillemi S, Barrios R, Montaner JSG. Virologic suppression and mortality of patients who migrate for HIV care in the province of British Columbia, Canada, from 2003 to 2012: a retrospective cohort study. BMC Health Serv Res 2015; 15:376. [PMID: 26369664 PMCID: PMC4570764 DOI: 10.1186/s12913-015-1042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/04/2015] [Indexed: 01/27/2023] Open
Abstract
Background Migration among persons living with HIV (PLWH) seeking HIV care is common; however its effect on health outcomes in resource-rich settings is not well understood. We conducted a retrospective cohort study to quantify the extent to which PLWH are migrating for care within British Columbia (BC) and its association with virologic suppression and mortality. Methods Eligible PLWH first initiated treatment in BC between 2003 and 2012 (N = 3653). Analyses were performed at the regional Health Authority (HA) level (N = 5). For privacy reasons, we kept the name of these HAs anonymous and we re-named these five regions as 1 to 5. PLWH were classified according to the HA where they resided and received HIV care. We calculated all-cause mortality rates, life expectancies (at age of 20 years), and in, out and net migration rates across HAs using different demographic methods. Virologic suppression (<50 copies/mL) was based on the last viral load available for each PLWH. We also calculated per-capita rates (per 100 PLWH ever on cART) for each HA by dividing the number of PLWH by the number of physicians attending this population. Results There is considerable heterogeneity in physician availability across all HAs, with per-capita rates (per 100 PLWH ever on cART) ranging from 2.2 (HA 1) to 12.7 (HA 3) based on the HA PLWH received care. We observed that in HAs 1, 4, and 5, between 4 and 10 % of PLWH migrated to HA 3 (i.e. the largest urban center) to receive care, and for HA 2 this proportion increased to 21 %. In HA 3, 77 % of its PLWH residents remained in the same HA for their care. Migrating to a larger center for HIV care was not associated with higher rates of viral load suppression; it was significantly associated with lower mortality rates and higher life expectancies. Conclusions A thorough understanding of the reason(s) for these significant migration rates across BC will be critical to inform resource allocation and optimize the impact of HIV treatment.
Collapse
Affiliation(s)
- Viviane Dias Lima
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6. .,Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6.
| | - Nicola Goldberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada, M5S 1A8.
| | - Lillian Lourenço
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6.
| | - William Chau
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6.
| | - Robert S Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada, V5A 1S6.
| | - Silvia Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6.
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6.
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6. .,Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6.
| |
Collapse
|
83
|
Barefoot KN, Smalley KB, Warren JC. Psychological Distress and Perceived Barriers to Care for Rural Lesbians. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015. [DOI: 10.1080/19359705.2015.1041629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
84
|
Hubach RD, Dodge B, Schick V, Ramos WD, Herbenick D, Li MJ, Cola T, Reece M. Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas. CULTURE, HEALTH & SEXUALITY 2015; 17:795-809. [PMID: 25608847 DOI: 10.1080/13691058.2014.994231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21-48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies.
Collapse
Affiliation(s)
- Randolph D Hubach
- a School of Applied Health and Educational Psychology, Oklahoma State University , Stillwater , USA
| | | | | | | | | | | | | | | |
Collapse
|
85
|
Setlhare V, Wright A, Couper I. The experiences of people living with HIV/AIDS in Gaborone, Botswana: stigma, its consequences and coping mechanisms. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786190.2014.975484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
86
|
Measuring food and nutrition security: tools and considerations for use among people living with HIV. AIDS Behav 2014; 18 Suppl 5:S490-504. [PMID: 24297517 DOI: 10.1007/s10461-013-0669-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As an increasing number of countries implement integrated food and nutrition security (FNS) and HIV programs, global stakeholders need clarity on how to best measure FNS at the individual and household level. This paper reviews prominent FNS measurement tools, and describes considerations for interpretation in the context of HIV. There exist a range of FNS measurement tools and many have been adapted for use in HIV-endemic settings. Considerations in selecting appropriate tools include sub-types (food sufficiency, dietary diversity and food safety); scope/level of application; and available resources. Tools need to reflect both the needs of PLHIV and affected households and FNS program objectives. Generalized food sufficiency and dietary diversity tools may provide adequate measures of FNS in PLHIV for programmatic applications. Food consumption measurement tools provide further data for clinical or research applications. Measurement of food safety is an important, but underdeveloped aspect of assessment, especially for PLHIV.
Collapse
|
87
|
Friedman SR, Downing MJ, Smyrnov P, Nikolopoulos G, Schneider JA, Livak B, Magiorkinis G, Slobodianyk L, Vasylyeva TI, Paraskevis D, Psichogiou M, Sypsa V, Malliori MM, Hatzakis A. Socially-integrated transdisciplinary HIV prevention. AIDS Behav 2014; 18:1821-34. [PMID: 24165983 DOI: 10.1007/s10461-013-0643-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.
Collapse
Affiliation(s)
- Samuel R Friedman
- Institute of Infectious Diseases Research, National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
88
|
Kaufman MR, Cornish F, Zimmerman RS, Johnson BT. Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach. J Acquir Immune Defic Syndr 2014; 66 Suppl 3:S250-8. [PMID: 25007194 PMCID: PMC4536982 DOI: 10.1097/qai.0000000000000236] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual–structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.
Collapse
Affiliation(s)
- Michelle R Kaufman
- *Johns Hopkins University Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD; †Department of Methodology, London School of Economics and Political Science, London, UK; ‡University of Missouri-St. Louis, College of Nursing; and §Department of Psychology, University of Connecticut and Center for Health, Intervention, and Prevention, Storrs CT
| | | | | | | |
Collapse
|
89
|
Suphanchaimat R, Sommanustweechai A, Khitdee C, Thaichinda C, Kantamaturapoj K, Leelahavarong P, Jumriangrit P, Topothai T, Wisaijohn T, Putthasri W. HIV/AIDS health care challenges for cross-country migrants in low- and middle-income countries: a scoping review. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:19-38. [PMID: 24600250 PMCID: PMC3942212 DOI: 10.2147/hiv.s56277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction HIV/AIDS has been one of the world’s most important health challenges in recent history. The global solidarity in responding to HIV/AIDS through the provision of antiretroviral therapy (ART) and encouraging early screening has been proved successful in saving lives of infected populations in past decades. However, there remain several challenges, one of which is how HIV/AIDS policies keep pace with the growing speed and diversity of migration flows. This study therefore aimed to examine the nature and the extent of HIV/AIDS health services, barriers to care, and epidemic burdens among cross-country migrants in low-and middle-income countries. Methods A scoping review was undertaken by gathering evidence from electronic databases and gray literature from the websites of relevant international initiatives. The articles were reviewed according to the defined themes: epidemic burdens of HIV/AIDS, barriers to health services and HIV/AIDS risks, and the operational management of the current health systems for HIV/AIDS. Results Of the 437 articles selected for an initial screening, 35 were read in full and mapped with the defined research questions. A high HIV/AIDS infection rate was a major concern among cross-country migrants in many regions, in particular sub-Saharan Africa. Despite a large number of studies reported in Africa, fewer studies were found in Asia and Latin America. Barriers of access to HIV/AIDS services comprised inadequate management of guidelines and referral systems, discriminatory attitudes, language differences, unstable legal status, and financial hardship. Though health systems management varied across countries, international partners consistently played a critical role in providing support for HIV/AIDS services to uninsured migrants and refugees. Conclusion It was evident that HIV/AIDS health care problems for migrants were a major concern in many developing nations. However, there was little evidence suggesting if the current health systems effectively addressed those problems or if such management would sustainably function if support from global partners was withdrawn. More in-depth studies were recommended to further explore those knowledge gaps.
Collapse
Affiliation(s)
- Rapeepong Suphanchaimat
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand ; Banphai Hospital, Khon Kaen, Thailand
| | | | - Chiraporn Khitdee
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| | - Chompoonut Thaichinda
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| | - Kanang Kantamaturapoj
- Department of Social Sciences, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Pattara Leelahavarong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Pensom Jumriangrit
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| | - Thitikorn Topothai
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| | - Thunthita Wisaijohn
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| | - Weerasak Putthasri
- International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand
| |
Collapse
|
90
|
Weissman S, Duffus WA, Vyavaharkar M, Samantapudi AV, Shull KA, Stephens TG, Chakraborty H. Defining the rural HIV epidemic: correlations of 3 definitions--South Carolina, 2005-2011. J Rural Health 2013; 30:275-83. [PMID: 24329575 DOI: 10.1111/jrh.12057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To gain a better understanding of the HIV epidemic in rural South Carolina (SC) by contrasting 3 definitions of rural and urban areas. METHODS The sample included newly diagnosed HIV cases aged ≥18 years in SC between January 1, 2005, and December 31, 2011. Each individual was assigned a rural or urban status as defined by the Office of Management and Budget (OMB), Census Bureau (CB), and Rural Urban Commuting Area (RUCA) classifications. Descriptive statistics were conducted to compare sociodemographic characteristics, CD4 counts, viral loads, and time to AIDS diagnosis between rural and urban populations. Kappa statistics measured the agreement between the 3 definitions of rurality. FINDINGS Depending on the definition used, the proportion of newly diagnosed HIV cases in rural areas varied from 23.3% to 32.0%. Based on the OMB and RUCA definitions, rural residents with HIV were more likely to be older, women, black, and non-Hispanic, report heterosexual contact, and have an AIDS diagnosis within 1 year of their HIV diagnosis. The OMB and RUCA definitions had a nearly perfect agreement (kappa = 0.8614; 95% CI = 0.8457, 0.8772), while poor agreements were noted between the OMB and CB or the RUCA and CB definitions. CONCLUSION When examining the rural HIV epidemic, how "rural" is defined matters. Using 3 definitions of rurality, statistically significant differences were found in demographic characteristics, timing of HIV diagnosis and the proportion of rural residents diagnosed with HIV in SC. The findings suggest possible misclassification biases that may adversely influence services and resource distribution.
Collapse
Affiliation(s)
- Sharon Weissman
- Division of Infectious Diseases, Department of Medicine, University of South Carolina, Columbia, South Carolina
| | | | | | | | | | | | | |
Collapse
|