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Freibott CE, Biondi BE, Rao SR, Blokhina E, Dugas JN, Patts G, Bendiks S, Krupitsky E, Chichetto NE, Samet JH, Freiberg MS, Stein MD, Tindle HA. Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV? AIDS Behav 2024; 28:1447-1455. [PMID: 38285292 DOI: 10.1007/s10461-023-04231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
Achieving abstinence from alcohol, tobacco, or both may improve mental health, but is understudied in people with HIV (PWH). The St PETER HIV randomized clinical trial compared varenicline, cytisine, and nicotine replacement therapy on alcohol and smoking behavior among 400 PWH in Russia. The primary exposure was thirty-day point prevalence abstinence (PPA) from (1) alcohol, (2) smoking, (3) both, or (4) neither and was assessed at 1, 3, 6 and 12-months as were the study outcomes of anxiety (GAD-7) and depressive (CES-D) symptoms. The primary aim was to examine the association between smoking and/or alcohol abstinence and subsequent symptoms of depression and anxiety. Primary analysis used repeated measures generalized linear modeling to relate PPA with mental health scores across time. In secondary analyses, Kruskal-Wallis tests related PPA with mental health scores at each timepoint. Primary analyses did not identify significant differences in anxiety or depressive symptoms between exposure groups over time. Secondary analyses found CES-D scores across PPA categories were similar at 1-month (11, 10, 11, 11) and 6-months (10, 10, 11, 11) but differed at 3-months (9, 11, 10, 12; p = 0.035) and 12-months (10, 6, 11, 10; p = 0.019). GAD-7 scores did not vary across PPA categories at any time point. While abstinence was associated with fewer depressive symptoms at times, findings were not consistent during follow-up, perhaps reflecting intermittent relapse. PWH with polysubstance use and mental health comorbidity are complex, and larger samples with sustained abstinence would further elucidate effects of abstinence on mental health.
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Affiliation(s)
- Christina E Freibott
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA.
| | - Breanne E Biondi
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Julianne N Dugas
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Natalie E Chichetto
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Matthew S Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA
| | - Hilary A Tindle
- Vanderbilt Center for Tobacco, Addiction and Lifestyle (VITAL), Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC), Vanderbilt University Medical Center, Nashville, TN, USA
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Fukunaga R, Pierre P, Williams JK, Briceno-Robaugh R, Kalibala S, Peterson M, Moonan PK. Prioritizing Mental Health within HIV and Tuberculosis Services in PEPFAR. Emerg Infect Dis 2024; 30:1-5. [PMID: 38526190 PMCID: PMC10977845 DOI: 10.3201/eid3004.231726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Underprioritization of mental health is a global problem and threatens the decades-long progress of the US President's Emergency Plan for AIDS Relief (PEPFAR) program. In recent years, mental health has become globally recognized as a part of universal healthcare, making this an opportune moment for the global community to integrate mental health services into routine programming. PEPFAR is well positioned to lead by example. We conceptualized 5 key strategies that might help serve as a framework to support mental health programming as part of PEPFAR's current 5-year strategic plan. PEPFAR and the global community have an opportunity to identify mental health service gaps and interweave global mental health priorities with actions to end the HIV and TB epidemics by 2030.
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Norcini Pala A, Turan B. A Bayesian network analysis to examine the effects of HIV stigma processes on self-concept and depressive symptoms among persons living with HIV. J Pers 2024. [PMID: 38494602 DOI: 10.1111/jopy.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This study examines the relationships between HIV stigma dimensions, self-related mechanisms, and depressive symptoms among persons living with HIV. BACKGROUND HIV stigma hinders the well-being of individuals living with HIV, which is linked to depressive symptoms and increased risk of poor clinical outcomes. However, the mechanisms underlying stigma's impact on depression are poorly understood. Psychosocial theories propose that experiencing HIV stigma leads to internalized stigma, impacting self-concept and mental health. METHOD Using Bayesian network analysis, we explored associations among HIV stigma processes (experienced, anticipated, internalized, perceived community stigma, and HIV status disclosure) and self-related mechanisms (self-esteem, fear of negative evaluation [FNE], self-blame coping, and social exclusion), and depressive symptoms. RESULTS Our diverse sample of 204 individuals, primarily men, gay/bisexual, Black, and lower-middle SES, who experienced stigma showed increased anticipated, internalized, and perceived community stigma, FNE, and depressive symptoms. Internalized stigma contributed to self-blame coping and higher depressive symptoms. Anticipated and perceived community stigma and FNE correlated with increased social exclusion. DISCUSSION This study investigates potential mechanisms through which HIV stigma may impact depression. Identifying these mechanisms establishes a foundation for future research to inform targeted interventions, enhancing mental health and HIV outcomes among individuals living with HIV, especially from minority backgrounds. Insights gained guide evidence-based interventions to mitigate HIV stigma's detrimental effects, ultimately improving overall well-being and health-related outcomes for people with HIV.
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Affiliation(s)
- Andrea Norcini Pala
- Department of Community Health Sciences, SUNY Downstate, New York, New York, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
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Stringer KL, Norcini Pala A, Cook RL, Kempf MC, Konkle-Parker D, Wilson TE, Tien PC, Wingood G, Neilands TB, Johnson MO, Logie CH, Weiser SD, Turan JM, Turan B. Intersectional Stigma, Fear of Negative Evaluation, Depression, and ART Adherence Among Women Living with HIV Who Engage in Substance Use: A Latent Class Serial Mediation Analysis. AIDS Behav 2024:10.1007/s10461-024-04282-6. [PMID: 38489140 DOI: 10.1007/s10461-024-04282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/17/2024]
Abstract
Women Living with HIV (WLHIV) who use substances face stigma related to HIV and substance use (SU). The relationship between the intersection of these stigmas and adherence to antiretroviral therapy (ART), as well as the underlying mechanisms, remains poorly understood. This study aimed to examine the association between intersectional HIV and SU stigma and ART adherence, while also exploring the potential role of depression and fear of negative evaluation (FNE) by other people in explaining this association. We analyzed data from 409 WLHIV collected between April 2016 and April 2017, Using Multidimensional Latent Class Item Response Theory analysis. We identified five subgroups (i.e., latent classes [C]) of WLHIV with different combinations of experienced SU and HIV stigma levels: (C1) low HIV and SU stigma; (C2) moderate SU stigma; (C3) higher HIV and lower SU stigma; (C4) moderate HIV and high SU stigma; and (C5) high HIV and moderate SU stigma. Medication adherence differed significantly among these classes. Women in the class with moderate HIV and high SU stigma had lower adherence than other classes. A serial mediation analysis suggested that FNE and depression symptoms are mechanisms that contribute to explaining the differences in ART adherence among WLHIV who experience different combinations of intersectional HIV and SU stigma. We suggest that FNE is a key intervention target to attenuate the effect of intersectional stigma on depression symptoms and ART adherence, and ultimately improve health outcomes among WLHIV.
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Affiliation(s)
- Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, 37132, USA.
| | | | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Oxford, MS, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Phyllis C Tien
- Department of Medicine, Department of Veteran Affairs Medical Center, University of California, San Francisco and Medical Service, San Francisco, CA, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, USA
- Women's College Research Institute, Women's College Hospital, Toronto, ON, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Public Health, School of Medicine, Koc University, Istanbul, Turkey
| | - Bulent Turan
- College of Social Sciences and Humanities, Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Nante RW, Muyinda H, Kiweewa JM, Ndagire R, Ssendikwanawa E, Ojiambo KO, Nangendo J, Nakku J, Semitala FC. Acceptance of assisted partner notification among HIV-positive adults with severe mental illness at a national referral hospital in Uganda: a cross-sectional study. BMC Health Serv Res 2024; 24:319. [PMID: 38459486 PMCID: PMC10924341 DOI: 10.1186/s12913-024-10770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND HIV mostly affects people with severe mental illnesses (SMIs) than the general population. In 2015, the World Health Organization (WHO) introduced assisted partner notification (APN) as a strategy to increase HIV testing. Although research has demonstrated the effectiveness of APN in the general population, its use among people living with HIV (PLHIV) who have SMI is not well understood. This study sought to determine the acceptance of the APN strategy among PLHIV who had a diagnosis of SMI. METHODS This study used a cross-sectional study design that was retrospective to determine acceptance of APN among PLHIV with a documented diagnosis of SMI. We enrolled participants with a diagnosis of both HIV and SMI from August 2018 to January 2022, attending the HIV clinic at Butabika Hospital. We used pretested questionnaires to extract participants' demographic and clinical data from their existing clinical charts, antiretroviral therapy (ART) registers and APN registers. We defined acceptance of APN as the number of PLHIV with SMI diagnoses who agreed to provide information about their sexual partners. We used modified Poisson regression analysis to assess the factors associated with the acceptance of APN. RESULTS A total of 125 participants were enrolled, of whom 83 (66.4%) were female. The median age was 30 (interquartile range (IQR) (25-34)), and 41 (33%) of them accepted APN (95% CI: 25.05-41.61). Receipt of at least three counselling sessions before enrollment in APN (aPR = 1.8, 95% CI: 1.72-1.98) was the most significant factor associated with increased acceptance of APN. Poor adherence to ART (aPR = 0.62, 95% CI: 0.54-0.80), being escorted to hospital by a distant relative (aPR = 0.55, 95% CI: 0.39-0.80), being married/cohabiting (aPR = 0.65, 95% CI: 0.60-0.81), and being a Seventh Day Adventist (SDA) (aPR = 0.53, 95% CI: 0.45-0.71) or Pentecostal (aPR = 0.44, 95% CI: 0.22-0.98) by faith were associated with reduced acceptance of APN. CONCLUSION AND RECOMMENDATION The acceptance of APN is low among PLHIV with a diagnosis of SMI. More structured counselling would facilitate earlier identification of undiagnosed HIV-positive partners. We recommend a follow-up study to compare acceptance of APN among PLHIV with SMI and those without SMI.
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Affiliation(s)
- Rachel Wangi Nante
- Clinical Epidemiology Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Herbert Muyinda
- Child Health and Development Centre (CHDC), College of Health Sciences, Makerere University, Kampala, Uganda
| | - John M Kiweewa
- Education Department, Fairfield University, Fairfield, CT, USA
| | - Regina Ndagire
- Clinical Epidemiology Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ssendikwanawa
- Clinical Epidemiology Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, Kampala, Uganda
| | - Fred C Semitala
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Mulago Immune Suppression Syndrome Clinic, Mulago National Referral Hospital, Kampala, Uganda
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Kerin T, Cortado R, Paiola SG, Ceballos J, Abdalian SE, Flynn R, Bolan R, Adebambo YV, Sim MS, Swendeman D, Ocasio MA, Fournier J, Ank B, Bryson Y, Nielsen-Saines K. Demographics of Youth With Newly Diagnosed Acute/Recent HIV Infection in Adolescent Trials Network 147: Early Treatment of Acute HIV Infection. J Adolesc Health 2024; 74:573-581. [PMID: 38043041 PMCID: PMC10840998 DOI: 10.1016/j.jadohealth.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE Gay, bisexual, and other cisgender men who have sex with men, and racial minority youth are at elevated risk of acquiring HIV infection. The Adolescent Trials Network 147 recruited youth with acute/recent HIV-infection for early antiretroviral treatment. The cohort make-up is described here. METHODS Treatment-naïve, recently identified HIV + youth, aged 12-24 years, from Los Angeles and New Orleans were recruited from community centers, clinics, social media, and a high-risk seronegative cohort (n = 1,727, the Adolescent Trials Network 149) using point-of-care assays. Acute HIV infection was determined by Fiebig staging. HIV RNA viral load (VL) and CD4 cell counts, along with demographic and behavioral data were assessed at enrollment. RESULTS Between July 2017 and July 2021, 103 newly diagnosed youth were enrolled, initiating antiretroviral treatment within a week. Mean age was 20.8 years (standard deviation: 2.4); 90.3% identified as cis male, 83.5% were single or in casual relationships, 71.8% were gay, bisexual, and other cisgender men who have sex with men; 60.2% were Black. One-fourth (24.3%) reported homelessness ever; 10.7% within last 4 months. At enrollment, median plasma VL was 37,313 HIV RNA copies/ml (interquartile range: 5,849-126,162) and median CD4 count 445.5 cells/mm3 (interquartile range: 357-613). 40% of youth reported acute retroviral symptoms before or at enrollment. Acutely infected, seroconverting youth had the highest VL. Sexually transmitted coinfections were present at enrollment in 56% of the cohort, with syphilis being most frequent (39%). DISCUSSION Early identification and treatment of HIV can increase positive HIV outcomes. A high sexually transmitted infection burden was present in recently HIV-infected youth. Acute retroviral symptoms were not reported by most participants, demonstrating that broad universal HIV screening is needed for identification of recent infection in youth.
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Affiliation(s)
- Tara Kerin
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
| | - Ruth Cortado
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Sophia G Paiola
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Justine Ceballos
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Sue Ellen Abdalian
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana
| | - Risa Flynn
- The Los Angeles LGBT Center, Los Angeles, California
| | - Robert Bolan
- The Los Angeles LGBT Center, Los Angeles, California
| | - Yetunde V Adebambo
- UCLA Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, California
| | - Myung Shin Sim
- UCLA Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, California
| | - Dallas Swendeman
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Manuel A Ocasio
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana
| | - Jasmine Fournier
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana
| | - Bonnie Ank
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Yvonne Bryson
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Hernandez M, Guarino H, Kozlowski S, Srivastava A, Schenkel R, Tapia T, Seabrook TB, Nash D, Irvine MK. Addressing Mental Health Barriers in HIV Care Coordination Is Crucial to Providing Optimal HIV/AIDS Care. AIDS Patient Care STDS 2024; 38:107-114. [PMID: 38471091 PMCID: PMC11301708 DOI: 10.1089/apc.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
For people with HIV (PWH) who have psychological comorbidities, effective management of mental health issues is crucial to achieving and maintaining viral suppression. Care coordination programs (CCPs) have been shown to improve outcomes across the HIV care continuum, but little research has focused on the role of care coordination in supporting the mental health of PWH. This study reports qualitative findings from the Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE) study, which evaluated a revised version of an HIV CCP for Ryan White Part A clients in New York City. Semistructured interviews were conducted with 30 providers and 27 clients from 6 CCP-implementing agencies to elucidate barriers and facilitators of program engagement. Transcripts were analyzed for key themes related to clients' mental health needs and providers' successes and challenges in meeting these needs. Providers and clients agreed that insufficiently managed mental health issues are a common barrier to achieving and maintaining viral suppression. Although the CCP model calls for providers to address clients' unmet mental health needs primarily through screening and referrals to psychiatric and/or psychological care, both clients and providers reported that the routine provision of emotional support is a major part of providers' role that is highly valued by clients. Some concerns raised by providers included insufficient training to address clients' mental health needs and an inability to document the provision of emotional support as a delivered service. These findings suggest the potential value of formally integrating mental health services into HIV care coordination provision. ClinicalTrials.gov protocol number: NCT03628287.
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Affiliation(s)
- Miguel Hernandez
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Sarah Kozlowski
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Schenkel
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Thamara Tapia
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Tyeirra B. Seabrook
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Mary K. Irvine
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
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Harkness A, Morales V, Atuluru P, Jaramillo J, Safren SA, Balise R, Turner D. PrEP and Behavioral Health Treatment Referral Among HIV Test Counselors in Miami-Dade County: A Rapid Qualitative Study Using the Consolidated Framework for Implementation Research. AIDS Behav 2024; 28:820-836. [PMID: 37792227 PMCID: PMC11110539 DOI: 10.1007/s10461-023-04184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
HIV test counselors are well positioned to refer individuals to pre-exposure prophylaxis (PrEP) and behavioral health treatments. HIV test counselors in Miami-Dade County (N = 20), a priority jurisdiction for Ending the HIV Epidemic, completed interviews to assess determinants of PrEP and behavioral health treatment referrals. To identify determinants, we used a rapid deductive qualitative analysis approach and the Consolidated Framework for Implementation Research (CFIR). Identified determinants sometimes served as facilitators (e.g., relative priority, leadership importance) and sometimes as barriers (e.g., lack of access to knowledge and information, available resources for referrals) to making referrals. We also observed differences in determinants between PrEP and behavioral health referrals. For example, complexity (perceived difficulty of the referral) was a barrier to behavioral health more often than PrEP referral. Our findings suggest that determinants across many CFIR domains affect referral implementation, and the corresponding need for multiple implementation strategies to improve implementation of PrEP and behavioral health referrals in the context of HIV testing.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr Coral Gables, Coral Gables, FL, 33146, USA.
| | - Vanessa Morales
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | | | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - DeAnne Turner
- College of Nursing, University of South Florida, Tampa, FL, USA
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Scaramutti C, Hervera B, Rivera Y, Chueng TA, Forrest DW, Suarez E, Serota DP, Alkamli H, Ciraldo K, Bartholomew TS, Tookes HE. Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma. Harm Reduct J 2024; 21:50. [PMID: 38396017 PMCID: PMC10893685 DOI: 10.1186/s12954-024-00961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. METHODS During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. RESULTS Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. CONCLUSION PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.
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Affiliation(s)
- Carolina Scaramutti
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Belén Hervera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yanexy Rivera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hatoun Alkamli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Knippler ET, Martinez AJ, Amiri I, Madundo K, Mmbaga BT, Goldston DB, Relf MV, Knettel BA. Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002762. [PMID: 38363789 PMCID: PMC10871509 DOI: 10.1371/journal.pgph.0002762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.
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Affiliation(s)
- Elizabeth T. Knippler
- Duke Center for AIDS Research, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Alyssa J. Martinez
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Jocelyn, Nasution FM, Nasution NA, Asshiddiqi MH, Kimura NH, Siburian MHT, Rusdi ZYN, Munthe AR, Chairenza I, Ginting Munthe MCFB, Sianipar P, Gultom SP, Simamora D, Uswanas IR, Salim E, Khairunnisa K, Syahputra RA. HIV/AIDS in Indonesia: current treatment landscape, future therapeutic horizons, and herbal approaches. Front Public Health 2024; 12:1298297. [PMID: 38420030 PMCID: PMC10899510 DOI: 10.3389/fpubh.2024.1298297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
HIV/AIDS is still a major worldwide health concern, and Indonesia is making efforts to mitigate its effects. Antiretroviral therapy (ARV), which aims to decrease viral replication, boost immunological function, and lengthen the lifespans of persons living with HIV/AIDS, is the cornerstone of Indonesia's strategy. The availability of ARV has significantly increased, yet problems including stigma and the requirement for regular medication adherence still exist. To address the broader needs of those affected by HIV/AIDS, Indonesia lays a major focus on comprehensive care, which includes mental health and social support, in addition to ARV. Data show that, despite progress, there is still a stigma surrounding HIV/AIDS, which affects patient outcomes and access to care. With vigorous research into cutting-edge antiretroviral medications and treatment techniques, Indonesia has a thriving future therapeutic landscape. The goals of these programs are to increase treatment effectiveness, decrease side effects, and increase access to cutting-edge treatments. Preventive methods, such as PrEP (pre-exposure prophylaxis), are making progress, and efforts to find a cure are gaining prominence. Notably, HIV/AIDS management plan of Indonesia heavily relies on natural remedies. Patient care incorporates traditional Indonesian medicine, such as jamu and several herbal medicines. Although there is little scientific proof to support the effectiveness of these herbal remedies, complementary and alternative therapies frequently employ them to manage symptoms and promote general wellness. In terms of the 95-95-95 targets, Indonesia is making an effort to comply with these international goals by seeking to diagnose 95% of HIV-positive individuals, provide sustained ARV to 95% of those diagnosed, and achieve viral suppression in 95% of ARV recipients. Although there are gaps in reaching these aims, progress is being made, in part because of the aforementioned challenges. In summary, Indonesia employs a multimodal approach to HIV/AIDS management, including traditional herbal cures, continuous research into cutting-edge treatments, and conventional ARV. In order to enhance overall health outcomes and create a healthier society, the future of HIV/AIDS treatment in Indonesia is concentrated on expanding therapeutic alternatives, reaching the 95-95-95 targets, decreasing stigma, and improving access to care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rony Abdi Syahputra
- Faculty of Pharmacy, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
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62
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Akoko B, Regan S, Idigbe I, Ezechi O, Pierce LJ, Musa Z, Okonkwo P, Freedberg KA, Ahonkhai AA. HIV-related stigma and psychological distress in a cohort of patients receiving antiretroviral therapy in Nigeria. AIDS Care 2024; 36:204-211. [PMID: 37229763 PMCID: PMC10674032 DOI: 10.1080/09540121.2023.2216006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Psychological distress is increasingly recognized as a barrier to engagement in HIV care, resulting in poor HIV outcomes. HIV-related stigma is a potential driver of distress in people living with HIV (PLWH). We conducted a prospective cohort study in 288 PLWH who newly initiated ART in a Nigeria. We assessed overall stigma (range 40-160) and four stigma subtypes (personalized, disclosure, negative self-image, and public stigma) at enrollment, and assessed psychological distress at enrollment, 6, and 12-months after ART initiation. We used logistic regression to assess the relationship between stigma and 12-month psychological distress. Overall stigma was high (102.34 ± 5.65) and was higher in both unmarried patients (p < 0.01) and those who had not disclosed their HIV status to anyone at enrollment (p < 0.01). Higher overall stigma (OR: 1.05, 95% CI 1.00-1.09) and personalized stigma (OR:1.08, 95% CI 1.00-1.16) were associated with higher odds of psychological distress at 12-months. Conclusions: Overall stigma levels were high in a cohort of PLWH initiating care in Nigeria. Higher stigma was associated with psychological distress. These data support the need for integration of measures to reduce stigma and psychological distress in the care of PLWH.
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Affiliation(s)
- Bentley Akoko
- Emerging Infections Program, Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan Regan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Ifeoma Idigbe
- Nigerian Institute for Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Nigerian Institute for Medical Research, Lagos, Nigeria
| | - Leslie J. Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Zaidat Musa
- Nigerian Institute for Medical Research, Lagos, Nigeria
| | | | - Kenneth A. Freedberg
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aima A. Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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63
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Zaleta AK, Fortune EE, Miller MF, Olson JS, Hollis-Hansen K, Dohn SK, Kwait JL. HIV Support Source: Development of a Distress Screening Measure for Adults with HIV. AIDS Behav 2024; 28:713-727. [PMID: 38261220 DOI: 10.1007/s10461-023-04261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
To provide an effective, multidimensional, and psychometrically valid measure to screen for distress among people with HIV, we developed and assessed the psychometric properties of HIV Support Source, a distress screening, referral, and support program designed to identify the unmet needs of adults with HIV and link them to desired resources and support. Development and testing were completed in three phases: (1) item generation and initial item pool testing (N = 375), (2) scale refinement via exploratory factor analysis (N = 220); external/internal item quality, and judging theoretical and practical implications of items, and (3) confirmatory validation (N = 150) including confirmatory factor analysis along with reliability and validity analyses to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk subscales. The final measure comprises 17-items representing four domains of concern: emotional well-being, financial and practical needs, physical well-being, and HIV treatment and sexual health, plus one screening item assessing tobacco and substance use. Our analyses showed strong internal consistency reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales was 0.90 and 0.79, respectively. HIV Support Source is a reliable and valid multidimensional measure of distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess and support the unmet needs of adults with HIV.
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Affiliation(s)
- Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
- Cancer Care, New York, NY, USA
| | - Erica E Fortune
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
| | - Melissa F Miller
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA.
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
| | - Kelseanna Hollis-Hansen
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
- UT Southwestern Medical Center, O'Donnell School of Public Health, Dallas, TX, USA
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64
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Sheira LA, Ryan KP, Fahey CA, Katabaro ED, Sabasaba AN, Njau PF, McCoy SI. The impact of cash incentives on mental health among adults initiating antiretroviral therapy in Tanzania. AIDS Care 2024; 36:195-203. [PMID: 37321981 PMCID: PMC10721724 DOI: 10.1080/09540121.2023.2222576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Mental illness is prevalent among people living with HIV (PLHIV) and hinders engagement in HIV care. While financial incentives are effective at improving mental health and retention in care, the specific effect of such incentives on the mental health of PLHIV lacks quantifiable evidence. We evaluated the impact of a three-arm randomized controlled trial of a financial incentive program on the mental health of adult antiretroviral therapy (ART) initiates in Tanzania. Participants were randomized 1:1:1 into one of two cash incentive (combined; provided monthly conditional on clinic attendance) or the control arm. We measured the prevalence of emotional distress, depression, and anxiety via a difference-in-differences model which quantifies changes in the outcomes by arm over time. Baseline prevalence of emotional distress, depression, and anxiety among the 530 participants (346 intervention, 184 control) was 23.8%, 26.6%, and 19.8%, respectively. The prevalence of these outcomes decreased substantially over the study period; additional benefit of the cash incentives was not detected. In conclusion, poor mental health was common although the prevalence declined rapidly during the first six months on ART. The cash incentives did not increase these improvements, however they may have indirect benefit by motivating early linkage to and retention in care.Clinical Trial Number: NCT03341556.
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Affiliation(s)
- Lila Aziz Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Kyle Patrick Ryan
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Carolyn Anne Fahey
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
| | | | | | | | - Sandra Irene McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA
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65
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Skogen V, Langseth R, Rohde GE, Rysstad O, Sørlie T, Lie B. Prevalence of mental distress and factors associated with symptoms of major depression among people living with HIV in Norway. AIDS Care 2024; 36:173-180. [PMID: 37909108 DOI: 10.1080/09540121.2023.2275043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
For people living with HIV (PLHIV) who can access lifesaving treatment, HIV has become a chronic lifelong condition; however, PLHIV have more mental and somatic comorbidities than their HIV-negative peers. In this cross-sectional study, we assessed the prevalence of mental distress and identified factors associated with major depression among 244 well-treated PLHIV residing in Norway. Participants completed validated questionnaires covering mental and somatic health. The prevalence of mental distress, defined as a score on the Hopkins Symptom Check List-25 >1.75, was 32%, and that of symptoms of major depression, defined as a score on the Beck Depression Inventory-II ≥20, was 15%. The factors associated with major depressive symptoms identified using logistic regression were risk of drug abuse (adjusted odds ratio (AOR) 15.1, 95% confidence interval (CI) 3.28, 69.3), fatigue (AOR 12.5, 95% CI 3.90, 40.0), trouble sleeping (AOR 7.90, 95% CI 2.85, 21.9), African origin (AOR 3.90, 95% CI 1.28, 11.9), low education (AOR 3.31, 95% CI 1.18, 9.30), and non-disclosure (AOR 3.22, 95% CI 1.04, 10.0). Our findings indicate that the prevalence rates of mental distress and major depressive symptoms are higher among well-treated PLHIV residing in Norway than in the general population. These conditions are under-diagnosed and under-treated, and increased awareness is needed.
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Affiliation(s)
- Vegard Skogen
- Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromso, Norway
- Institute for Clinical Medicine, University of Tromso - The Arctic University of Norway, Tromso, Norway
| | - Ranveig Langseth
- Department of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromso, Norway
| | - Gudrun E Rohde
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
- Faculty of Health & Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ole Rysstad
- Department of Internal Medicine, Hospital of Southern Norway, Kristiansand, Norway
| | - Tore Sørlie
- Institute for Clinical Medicine, University of Tromso - The Arctic University of Norway, Tromso, Norway
- Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromso, Norway
| | - Birgit Lie
- Department of Psychosomatic and Trauma, Hospital of Southern Norway, Kristiansand, Norway
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66
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Liu J, Guo T, Han B, Cheng X, Qu S, Wang R, Dong X, Fang J, Wang J, Tang M, Yao Y, Jin L. Adverse childhood experiences and human immunodeficiency virus testing among adults with human immunodeficiency virus risk behaviours. Stress Health 2024; 40:e3262. [PMID: 37226429 DOI: 10.1002/smi.3262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023]
Abstract
Adverse childhood experiences (ACEs) have been associated with poor HIV testing in adulthood yet, they have not been extensively described in those at increased risk for HIV. Cross-sectional analysis data (n = 204,231) on ACEs and HIV testing were obtained from the 2019-2020 Behavioural Risk Factor Surveillance Survey. Weighted logistic regression models were used to access the association of ACEs exposure, ACEs score, and ACEs type with HIV testing among adults with HIV risk behaviours, and stratified analysis was also performed to examine gender differences. The results indicated the overall rate of HIV testing was 38.8% and was higher among those with HIV risk behaviours (64.6%) than those without (37.2%). In populations with HIV risk behaviours, the negative association of HIV testing with ACEs exposure, ACEs score, and ACEs type was identified. Relative to those without ACEs, adults who were exposed to ACEs might decrease the rate of HIV testing, participants with ≥4 ACEs scores were less likely to have HIV testing, and childhood exposure to sexual abuse had the greatest impact on HIV testing. For both males and females, childhood exposure to ACEs was associated with lower odds of HIV testing and ACEs score ≥4 had the most robust associations with HIV testing. For males, those who experienced witnessed domestic violence had the lowest odds of HIV testing but the odds of engaging in HIV testing for females were the lowest among those who experienced childhood sexual abuse.
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Affiliation(s)
- Jun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Tingting Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Baihui Han
- Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Xiaowei Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Shifang Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ruying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinxin Dong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Mengyao Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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67
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Mi T, Zhang J, Yang X, Chen S, Weissman S, Olatosi B, Li X. Suicide Ideation and Attempt Among People With HIV: A Statewide Population-level Cohort Analysis Between 2005 and 2020. J Acquir Immune Defic Syndr 2024; 95:117-125. [PMID: 37977196 DOI: 10.1097/qai.0000000000003342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Risk factors for suicidality among people with HIV (PWH) may evolve over their disease course, particularly as they develop comorbidities such as mental health disorders over time. SETTING This study compared the leading risk factors of suicide ideation/attempt among PWH in South Carolina across different combination antiretroviral therapy (cART) eras. METHODS A statewide cohort of PWH who were diagnosed between 2005 and 2016, with a follow-up record until 2020, was involved in the study. A Cox proportional hazards model was used to examine the association of suicide ideation/attempt and predictors, including demographics, HIV-related characteristics, and mental health conditions. RESULTS Among 8567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years [95% confidence interval (CI): 460.2 to 615.1] in the early cART cohort (2005-2008) to 782.5 (95% CI: 697.6 to 867.4) in the late cART cohort (2009-2016). Leading risk factors of suicide ideation/attempt changed across the cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder ( P' s < 0.05). In the late cART cohort, suicide ideation/attempt was positively associated with transmission through injection drug use, anxiety, posttraumatic stress disorder, schizophrenia, and personality disorder ( P' s < 0.05). CONCLUSIONS Mental health conditions have emerged as more prominent risk factors for suicide ideation/attempt in the late cART cohort. Enhanced access to psychiatric care could facilitate the early identification of mental health conditions, enabling timely counseling or psychosocial interventions that may mitigate mental health issues and, consequently, reduce the likelihood of suicide ideation/attempts among PWH.
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Affiliation(s)
- Tianyue Mi
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Shujie Chen
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC; and
| | - Bankole Olatosi
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Arnold School of Public Health, Columbia, SC
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68
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Tackey C, Slepian PM, Clarke H, Mittal N. Post-Viral Pain, Fatigue, and Sleep Disturbance Syndromes: Current Knowledge and Future Directions. Can J Pain 2024; 7:2272999. [PMID: 38239826 PMCID: PMC10795785 DOI: 10.1080/24740527.2023.2272999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/16/2023] [Indexed: 01/22/2024]
Abstract
Background Post-viral pain syndrome, also known as post-viral syndrome, is a complex condition characterized by persistent pain, fatigue, musculoskeletal pain, neuropathic pain, neurocognitive difficulties, and sleep disturbances that can occur after an individual has recovered from a viral infection. Aims This narrative review provides a summary of the sequelae of post-viral syndromes, viral agents that cause it, and the pathophysiology, treatment, and future considerations for research and targeted therapies. Methods Medline, PubMed, and Embase databases were used to search for studies on viruses associated with post-viral syndrome. Conclusion Much remains unknown regarding the pathophysiology of post-viral syndromes, and few studies have provided a comprehensive summary of the condition, agents that cause it, and successful treatment modalities. With the COVID-19 pandemic continuing to affect millions of people worldwide, the need for an understanding of the etiology of post-viral illness and how to help individuals cope with the sequalae is paramount.
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Affiliation(s)
- Caleb Tackey
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P. Maxwell Slepian
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nimish Mittal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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69
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Yuan GF, Qiao S, Li X. Bridging internalized HIV stigma and depressive symptoms among people living with HIV in China during the COVID-19 pandemic: a network analysis. Front Public Health 2024; 11:1306414. [PMID: 38249397 PMCID: PMC10796684 DOI: 10.3389/fpubh.2023.1306414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Previous research has documented that HIV-related stigma may be a significant trigger of mental health problems among people living with HIV (PLWH). However, less is known about how internalized HIV stigma is linked to depressive symptoms among PLWH during the COVID-19 pandemic. The current study sought to explore the network structure of internalized HIV stigma and depressive symptoms, along with bridge nodes, to elucidate how they co-exist. Participants were 1,197 Chinese PLWH (64.3% male, Mage = 41.52, SD = 9.20) who completed the measurements of internalized HIV stigma and depressive symptoms during the early phase of the COVID-19 outbreak (May 2020). Results revealed that "ashamed of having HIV" was identified as the most central nodes in the internalized HIV stigma network, whereas "mind wandered during tasks" ranked highest on centrality in the depressive symptoms network. Two bridge connections were exhibited within the combined internalized HIV stigma and depressive symptoms network model: "inferiority due to HIV" and "gloomy feelings" from internalized HIV stigma and depressive symptoms communities, respectively. This study is one of the first to examine the co-occurrence of internalized HIV stigma and depressive symptoms in the context of the COVID-19 pandemic using a network approach. These findings have potential clinical implications for mitigating depressive symptoms in populations facing socioeconomic disadvantage and vulnerability.
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Affiliation(s)
- Guangzhe F. Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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70
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Morrison CA, Corbeil T, Kluisza L, Poku O, Liotta L, Attoh Okine ND, Dolezal C, Wiznia A, Abrams EJ, Robbins RN, Mellins CA. Identifying the Mental Health Effects of Cumulative Traumatic Exposure in HIV-Affected Youth: A Longitudinal Assessment. J Acquir Immune Defic Syndr 2024; 95:18-25. [PMID: 37820277 PMCID: PMC10841068 DOI: 10.1097/qai.0000000000003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Traumatic events (TEs) in early life can precede adult psychopathology. Limited research exists on this relationship in young adults with perinatally acquired HIV-infection (PHIV) or perinatal HIV-exposure without infection (PHEU), who often experience social and health disparities. This study examined TEs experienced in childhood/adolescence and their association with psychiatric and substance use disorders in young adults with PHIV and PHEU. METHODS Participants in a New York City-based longitudinal cohort study were assessed for TE exposure at enrollment (mean age = 12 years) and the first 2 follow-up interviews. Past-year psychiatric and substance use disorders were evaluated via psychiatric interview (DISC-IV) at the fifth follow-up interview (mean age = 22 years). Unadjusted and adjusted logistic regression models assessed associations between cumulative childhood/adolescence TEs and young adult psychiatric and substance use outcomes. Group differences were tested for PHIV and PHEU subgroups. RESULTS Among 236 participants (60% Black, 51% Latinx), mean cumulative traumatic event count was 3.09 (SD = 1.77); 26% had a past-year psychiatric diagnosis, and 28% had a past-year substance use diagnosis. Increased TEs were associated with past-year psychiatric diagnoses in young adulthood [average marginal effects (AME) 4.21, 95% confidence interval (CI): 0.83 to 7.58]; for PHEU participants, increased TEs were associated with a past-year substance use disorder (AME 15.67, 95% CI: 8.08 to 23.25). CONCLUSIONS High levels of TEs in childhood/adolescence may contribute to psychiatric and substance use disorders in young adults with PHIV or PHEU. Research exploring relationships between TE exposure and later psychiatric problems is needed to inform interventions for HIV-affected youth.
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Affiliation(s)
- Corey A Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Ohemaa Poku
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Lucy Liotta
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Naa-Djama Attoh Okine
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, NY; and
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
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Kim GS, Kim L, Baek S, Shim MS, Lee S, Kim JM, Yoon JY, Kim J, Choi J, Choi JP. Three cycles of mobile app design to improve HIV self-management: A development and evaluation study. Digit Health 2024; 10:20552076241249294. [PMID: 38680735 PMCID: PMC11055484 DOI: 10.1177/20552076241249294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/08/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Employing three cycles of Design Science Research (DSR) to develop a mobile app 'ESSC (Excellent Self Supervised HIV Care)' to improve self-management among people living with HIV (PLWH). Methods This study is based on the DSR framework comprising three iterative cycles. In the Relevance cycle, PLWH participated in a survey of mobile health (mHealth) experiences and needs. In the Rigor cycle, the information-motivation-behavioural skills (IMB) model was applied to foundations of the app, and HIV specialists verified the contents. Experts evaluated the heuristic system and the app quality with the Mobile Application Rating Scale (MARS). In the Design cycle, ESSC was built on the findings of the other two cycles, and end-users tested the usability using uMARS. Results The contents of the app were developed based on user requirements. The IMB model led ESSC to supplement motivational components for self-management, which built five functions: information contents; health life records including mental and sexual health; interactive counselling with healthcare providers; setting health goals after watching videos; and my page for self-reflection. To reduce social stigma and promote acceptance of the information-driven app, we created animated characters with neutral and bright features. The HIV specialists evaluated content validity as highly appropriate. The MARS score by the overall raters was between 3-acceptable and 4-good: functionality, 4.38; information, 4.12; aesthetics, 3.96; engagement, 3.37; and subjective quality, 3.25. Conclusions The DSR approach is effective for implementing usable and useful mHealth. The ESSC app would be feasible and contribute PLWH to retention in care.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Layoung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Seoyoung Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Republic
of Korea
| | - SangA Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Ji Min Kim
- Division of Infectious Disease, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Yae Yoon
- Division of Infectious Disease, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Kim
- Gwangju Center for Infectious Disease Control and Prevention, Gwangju, Republic of Korea
| | - JunYong Choi
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jae-Phil Choi
- Division of Infectious Diseases, Seoul Medical Center, Seoul, Republic of Korea
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72
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Manavalan P, Li Y, Mills JC, Kwara A, Zhou Z, Ritter AS, Spencer E, Pence BW, Cook RL. Depression and Anxiety Symptoms and Treatment Utilization, and Associated HIV Outcomes among Adults with HIV in Rural Florida. AIDS Behav 2024; 28:164-173. [PMID: 37566153 PMCID: PMC11217930 DOI: 10.1007/s10461-023-04147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Persons living with HIV (PLWH) and depression or anxiety in the rural South may have suboptimal HIV outcomes. We sought to examine the proportion of PLWH from rural Florida with symptoms of depression or anxiety, the proportion who received depression or anxiety treatment, and the relationship between untreated and treated symptoms of depression or anxiety and HIV outcomes. Cross-sectional survey data collected between 2014 and 2018 were analyzed. Among 187 PLWH residing in rural Florida (median age 49 years, 61.5%, male 45.5% Black), 127 (67.9%) met criteria for symptoms of depression and/or anxiety. Among these 127 participants, 60 (47.2%) were not on depression or anxiety treatment. Participants with untreated symptoms of depression and anxiety (OR 3.2, 95% CI 1.2-9.2, p = 0.03) and treated depression and anxiety with uncontrolled symptoms (OR 1.4, 95% CI 0.5-4.0, p = 0.52) were more likely to have viral non-suppression compared to those without depression or anxiety in an unadjusted bivariate analysis. Only the association between untreated symptoms of depression and anxiety and viral non-suppression was statistically significant, and when adjusting for social and structural confounders the association was attenuated and was no longer statistically significant. This suggests that social and structural barriers impact both mental health and HIV outcomes. Our findings support the need for increased mental health services and resources that address the social and structural barriers to care for PLWH in the rural South.
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Affiliation(s)
- Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
| | - Yancheng Li
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Jon C Mills
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Awewura Kwara
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Alaina S Ritter
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Emma Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Kreniske P, Namuyaba OI, Kasumba R, Namatovu P, Ssewamala F, Wingood G, Wei Y, Ybarra ML, Oloya C, Tindyebwa C, Ntulo C, Mujune V, Chang LW, Mellins CA, Santelli JS. Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49352. [PMID: 38113102 PMCID: PMC10762611 DOI: 10.2196/49352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. OBJECTIVE This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo's effectiveness in increasing HIV testing and linking users to mental health counselors. METHODS We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message-based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention's impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. RESULTS Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. CONCLUSIONS Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. TRIAL REGISTRATION ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49352.
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Affiliation(s)
- Philip Kreniske
- Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | | | - Robert Kasumba
- Washington University in St Louis, St Louis, MO, United States
| | - Phionah Namatovu
- International Center for Child Development, Masaka, Uganda
- Washington University in St Louis, St Louis, MO, United States
| | - Fred Ssewamala
- International Center for Child Development, Masaka, Uganda
- Washington University in St Louis, St Louis, MO, United States
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Michele L Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, United States
| | | | | | | | | | - Larry W Chang
- Department of Epidemiology, School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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Cox CM, Masiano S, Mazenga A, Stark M, Udedi M, Simon KR, Ahmed S, Nyasulu P, Kim MH. Phone-based psychosocial counseling for people living with HIV: Feasibility, acceptability and impact on uptake of psychosocial counseling services in Malawi. Glob Ment Health (Camb) 2023; 11:e3. [PMID: 38283875 PMCID: PMC10808978 DOI: 10.1017/gmh.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 01/30/2024] Open
Abstract
People living with HIV experience psychosocial needs that often are not addressed. We designed an innovative low-resource model of phone-based psychosocial counseling (P-PSC). We describe cohort characteristics, acceptability, feasibility and utilization of P-PSC at health facilities supported by Baylor Foundation Malawi. Staff were virtually oriented at 120 sites concurrently. From facility-based phones, people with new HIV diagnosis, high viral load, treatment interruption or mental health concerns were referred without identifiable personal information to 13 psychosocial counselors via a WhatsApp group. Routine program data were retrospectively analyzed using univariate approaches and regressions with interrupted time series analyses. Clients utilizing P-PSC were 63% female, 25% youth (10-24 y) and 9% children (<10 y). They were referred from all 120 supported health facilities. Main referral reasons included new HIV diagnosis (32%), ART adherence support (32%) and treatment interruption (21%). Counseling was completed for 99% of referrals. Counseling sessions per month per psychosocial counselor increased from 77 before P-PSC to 216 in month 1 (95% CI = 82, 350, p = 0.003). Total encounters increased significantly to 31,642 in year 1 from ~6,000 during the 12 prior months, an over fivefold increase. P-PSC implementation at 120 remote facilities was acceptable and feasible with immediate, increased utilization despite few psychosocial counselors in Malawi.
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Affiliation(s)
- Carrie M. Cox
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
| | - Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Madeline Stark
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Michael Udedi
- Curative, Medical and Rehabilitation Services – Mental Health, Malawi Ministry of Health, Lilongwe, Malawi
| | - Katherine R. Simon
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
| | - Phoebe Nyasulu
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Maria H. Kim
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor College of Medicine, Texas Children’s Hospital, Houston, USA
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Gordon KJ, Martin CE, Kutywayo A, Cox LA, Nongena P, Mullick S. Mental Health Needs of Adolescent and Young Adult PrEP Users in South Africa: Implications for Sexual and Reproductive Health Programming. J Adolesc Health 2023; 73:S73-S80. [PMID: 37953012 DOI: 10.1016/j.jadohealth.2023.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Poor mental health is associated with sexual and reproductive health (SRH) risks, including human immunodeficiency virus (HIV) and pre-exposure prophylaxis discontinuation. Adolescents and young people (AYP) are vulnerable to HIV and depression. This paper describes the prevalence and severity of depression and associated factors in AYP accessing SRH services in South Africa. METHODS A cross-sectional analysis of enrollment data (January 2019 to December 2021) from a cohort of individuals receiving pre-exposure prophylaxis services at eight clinics in three provinces in South Africa was conducted. Females (n = 1,074) and males (n = 231) aged 15-24 years were included. Interviewer-administered questionnaires were conducted, and the prevalence and severity of depression assessed using the Patient Health Questionnaire-9. Multivariate analysis was used to identify factors associated with depression. RESULTS Over 40% of participants had experienced any depression symptoms (43.7% of females, 38.5% of males). For males, experiencing intimate partner violence was the only predictor of depression symptoms (adjusted odds ratio (AOR) 8.81, 95% confidence intervals (CI) 1.03-75.44). For females, living with both parents (AOR 1.70, 95% CI 1.15-2.51), having transactional sex (AOR 1.63, 95% CI 1.00-2.65), experiencing any intimate partner violence (AOR 1.96, 95% CI 1.34-2.89), and using drugs (AOR 1.78, 95% CI 1.03-3.11) were all positively associated with depression symptoms. Resilience was a protective factor against depression symptoms for both sexes (males: AOR 0.96, 95% CI 0.93-0.98; females: AOR 0.96, 95% CI 0.95-0.97). DISCUSSION There is a high burden of depression among AYP accessing SRH services in South Africa. Mental health screening should be integrated into SRH and HIV prevention programs for AYP.
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Affiliation(s)
- Kerry Joan Gordon
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alison Kutywayo
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Pelisa Nongena
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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Sabri B, Budhathoki C, McFall AM, Mehta SH, Celentano DD, Solomon SS, Srikrishnan AK, Anand S, Vasudevan CK, Lucas GM. Cumulative violence exposures among men who have sex with men living with HIV in India: Psychosocial correlates of HIV care continuum outcomes. PLoS One 2023; 18:e0295225. [PMID: 38039322 PMCID: PMC10691715 DOI: 10.1371/journal.pone.0295225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/17/2023] [Indexed: 12/03/2023] Open
Abstract
Lifetime exposures to violence among men who have sex with men (MSM) are associated with multiple psychosocial health risks and can affect engagement and outcomes of HIV treatment. This study a) explored relationships between levels of exposures to violence and HIV care continuum outcomes among MSM living with HIV in India, and b) identified psychosocial correlates of HIV care continuum outcomes among MSM living with HIV and those with lifetime cumulative exposures to violence (CVE). CVE referred to exposures to violence in both childhood and adulthood. This cross-sectional analysis used survey data collected between August 2016 and May 2017 from 1763 men who have sex with men living with HIV across 10 cities in India, using respondent-driven sampling. We found that higher levels of violence exposure were significantly associated with lower awareness of HIV positive status, and lower likelihood of initiating antiretroviral therapy. Compared with MSM living with HIV that had no CVE, those with CVE were more likely to report perpetration of interpersonal violence, alcohol misuse, depressive symptoms, and HIV transmission risk behaviors and to have two to four co-occurring psychosocial problems. In multivariable analysis with the subset of MSM with CVE, psychosocial correlates significantly associated with at least one HIV care continuum outcome were HIV transmission risk behaviors, perpetration of interpersonal violence, depression, and alcohol misuse. The findings highlight the need for integrating care for lifetime violence exposures and associated behavioral problems in HIV care settings for men who have sex with men living with HIV in India.
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Affiliation(s)
- Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Allison M. McFall
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Shruti H. Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - David D. Celentano
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sunil S. Solomon
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | - Gregory M. Lucas
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
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Nabunya P, Byansi W, Bahar OS, Namuwonge F, Atwebembere R. Emotional and Behavior Difficulties and the Mental Health of Caregivers of Adolescents Living with HIV. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:3766-3774. [PMID: 37362624 PMCID: PMC10256973 DOI: 10.1007/s10826-023-02609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
This study examined the relationship between child emotional and behavioral difficulties, parenting stress and the mental health of caregivers of adolescents living with HIV. Caregiver data from a two-year pilot study for adolescents and their caregivers (N = 89 dyads) in Uganda, were analyzed. Ordinary Least Square regression models were conducted to examine the association between child difficulties reported by caregivers using the Strengths and Difficulties Questionnaire on parenting stress (measured by Parenting Stress Index) and caregiver mental health (measured by the Brief Symptoms Inventory). Results indicate that 12.36% of caregivers reported child difficulty scores within the borderline range and 8.99% reported scores within the abnormal range. Child difficulties (b = 0.52, 95% CI: 0.18, 0.85) were associated with parenting stress. Similarly, the perceived impact of child difficulties was associated with both parenting stress (b = 0.89, 95% CI: 0.24, 1.54) and caregiver mental health (b = 1.73, 95% CI: 1.09, 2.37). Study findings have important implications for developing effective psychosocial interventions targeting children and adolescents living with HIV and their caregivers.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - William Byansi
- Boston College, School of Social Work, Chestnut Hill, MA USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Flavia Namuwonge
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO USA
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Liotta L, Kluisza L, Nguyen N, Leu CS, Levine A, Snyder C, Robbins R, Dolezal C, Kreniske P, Wiznia A, Abrams EJ, Mellins CA. Hope for the future protects against suicidal ideation among adolescents and young adults affected by perinatal HIV. AIDS Care 2023; 35:1948-1954. [PMID: 36892951 PMCID: PMC10491736 DOI: 10.1080/09540121.2023.2184764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Hope for the future has been found protective against suicidal ideation (SI) in adolescents and young adults (AYA) yet has not been examined in AYA with perinatal HIV-infection (PHIV) or AYA who were perinatally HIV-exposed but uninfected (PHEU), who are at higher risk for SI than general populations. Using data from a New York City-based longitudinal study of AYAPHIV and AYAPHEU enrolled when 9-16 years old, we examined associations between hope for the future, psychiatric disorders, and SI over time using validated measures. Generalized estimating equations were used to estimate differences in mean hope for the future scores by PHIV-status and to estimate adjusted odds ratios for associations between hope for the future and SI. AYA reported high hope for the future scores and low SI across visits, irrespective of PHIV-status. Higher hope for the future scores were associated with lower odds of SI (AOR = 0.48, 95% CI: 0.23, 0.996). Mood disorder was associated with increased odds of SI (AOR = 13.57, 95% CI: 5.11, 36.05) in a model including age, sex, follow-up, PHIV-status, mood disorder, and hope for the future. Understanding how hope can be cultivated and how it protects against SI can help to inform preventive interventions for HIV-affected AYA.
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Affiliation(s)
- Lucy Liotta
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Nadia Nguyen
- Aaron Diamond AIDS Research Center, Columbia University Irving Medical Center, New York, United States
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Alina Levine
- Mental Health Data Science, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Clayton Snyder
- Mental Health Data Science, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Reuben Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, United States
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, New York, United States
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, United States
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Rzeszutek M, Gruszczyńska E. Profiles of subjective well-being among people living with HIV during the COVID-19 pandemic. Qual Life Res 2023; 32:3453-3462. [PMID: 37561336 PMCID: PMC10624723 DOI: 10.1007/s11136-023-03493-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The aim of our study was to examine subjective well-being (SWB) profiles and their sociodemographic and clinical correlates among people living with HIV (PLWH) during the COVID-19 pandemic. METHODS The participants were 663 PLWH undergoing antiretroviral treatment. Their SWB was evaluated using the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Sociodemographic and clinical covariates, together with COVID-19 distress, were assessed with a self-report survey. RESULTS Latent profile analysis revealed four SWB profiles: average negative, average positive, flourishing and languishing. The languishing profile was the worse in terms of values of SWB components and had a relative overrepresentation of PLWH who were single, without a university degree, and not employed for money. The pandemic-related distress was positively related to being a member of average negative and languishing profiles. Gender and age had no significant effect on either profile membership or directly on the SWB components. CONCLUSION It seems that in the context of chronic illness and socially shared stressful circumstances, which was the COVID-19 pandemic, the components of SWB among PLWH developed rather congruent profiles. Sociodemographic, but not clinical characteristics were found to be significant correlates of belonging to obtained SWB profiles in this sample. The most striking effect with this regards was obtained for the members of the languishing profile, defined by the co-occurrence of low positive affect, low satisfaction with life, and high negative affect.
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Affiliation(s)
- Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
| | - Ewa Gruszczyńska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19/31, 03-815, Warsaw, Poland
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Bhattacharyya A, Chakraborty R, Raj T, Padhi BK, Khubchandani J, Satapathy P, Rustagi S, Chattu VK. Comprehensive Knowledge about HIV/AIDS among Women of Reproductive Age in India. EPIDEMIOLOGIA 2023; 4:492-504. [PMID: 37987313 PMCID: PMC10660847 DOI: 10.3390/epidemiologia4040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
HIV/AIDS has been a major threat to global public health, with India ranking third when it comes to the global burden of people living with HIV, especially women. It is imperative to assess the level of knowledge women have about transmission and prevention of this infection. This study sought to delineate the determinants of the comprehensive knowledge of HIV/AIDS among women in the reproductive age groups in India. Data from the fifth round of the National Family Health Survey conducted in India were analyzed. The sample included 95,541 women aged 15-49 years. Multilevel logistic regression was fitted with individual characteristics, household characteristics, and community characteristics to identify determinants of comprehensive knowledge on HIV/AIDS. Nearly a fourth (24.8%) of the women aged 15-49 in India who had ever heard of HIV had comprehensive knowledge of HIV/AIDS. Multilevel logistic regression showed that the likelihood of comprehensive knowledge of HIV/AIDS was higher among women aged 40-44 (AOR = 1.57) and 30-34 (AOR = 1.56). The likelihood of having comprehensive knowledge increased with the increase in the level of education. Women with secondary and higher levels of education were 1.9 times and 3.38 times more likely to have comprehensive knowledge, respectively, than those with no education. Household wealth, access to mass media, and having ever tested for HIV were also significant determinants of comprehensive knowledge of HIV/AIDS among women. The odds of having comprehensive knowledge about HIV/AIDS were higher for women with higher community wealth (AOR = 1.31), higher community education (AOR = 1.09), and higher community employment (AOR = 1.12). Factors at both the individual and community levels were shown to be indicators of comprehensive knowledge of HIV/AIDS. Policymakers and public health practitioners in India should come up with plans to close the information gaps about HIV/AIDS that exist among women and their demographic subgroups.
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Affiliation(s)
- Aritro Bhattacharyya
- International Institute for Population Sciences, Mumbai 400088, India; (A.B.); (R.C.); (T.R.)
| | - Ritankar Chakraborty
- International Institute for Population Sciences, Mumbai 400088, India; (A.B.); (R.C.); (T.R.)
| | - Tapasya Raj
- International Institute for Population Sciences, Mumbai 400088, India; (A.B.); (R.C.); (T.R.)
| | - Bijaya Kumar Padhi
- Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico State University, Las Cruces, NM 88003, USA
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602105, India; (P.S.); (V.K.C.)
- School of Pharmacy, Graphic Era Hill University, Dehradun 248007, India
| | - Sarvesh Rustagi
- Department of Food Technology, Uttaranchal University, Dehradun 248007, India;
| | - Vijay Kumar Chattu
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602105, India; (P.S.); (V.K.C.)
- Department of Occupation Science and Occupational Therapy-Temerty, Faculty of Medicine, University of Toronto, Toronto, ON P3C 1T6, Canada
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81
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Freeman MC, Wainberg ML, Slabbert JD, Mabela S, Wolvaardt G. Persons with severe mental health conditions should be included as a key population in HIV programmes. AIDS 2023; 37:2115-2118. [PMID: 37598396 PMCID: PMC10621635 DOI: 10.1097/qad.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Melvyn C. Freeman
- Foundation for Professional Development, Pretoria
- University of Stellenbosch, Stellenbosch, Western Cape, South Africa
| | - Milton L. Wainberg
- Columbia University/New York State Psychiatric Institute New York, New York, USA
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Mousavi ME, Nejad SM, Shafaati M, Mykyta-Chomsky R, Akbarpour S, Hadavandsiri F. Association between psychological discomforts and sleep quality among people living with HIV/AIDS. AIDS Res Ther 2023; 20:78. [PMID: 37951932 PMCID: PMC10638710 DOI: 10.1186/s12981-023-00579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Psychological discomfort and sleep problems are considered separate disorders. Due to the high prevalence of both disorders among people living with HIV (PLWH), this study was designed to evaluate how those challenges are present among PLWH. METHOD A cross-sectional study was conducted using data from a national survey of 1185 confirmed PLWH from 15 provinces in Iran from April to August 2019. Psychological discomfort and sleep quality were assessed using standardized versions of related Persian questionnaires. Logistic regression was used to assess the association between psychological discomfort and sleep quality in PLWH. RESULTS The overall prevalence of poor sleep quality, depression, anxiety, and stress was 47.71%, 50.95%, 44.26%, and 41.77%, respectively. The results of multivariate-adjusted logistic regression showed that each psychological discomfort covariate increased the odds of poor sleep quality. Depression by adjusting for anxiety and stress, anxiety by adjusting for depression and stress, and stress by adjusting for depression and anxiety all increased the odds of poor sleep quality. CONCLUSION A high prevalence of psychological discomfort was observed in PLWH. Depression, anxiety, and stress were strongly associated with sleep quality. PLWH needed more attention and social support in order to reduce sleep and psychological issues.
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Affiliation(s)
| | - Safieh Mohammad Nejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shafaati
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital complex, Tehran University of Medical Science, Tehran, Iran
| | - Rosa Mykyta-Chomsky
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Samaneh Akbarpour
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital complex, Tehran University of Medical Science, Tehran, Iran.
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Hadavandsiri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Evangelidou S, Cruz A, Osorio Y, Sequeira-Aymar E, Gonçalves AQ, Camps-Vila L, Monclús-González MM, Cuxart-Graell A, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Dalmau Llorca MR, Aguilar Martín C, Requena-Mendez A. Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study. J Migr Health 2023; 8:100205. [PMID: 38047139 PMCID: PMC10692454 DOI: 10.1016/j.jmh.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/26/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Background Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.
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Affiliation(s)
- Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Yolanda Osorio
- Parc Sanitari Sant Joan de Deu, Programa Atenció a la Salut Mental de les persones Immigrades i Programa per Persones Sense Llar, Carrer Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
| | - Ethel Sequeira-Aymar
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Carrer Rosselló 161, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló, 149, Barcelona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Laura Camps-Vila
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
| | - Marta M. Monclús-González
- Centre d'Atencio Primaria Sagrada Família, Consorci Sanitari Integral (CSI), Carrer Còrsega 643, 08025 Barcelona, Spain
| | - Alba Cuxart-Graell
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Elisa M. Revuelta-Muñoz
- Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Carrer Rambla Ferran 44, 25007, Lleida, Spain
| | - Núria Busquet-Solé
- Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Carrer St. Cristòfol, 34, 08243 Manresa, Barcelona, Spain
| | - Susana Sarriegui-Domínguez
- Centre d'Atencio Primaria 1 Maig, Institut Català de la Salut (ICS), Carrer De la Mercè, 5, 25003, Lleida, Spain
| | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - M. Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500, Tortosa, Tarragona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 17177, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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84
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Wang R, Zheng F, Cao G, Goldsamt LA, Shen Y, Zhang C, Yi M, Peng W, Li X. The relationship between social support and depression among HIV-positive men who have sex with men in China: the chain mediating role of psychological flexibility and hope. Front Public Health 2023; 11:1271915. [PMID: 38026353 PMCID: PMC10665023 DOI: 10.3389/fpubh.2023.1271915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction HIV and mental health problems are a global syndemic. One key issue is that the significant mental health problems among people vulnerable to acquiring or living with HIV have not been fully addressed. Access to social support has been one of the biggest challenges for HIV-positive men who have sex with men (HIV+ MSM). Lower social support has been linked to more severe depression symptoms. However, the mechanisms underlying the association between social support and depression in HIV+ MSM are unclear. Two possible mediators include hope and psychological flexibility. This study aimed to examine the relationship between social support and depression in HIV+ MSM and to explore the single mediating effects of hope and psychological flexibility and the chain mediating effect of these two variables on this relationship. Methods A convenience sample was used to recruit participants from the designated HIV/AIDS hospital in Changsha city, Hunan Province of China. A total of 290 HIV+ MSM completed questionnaires. Results Our findings showed that hope mediated the relationship between social support and depression in HIV+ MSM. Furthermore, the chain mediation model confirmed a direct negative association between social support and depression, but this relationship was largely mediated by the chain effects of hope and psychological flexibility. Conclusions Integrating hope and psychological flexibility into interventions may provide better mental health support for HIV+ MSM and improve their wellbeing and quality of life.
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Affiliation(s)
- Run Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Fang Zheng
- Department of AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Guiying Cao
- Department of AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Yan Shen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Mengyao Yi
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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85
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Ba DM, Risher KA, Ssentongo P, Zhang Y, Dai Q, Liu G, Maiga M, Zhang X, Diakite B, Coulibaly SDP, Hou L, Leslie DL, Chinchilli VM. Human Immunodeficiency Virus (HIV) Treatment With Antiretroviral Therapy Mitigates the High Risk of Mental Health Disorders Associated With HIV Infection in the US Population. Open Forum Infect Dis 2023; 10:ofad555. [PMID: 38033986 PMCID: PMC10686352 DOI: 10.1093/ofid/ofad555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Background Whether treatment of human immunodeficiency virus (HIV) with antiretroviral therapy (ART) is associated with lower risk of mental health disorders (MHDs) among people with HIV (PWH) remains unknown. We aim to determine the association between HIV and MHDs and whether ART alters the risk of MHDs among PWH in the US adult population. Methods We conducted a real-world study using the Merative MarketScan claims database (2016-2020), identifying individuals with HIV (diagnosed using International Classification of Diseases, Tenth Revision, Clinical Modification codes) and those without HIV. A multivariable stratified Cox proportional hazard regression model was conducted to examine the association of HIV treatment status with MHDs, adjusting for potential confounders. Additionally, we sought to determine the effect modification of ART on the relationship between living with HIV and MHDs. Results A total of 313 539 individuals, with a mean age of 44.2 (standard deviation, 11.4) years, predominantly males (81.2%), residing in the South region of the US (50.9%) were included in the present analysis. During 671 880 person-years of follow-up, 46 235 incident MHD cases occurred. In the multivariable Cox proportional hazard model, living with HIV was associated with higher risk of incident MHDs. Relative to those without HIV, the adjusted hazard ratio was 1.85 (95% confidence interval [CI], 1.79-1.92; P < .001) for those with HIV on treatment, and 2.70 (95% CI, 2.59-2.82; P < .001) for those with HIV without any treatment. Stronger associations between HIV and MHDs were observed in men relative to women, among those aged 18-34 years relative to those aged 55-63 years, and among those with no overweight/obesity relative to obese individuals (Pinteraction < .001 for all). Conclusions HIV was associated with an increased risk of developing MHDs. However, HIV treatment mitigated the risk.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kathryn A Risher
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Yue Zhang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Qi Dai
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Mamoudou Maiga
- Preventive Medicine Department, Northwestern University, Chicago, Illinois, USA
| | - Xuehong Zhang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brehima Diakite
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Souleymane dit Papa Coulibaly
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Lifang Hou
- Preventive Medicine Department, Northwestern University, Chicago, Illinois, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Diaz JE, Preciado E, Chiasson MA, Hirshfield S. Association Between Age of Anal Sex Debut and Adult Health Behaviors Among Sexual Minoritized Men Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3565-3575. [PMID: 37378702 PMCID: PMC11034742 DOI: 10.1007/s10508-023-02642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Earlier age of anal sex debut (ASD) has been linked with contemporary and long-term health outcomes, including vulnerability to HIV acquisition. The goal of this study was to utilize a life course approach to examine associations between earlier ASD and recent health behaviors among sexual minoritized men (SMM) living with HIV. A total of 1156 U.S. SMM living with HIV recruited from social and sexual networking apps and websites completed online surveys as part of a longitudinal eHealth intervention. Data from baseline surveys were analyzed to determine associations between age of ASD and adult health outcomes, including mental health, HIV viral load, and substance use. The median age of ASD among these participants was 17 years old, consistent with other work. Earlier ASD was significantly associated with a greater likelihood of past 2-week anxiety (AOR = 1.45, 95% CI 1.07-1.97) and past 3-month opioid use (AOR = 1.60, 95% CI 1.13-2.26); no significant associations were found for recent depression, HIV viral load, or stimulant use. Earlier ASD may function as an important proxy measure for deleterious health outcomes in adulthood, particularly recent anxiety and opioid use. Expansion of comprehensive and affirming sexual health education is critical to early engagement of individuals with a higher risk of HIV acquisition, with plausible downstream health benefits lasting into adulthood among SMM living with HIV.
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Affiliation(s)
- José E Diaz
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | | | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
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87
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Ojiambo KO, Nakku J, Wangi RN, Segawa I, Ndagire R, Nangendo J, Katahoire A, Semitala F. Socio-demographic and clinical characteristics associated with retention in care among adults living with HIV and severe mental illness and reasons for loss to follow-up in Uganda: a mixed-methods study. BMJ Open 2023; 13:e073623. [PMID: 37899147 PMCID: PMC10619097 DOI: 10.1136/bmjopen-2023-073623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study aimed to determine the socio-demographic and clinical characteristics associated with retention in care and reasons for loss to follow-up (LTFU) among people living with HIV (PLWH) with a known diagnosis of severe mental illness (SMI). DESIGN We conducted a parallel convergent mixed-methods study. The quantitative study was used to determine the proportion and factors associated with retention in care among PLWH and SMI. The qualitative study explored reasons for LTFU. SETTING This study was conducted at two the HIV clinics of two tertiary hospitals in Uganda. PARTICIPANTS We reviewed records of 608 PLWH who started antiretroviral therapy (ART) and included participants who had a documented diagnosis of SMI. OUTCOMES The primary outcome was retention in care. Age, gender, religion, tuberculosis (TB) status, WHO clinical stage, functional status, cluster of differentiation 4 (CD4) cell count, viral load and SMI diagnosis were among the predictor variables. RESULTS We collected data from 328 participants. Retention at 6 months was 43.3% compared with 35.7% at 12 months. Having an unsuppressed viral load (≥1000 copies/mL) (adjusted incidence risk ratio (IRR)=1.54, 95% CI: 1.17 to 2.03), being 36 years and below (adjusted IRR=0.94, 95% CI: 0.94 to 0.95), initial presentation at outpatient department (adjusted IRR=0.74, 95% CI: 0.57 to 0.96), having TB signs and symptoms (adjusted IRR=0.98 95% CI: 0.97 to 0.99) and being in lower WHO stages (I and II) (adjusted IRR=1.08, 95% CI: 1.02 to 1.14) at ART initiation were significantly associated with retention in care at 6 and 12 months. Inadequate social support, long waiting hours at the clinic, perceived stigma and discrimination, competing life activities, low socioeconomic status and poor adherence to psychiatric medication were barriers to retention in care. CONCLUSION Twelve-month retention in care remains low at 35.7% far below the 90% WHO target. There is a need to design and implement targeted interventions to address barriers to retention in care among PLWH and SMI.
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Affiliation(s)
- Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Rachel Nante Wangi
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Segawa
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Regina Ndagire
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre (CHDC), Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Semitala
- Department of Medicine, School of medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Mulago Immune Suppression Syndrome Clinic, Mulago National Referral Hospital, Kampala, Uganda
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88
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Sameen S, Lakhdir MPA, Azam SI, Asad N. Evaluating knowledge about HIV and discriminatory attitudes among Pakistani women of reproductive age using 2017-18 Demographic Health Survey data. Sci Rep 2023; 13:17849. [PMID: 37857793 PMCID: PMC10587286 DOI: 10.1038/s41598-023-45117-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023] Open
Abstract
A prominent issue associated with HIV is the stigma around it owing to a lack of awareness. This study aimed to find the association between HIV and AIDS-related knowledge and discriminatory attitudes amongst Pakistani women of reproductive age using the 2017-18 Pakistani Demographic Health Survey (PDHS) data. We analyzed a sample of 3381 Pakistani women of reproductive age using ordinal logistic regression for complex survey data. Two composite variables were created using the HIV module to denote the respondents' HIV-related knowledge and their attitude toward people living with HIV (PLHIV) and calculated using a scoring method. Additional variables included the respondents' age, education level, socioeconomic status, residential setting, and HIV testing history. More than half (58.8%) of the respondents presented with a negative attitude toward PLHIV and 64.3% of the respondents had poor knowledge regarding the illness. In the multivariable analysis, knowledge about HIV and level of education reported significant associations with discriminatory attitudes. We concluded that the odds of individuals living in a rural setting and hailing from a low socioeconomic background presenting with a negative attitude towards PLHIV were 2.52 times (95% CI 1.07-5.89) higher as compared to those living in an urban setting from a high socioeconomic background.
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Affiliation(s)
- Sonia Sameen
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Syed Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
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89
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Regan M, Muhihi A, Saleh A, Duggan CP, Ulenga N, Alwy Al-Beity FM, Aboud S, Fawzi WW, Manji KP, Sudfeld CR. Antenatal depression and adverse birth outcomes among pregnant women living with HIV in Dar es Salaam, Tanzania. J Affect Disord 2023; 339:82-88. [PMID: 37437720 PMCID: PMC10538406 DOI: 10.1016/j.jad.2023.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Women who experience antenatal depression may be at increased risk of adverse birth outcomes. Few studies have examined this association among women living with HIV (WHIV). METHODS We conducted a prospective cohort study of 2298 pregnant WHIV on antiretroviral therapy (ART) in Dar es Salaam, Tanzania, who were participants in a randomized trial of vitamin D3 supplementation. Depressive symptoms were assessed at 12-27 weeks gestation using the Hopkins Symptoms Checklist (HSCL-25). Generalized estimating equations to account for twins were used to assess the relative risks of adverse birth outcomes. RESULTS Approximately 67 % of the women in our study population reported symptoms consistent with depression. We observed a 4.0 % prevalence of stillbirth and a 25.1 % prevalence of preterm birth. We found that low social support, higher education, and more recent initiation of ART were associated with a greater risk of antenatal depression. There was no association of antenatal depression with risk of fetal loss, stillbirth, low birth weight, birth weight, preterm birth, gestational age at delivery, or small-for-gestational age. LIMITATIONS Depression was self-reported and only collected at one timepoint in pregnancy. Our findings may not be generalizable to all WHIV. CONCLUSIONS Our findings illustrate the high risk of both depression and adverse birth outcomes among WHIV and underscore the need for interventions to improve their mental health and the health of their infants; however, the relationship between depression and birth outcomes remains unclear. Further research on this topic is merited, particularly examining the chronicity and timing of depression in pregnancy.
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Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Arvin Saleh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M Alwy Al-Beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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90
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Saberi P, Stoner MCD, McCuistian CL, Balaban C, Ming K, Wagner D, Chakraborty B, Smith L, Sukhija-Cohen A, Neilands TB, Gruber VA, Johnson MO. iVY: protocol for a randomised clinical trial to test the effect of a technology-based intervention to improve virological suppression among young adults with HIV in the USA. BMJ Open 2023; 13:e077676. [PMID: 37802624 PMCID: PMC10565330 DOI: 10.1136/bmjopen-2023-077676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Young adults with HIV (YWH) experience worse clinical outcomes than adults and have high rates of substance use (SU) and mental illness that impact their engagement in care and adherence to antiretroviral therapy (ART). The intervention for Virologic Suppression in Youth (iVY) aims to address treatment engagement/adherence, mental health (MH) and SU in a tailored manner using a differentiated care approach that is youth friendly. Findings will provide information about the impact of iVY on HIV virological suppression, MH and SU among YWH who are disproportionately impacted by HIV and at elevated risk for poor health outcomes. METHODS AND ANALYSIS The iVY study will test the effect of a technology-based intervention with differing levels of resource requirements (ie, financial and personnel time) in a randomised clinical trial with an adaptive treatment strategy among 200 YWH (18-29 years old). The primary outcome is HIV virological suppression measured via dried blood spot. This piloted and protocolised intervention combines: (1) brief weekly sessions with a counsellor via a video-chat platform (video-counselling) to discuss MH, SU, HIV care engagement/adherence and other barriers to care; and (2) a mobile health app to address barriers such as ART forgetfulness, and social isolation. iVY has the potential to address important, distinct and changing barriers to HIV care engagement (eg, MH, SU) to increase virological suppression among YWH at elevated risk for poor health outcomes. ETHICS AND DISSEMINATION This study and its protocols have been approved by the University of California, San Francisco Institutional Review Board. Study staff will work with a Youth Advisory Panel to disseminate results to YWH, participants and the academic community. TRIAL REGISTRATION NUMBER NCT05877729.
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Affiliation(s)
- Parya Saberi
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Caravella L McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Celeste Balaban
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Kristin Ming
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Bibhas Chakraborty
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, NC, USA
- Centre for Quantitative Medicine and Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Louis Smith
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | | | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Valerie A Gruber
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
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91
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Tigirigi TO, Sithole GY, Chakara P, Chirombo GZ, Chiweza AR, Mubayiwa TR, Muchemwa S, Chibanda D, Dambi JM. Evaluation of the health-related quality of life and associated factors in Zimbabwean adults living with HIV: a cross-sectional study. BMC Res Notes 2023; 16:251. [PMID: 37794503 PMCID: PMC10548739 DOI: 10.1186/s13104-023-06536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE HIV remains a global burden, with the Sub-Saharan Africa (SSA) region reporting the largest number of people living with HIV/AIDS (PLHIV). An exponential improvement in the accessibility and uptake of antiretroviral treatment across SSA has significantly improved outcomes for PLHIV. Hence, HIV care goals have shifted from reducing mortality and morbidity to improving health-related quality of life (HRQoL). This study uses generic and condition-specific HRQoL outcomes to holistically determine the HRQoL of Zimbabwean adult PLHIV and associated factors. HRQoL is a dynamic subject construct that warrants continuous evaluation to provide meaningful feedback to various stakeholders. We enrolled 536 adult PLHIV in Zimbabwe. Collected data were analyzed through descriptive statistics and multivariate binary logistic regression. RESULTS Our study shows a high HRQoL perception by Zimbabwean PLHIV. Anxiety, depression, and poor environmental health were widely reported domains influencing HRQoL. Also, being aware of HIV status for over a year, not experiencing an adverse event, being married, having adequate finances and food security and having higher educational status were associated with higher HRQoL. It is essential to integrate mental health care into routine HIV care to improve treatment outcomes and HRQoL. Last, implementing bespoke multisectoral HRQoL-enhancement interventions is paramount.
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Affiliation(s)
- Tendai Orial Tigirigi
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
| | - Grace Yolanda Sithole
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
| | - Princess Chakara
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
| | - Gracious Z Chirombo
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
| | - Annamore Rutendo Chiweza
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
| | - Trish R Mubayiwa
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
| | - Sidney Muchemwa
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe.
| | - Dixon Chibanda
- Mental Health Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe
| | - Jermaine M Dambi
- Rehabilitation Sciences Unit - Faculty of Medicine and Health Sciences, University of Zimbabwe, PO BOX AV 178, Avondale, Harare, Zimbabwe
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92
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Mthiyane N, Rapulana AM, Harling G, Copas A, Shahmanesh M. Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e066586. [PMID: 37788931 PMCID: PMC10551963 DOI: 10.1136/bmjopen-2022-066586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA. DESIGN Systematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach. DATA SOURCES A systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10-24 years. DATA EXTRACTION AND SYNTHESIS We included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants. RESULTS Of 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes. CONCLUSIONS The evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts. PROSPERO REGISTRATION NUMBER CRD42021258826.
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Affiliation(s)
- Nondumiso Mthiyane
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
| | - Antony M Rapulana
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa
| | - Guy Harling
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
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93
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Wainberg ML, Wolvaardt GG, Gouveia L, Ferenchick E. World Mental Health Day 2023: We must leave no one behind in the response to HIV and mental health. J Int AIDS Soc 2023; 26:e26183. [PMID: 37814801 PMCID: PMC10562895 DOI: 10.1002/jia2.26183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
| | | | - Lidia Gouveia
- Department of Mental HealthMinistry of HealthMaputoMozambique
| | - Erin Ferenchick
- Center for Family and Community MedicineColumbia UniversityNew YorkNYUSA
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94
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Breslow AS, Fazzari M, Franz PJ, Hanna DB, Felson UR, Cavic E, Fisher MR, Bauman L. Longitudinal Associations of Psychiatric Risk Factors with Non-psychiatric Hospitalization in a Large Cohort of People Living with HIV in New York City. AIDS Behav 2023; 27:3487-3497. [PMID: 37084105 PMCID: PMC10516773 DOI: 10.1007/s10461-023-04064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Hospitalizations among people living with HIV (PLWH) are frequent and costly. This study examined the association between psychiatric, HIV-related, and demographic factors and hospitalization rates among PLWH using data from the Einstein-Rockefeller-City University of New York Center for AIDS Research Clinical Cohort Database. Of the 10,215 PLWH included in the sample, 45% had at least one non-psychiatric hospitalization between 2009 and 2018, with significant risk factors including prior psychiatric outpatient visits, depression, or alcohol-related disorder diagnoses, female sex, older age, CD4 count < 500 cells/uL, and detectable viral load. Additionally, 14% had an HIV-related hospitalization, with significant risk factors including prior psychiatric outpatient visits, alcohol- and substance-related disorder diagnoses, female sex, older age, CD4 count < 500 cells/uL, and detectable viral load. The study emphasizes the need for tailored interventions, including integrated treatment and comprehensive case management, for PLWH with comorbid psychiatric disorders, women, and older adults.
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Affiliation(s)
- Aaron S Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
- Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA.
- PRIME Center for Health Equity, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 4A-47, Bronx, NY, 10461, USA.
| | - Melissa Fazzari
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA
| | - Peter J Franz
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David B Hanna
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA
| | - Uriel R Felson
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA
| | - Elizabeth Cavic
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA
| | - Marla R Fisher
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Morningside and Mount Sinai West, New York, NY, USA
| | - Laurie Bauman
- Einstein-Rockefeller-City University of New York Center for AIDS Research, Bronx, NY, USA
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
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Lo SWK, Muschialli L, Fernandez T, Smith C, Peppa D, Burns F. Investigation into the psychological impact of the COVID-19 pandemic for people living with HIV. Int J STD AIDS 2023; 34:777-784. [PMID: 37269326 PMCID: PMC10240304 DOI: 10.1177/09564624231179275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND People living with HIV (PLWH) report high levels of anxiety. This study assessed the prevalence of COVID-19-related anxiety in PLWH. METHODS Participants were recruited from two UK HIV clinics (01/03/2020 - 30/05/2022) and asked to complete the Coronavirus Anxiety Scale. The proportion with scores ≥9 (cut-off for dysfunctional pandemic-related anxiety) and ≥1 (reporting of any pandemic-related anxiety) were analysed. RESULTS 115 PLWH were included, predominantly identifying as male (83.5%, n = 96), white (58.3%, n = 67) and reporting post-secondary education (82.6%, n = 95), with a median age of 51 years (range 22-93). Median CAS score was 0, with 4.4% scoring ≥9 (n = 5). More women scored ≥9 than men (16.7% (n = 3) and 2.1% (n = 2) respectively). Black African (13.6%, n = 3) and Other Ethnic Minority PLWH (25%, n = 2) had a greater proportion of scores ≥9 than White/Asian PLWH (both 0%). SARS-CoV-2 exposure was associated with scores greater than 1 but not greater than 9. CAS score was not associated with lower CD4 (<350 cells/mm3), detectable HIV viral load (≥50 copies/ml), or a history of pre-pandemic anxiety. CONCLUSIONS Pandemic-related anxiety was low, but we identified a sub-population reporting dysfunctional pandemic related anxiety. Future work should further investigate the psychological impact of the pandemic on this group.
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Affiliation(s)
- Sze Wing Karina Lo
- University College London, Division of Infection and Immunity, London UK
| | - Luke Muschialli
- University College London, Division of Infection and Immunity, London UK
| | | | - Colette Smith
- University College London, Division of Infection and Immunity, London UK
- Institute for Global Health, University College London, London, UK
- Mortimer Market Centre, Department of HIV, CNWL NHS Trust, London UK
| | - Dimitra Peppa
- HIV Medicine, Royal Free London NHS Foundation Trust, London UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- HIV Medicine, Royal Free London NHS Foundation Trust, London UK
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96
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Rodriguez-Hart C, Zhao G, Goldstein Z, Radix A, Torian L. An Exploratory Study to Describe Transgender People with HIV Who Accessed Medicaid and Their Viral Suppression Over Time in New York City, 2013-2017. Transgend Health 2023; 8:429-436. [PMID: 37810942 PMCID: PMC10551759 DOI: 10.1089/trgh.2021.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Although HIV surveillance contains information on HIV outcomes among transgender persons with HIV (TPWH), it does not include other important data, for example, gender-affirming health care, which may influence viral suppression (VS). We describe TPWH accessing Medicaid and the association of gender-affirming surgery with VS. Methods Through matching Medicaid claims with HIV registry data, a cohort of previously identified TPWH in Medicaid was compared to cisgender women and men in terms of VS in 2013-2017 in New York City. Medicaid claims were used to identify TPWH who obtained gender-affirming surgery (e.g., chest, genital surgeries). We described the VS of those who had surgery and examined temporal trends in VS pre- and postsurgery and by surgery type. Results 1730 TPWH were enrolled in Medicaid and in HIV care in 2013-2017. Overall for VS at last laboratory, TPWH in Medicaid had lower VS (76.0%) than cisgender women (80.4%) and men (83.3%). The exception was the 185 TPWH who obtained gender-affirming surgery (86.5%). Among 160 TPWH in Medicaid who obtained gender-affirming surgery and achieved VS, VS increased presurgery (66.3% 2 years prior, 76.9% 1 year prior) and remained high 1 year after (86.3%) and 2 years after (87.7%) (the last percentage is only among those who had surgery before 2017, N=81). Conclusion Gender-affirming surgery may be an important motivator to becoming virally suppressed and was associated with sustained high VS, which can lead to improved survival and quality of life. Medicaid and other insurers should consider improving access to gender-affirming surgery among TPWH.
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Affiliation(s)
- Cristina Rodriguez-Hart
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Gagarin Zhao
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Zil Goldstein
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Lucia Torian
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
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Bernays S, Lariat J, Cowan F, Senzanje B, Willis N, Nenguke ZM. "They test my blood to know how much blood is in my body": the untapped potential of promoting viral load literacy to support adherence and viral suppression among adolescents living with HIV. J Int AIDS Soc 2023; 26:e26153. [PMID: 37880186 PMCID: PMC10600064 DOI: 10.1002/jia2.26153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/16/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Achieving sustained HIV viral suppression is a key strategy to optimize the health and wellbeing of those living with HIV. Sub-optimal adherence to antiretroviral therapy (ART) in adolescents and young people living with HIV (AYPLHIV) in Southern Africa, due to a range of social and contextual factors, including poor mental health, has presented a substantial challenge to meeting targets aimed towards improving treatment outcomes and reducing transmission. With the increasing availability of viral load (VL) testing in Southern Africa, there is an opportunity to better understand the relationship between VL literacy, wellbeing and adherence among adolescents. METHODS We conducted qualitative interviews with 45 AYPLHIV aged 10-24 years in three districts (urban, peri-urban and rural) in Zimbabwe between March and August 2021. The sample was purposively selected to represent a range of experiences related to HIV status disclosure, gender, marital status and treatment experience. Separate workshops were conducted with 18 healthcare workers (HCWs) and 20 caregivers to better understand existing support mechanisms to AYPLHIV accessing ART. We used thematic analysis to examine adolescent VL literacy, treatment support networks, experiences of clinic interactions, VL testing procedures and barriers to adherence. RESULTS VL literacy was consistently under-developed among participants. Comprehension of phrases commonly heard during clinic visits, such as TND (target not detected) and "high" and "low" VL, were better understood by older participants. VL testing was predominantly understood as a clinical procedure that enables HCWs to monitor treatment adherence. Absent throughout the interviews were descriptions of how viral suppression improves health and quality of life, likely fosters wellbeing and enhances self-esteem, enables participation in education and social activities, and eliminates the risk of onward transmission. CONCLUSIONS It is imperative that we reconsider how routine VL monitoring is communicated to and understood by AYPLHIV. Reframing ART, including VL test results, in terms of the psychosocial benefits that viral suppression can generate is likely to be crucial to motivating AYPLHIV to maintain optimal treatment engagement and develop self-management approaches as they move into adulthood. Access to accurate information tailored to individual concerns and circumstances can support AYPLHIV to achieve wellbeing.
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Affiliation(s)
- Sarah Bernays
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
- Department of Global Health and Development London School of Hygiene & Tropical MedicineLondonUK
| | - Joni Lariat
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
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Nguyen MX, Zimmer C, Latkin CA, Lancaster KE, Dowdy DW, Hutton H, Chander G, Frangakis C, Gaynes BN, Sripaipan T, Tran HV, Go VF. Validation of the combined Patient Health Questionnaire Anxiety and Depression Scale among people with HIV in Vietnam. Int J STD AIDS 2023; 34:832-840. [PMID: 37287254 DOI: 10.1177/09564624231180782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Our study aims to examine the factor structure, validity, and reliability of the combined scale Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) among people with HIV (PWH) in Vietnam. METHODS Baseline data from an alcohol-reduction intervention trial among ART clients in Thai Nguyen, Vietnam were used for this analysis (n = 1547). A score ≥10 on the PHQ-9, GAD-7 and PHQ-ADS scale was considered having clinically meaningful depression, anxiety and distress symptoms. Factor structure of the combined PHQ-ADS scale was validated using confirmatory factor analysis, and three models were tested: a one-factor, a two-factor, and a bi-factor model. Reliability and construct validity were examined. RESULTS The prevalence of clinically meaningful depression and anxiety symptoms was 7% and 2%, respectively, while 19% had distress symptoms. A bi-factor model had the best fit to the data (RMSEA = 0.048; CFI = 0.99; TLI = 0.98). The Omega index of the bi-factor model was 0.97. The scale showed good construct validity through negative associations between depression, anxiety, distress symptoms and quality of life. CONCLUSIONS Our study supports the use of a combined scale to measure general distress for PWH, which has good validity, reliability and is unidimensional enough to justify the use of a composite depression and anxiety score.
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Affiliation(s)
- Minh X Nguyen
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Catherine Zimmer
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teerada Sripaipan
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ha V Tran
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Vivian F Go
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
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99
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Borrajo A, Pérez-Rodríguez D, Fernández-Pereira C, Prieto-González JM, Agís-Balboa RC. Genomic Factors and Therapeutic Approaches in HIV-Associated Neurocognitive Disorders: A Comprehensive Review. Int J Mol Sci 2023; 24:14364. [PMID: 37762667 PMCID: PMC10531836 DOI: 10.3390/ijms241814364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
HIV-associated neurocognitive disorders (HANDs) still persist despite improved life expectancy, reduced viral loads, and decreased infection severity. The number of patients affected by HANDs ranges from (30 to 50) % of HIV-infected individuals. The pathological mechanisms contributing to HANDs and the most serious manifestation of the disease, HIV-associated dementia (HAD), are not yet well understood. Evidence suggests that these mechanisms are likely multifactorial, producing neurocognitive complications involving disorders such as neurogenesis, autophagy, neuroinflammation, and mitochondrial dysfunction. Over the years, multiple pharmacological approaches with specific mechanisms of action acting upon distinct targets have been approved. Although these therapies are effective in reducing viral loading to undetectable levels, they also present some disadvantages such as common side effects, the need for administration with a very high frequency, and the possibility of drug resistance. Genetic studies on HANDs provide insights into the biological pathways and mechanisms that contribute to cognitive impairment in people living with HIV-1. Furthermore, they also help identify genetic variants that increase susceptibility to HANDs and can be used to tailor treatment approaches for HIV-1 patients. Identification of the genetic markers associated with disease progression can help clinicians predict which individuals require more aggressive management and by understanding the genetic basis of the disorder, it will be possible to develop targeted therapies to mitigate cognitive impairment. The main goal of this review is to provide details on the epidemiological data currently available and to summarise the genetic (specifically, the genetic makeup of the immune system), transcriptomic, and epigenetic studies available on HANDs to date. In addition, we address the potential pharmacological therapeutic strategies currently being investigated. This will provide valuable information that can guide clinical care, drug development, and our overall understanding of these diseases.
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Affiliation(s)
- Ana Borrajo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy
| | - Daniel Pérez-Rodríguez
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Facultade de Bioloxía, Universidade de Vigo (UVigo), Campus Universitario Lagoas-Marcosende, s/n, 36310 Vigo, Spain
| | - Carlos Fernández-Pereira
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Area Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | - José María Prieto-González
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Translational Research in Neurological Diseases (ITEN), Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Roberto Carlos Agís-Balboa
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Translational Research in Neurological Diseases (ITEN), Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
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Thomas MD, Vittinghoff E, Koester KA, Dahiya P, Riano NS, Cournos F, Dawson L, Olfson M, Pinals DA, Crystal S, Walkup J, Shade S, Mangurian C, Arnold EA. Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia. J Acquir Immune Defic Syndr 2023; 94:18-27. [PMID: 37229531 PMCID: PMC10524352 DOI: 10.1097/qai.0000000000003225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia. SETTING Nationally representative sample of Medicaid enrollees with and without schizophrenia. METHODS Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002-2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. RESULTS Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. CONCLUSION Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.
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Affiliation(s)
- Marilyn D. Thomas
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
| | - Kimberly A. Koester
- Department of Medicine, University of California San Francisco, School of Medicine 533 Parnassus Ave, San Francisco, CA 94143
| | - Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
| | - Nicholas S. Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
- Department of Psychological Science, School of Social Ecology, University of California Irvine, 2220 Social and Behavioral Sciences Gateway, 214 Pereira Dr, Irvine, CA 92617
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 630 W 168th St, New York, NY 10032
- Department of Epidemiology, Columbia University Mailman School of Public Health 722 W 168th St, New York, NY 10032
| | - Lindsey Dawson
- KFF (Kaiser Family Foundation) 185 Berry St #2000, San Francisco, CA 94107
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 630 W 168th St, New York, NY 10032
- Department of Epidemiology, Columbia University Mailman School of Public Health 722 W 168th St, New York, NY 10032
- New York State Psychiatric Institute 1051 Riverside Dr, New York, NY 10032
| | - Debra A. Pinals
- Department of Psychiatry, University of Michigan Medical School 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Steven Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University 112 Paterson St, New Brunswick, NJ 08901
| | - James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University 112 Paterson St, New Brunswick, NJ 08901
- Graduate School of Applied and Professional Psychology, Rutgers University 152 Frelinghuysen Rd, Piscataway, NJ 08854
| | - Starley Shade
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital 2789 25th St, San Francisco, CA 94110
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco 490 Illinois Street 7 Floor, San Francisco, CA 94158
| | - Emily A. Arnold
- Department of Medicine, University of California San Francisco, School of Medicine 533 Parnassus Ave, San Francisco, CA 94143
- Center for AIDS Prevention Studies, University of California San Francisco 550 16th St 3rd floor, San Francisco, CA 94158
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