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Kacanek D, Malee K, Mellins CA, Tassiopoulos K, Smith R, Grant M, Lee S, Siddiqui DQ, Puga A. Exposure to Violence and Virologic and Immunological Outcomes Among Youth With Perinatal HIV in the Pediatric HIV/AIDS Cohort Study. J Adolesc Health 2016; 59:30-7. [PMID: 27089837 PMCID: PMC4920719 DOI: 10.1016/j.jadohealth.2016.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Exposure to violence in childhood has been linked to adverse health outcomes. Little is known about the prevalence and relationship of youth and caregiver violence exposure to clinical outcomes among youth with perinatal human immunodeficiency virus (HIV) infection (PHIV). We evaluated associations of youth and caregiver violence exposure with unsuppressed viral load (VL) (HIV RNA > 400 copies/mL) and CD4% <25% among 8- to 15-year-old participants with PHIV in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol. METHODS Annual clinical examination, record abstraction, and interview data were collected, including youth report of recent exposure to violence and caregivers' self-report of being assaulted/abused in adulthood. Multivariable logistic regression methods were used to calculate adjusted odds ratios for unsuppressed VL and CD4% <25%, controlling for sociodemographic characteristics. RESULTS Among 268 youth with PHIV (53% girls, mean age 12.8 years, 21% white, 42% with household income <$20,000/year), 34% reported past year violence exposure; 30% had a caregiver who reported being assaulted in adulthood. One quarter of youth (24%) had unsuppressed VL and 22% had CD4% <25%. Youth who were exposed to violence in the past year versus those who were not had elevated odds of unsuppressed VL. Youth with indirect exposure to violence in the past year versus those without had elevated odds of unsuppressed VL and CD4% <25% in adjusted models. CONCLUSIONS Youth with PHIV report a high prevalence of recent violence exposure, which was associated with poor virologic and immunologic outcomes. Reducing violence and providing support to youth with violence exposure and PHIV may improve health outcomes.
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Affiliation(s)
- Deborah Kacanek
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Kathleen Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University Medical Center, NY, NY
| | | | - Renee Smith
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL
| | - Mitzie Grant
- Department of Psychiatry, Drexel University College of Medicine & St. Christopher's Hospital for Children, Philadelphia, PA
| | - Sonia Lee
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Danish Q. Siddiqui
- Department of Pediatrics Infectious Diseases, Tulane School of Medicine, New Orleans, LA
| | - Ana Puga
- Children's Diagnostic and Treatment Center, Fort Lauderdale, FL
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102
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Dale SK, Traeger L, O'Cleirigh C, Bedoya CA, Pinkston M, Wilner JG, Stein M, Safren SA. Baseline Substance Use Interferes with Maintenance of HIV Medication Adherence Skills. AIDS Patient Care STDS 2016; 30:215-20. [PMID: 27158849 DOI: 10.1089/apc.2015.0340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV improves both adherence and depression outcomes relative to enhanced treatment as usual (ETAU). However, in persons with injection drug use (PWIDU) histories, adherence gains seen during treatment have not been maintained postintervention. Therefore, we examined whether heroin or cocaine use at study entry moderated acquisition or maintenance of adherence gains after CBT-AD. HIV-positive adults in treatment for opioid dependence (n = 89) were randomly assigned to CBT-AD or ETAU and completed 3-, 6-, and 12-month assessments. Participants were majority male (61%), white (48%), and heterosexual (79%). Hierarchical linear modeling was used to evaluate whether heroin or cocaine use at baseline interacted with intervention assignment to predict change in adherence during active treatment and follow-up. CBT-AD-related improvement in adherence during the active intervention period did not vary by baseline substance use. However, cocaine use (but not heroin use) at baseline interacted with intervention assignment to predict a significant decline in follow-up adherence (cocaine use × group condition coefficient = -0.77, t = -2.44, p = 0.02) such that by 12 months, adherence among CBT participants was significantly lower among those who used cocaine (45.0%) compared to those who did not (72.3%; t = 2.50, p = 0.018). HIV-positive PWIDU who use heroin or cocaine at baseline can benefit from the CBT-AD intervention to improve adherence to antiretroviral therapy; therefore, providers should not withhold an active psychosocial treatment for HIV-positive PWIDU who are using. Cocaine use at baseline may limit the degree to which gains are maintained postintervention, and therefore, booster sessions may be needed.
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Affiliation(s)
- Sannisha K. Dale
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Lara Traeger
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Conall O'Cleirigh
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - C. Andres Bedoya
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Megan Pinkston
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
- Behavioral Medicine Clinical Services, The Miriam Hospital, Providence, Rhode Island
| | - Julianne G. Wilner
- Psychological & Brain Sciences, Boston University, Boston, Massachusetts
| | - Michael Stein
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
- Butler Hospital, Providence, Rhode Island
| | - Steven A. Safren
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychology, University of Miami, Coral Gables, Florida
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103
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McCree DH, Koenig LJ, Basile KC, Fowler D, Green Y. Addressing the Intersection of HIV and Intimate Partner Violence Among Women with or at Risk for HIV in the United States. J Womens Health (Larchmt) 2016; 24:331-5. [PMID: 25973798 DOI: 10.1089/jwh.2015.5301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2012, the White House established a working group in recognition of the need to understand and address the intersection of human immunodeficiency virus (HIV) infection and violence against women and girls. This report describes the Centers for Disease Control and Prevention (CDC)'s efforts for addressing intimate partner violence and HIV among women and provides suggestions for future prevention efforts. CDC's current efforts are focused on understanding these often co-occurring public health problems, identifying effective interventions, and ensuring that states and communities have the capacity and resources to implement prevention approaches based on the best available evidence. Additional research is needed on effective strategies for integrating violence prevention and HIV programming into health services targeting adolescent girls and women who experience intimate partner violence or are at risk for HIV.
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Affiliation(s)
- Donna Hubbard McCree
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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104
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Ocampo JMF, Plankey M, Zou K, Collmann J, Wang C, Young MA, Liu C, Ripple JA, Kassaye S. Trajectory analyses of virologic outcomes reflecting community-based HIV treatment in Washington DC 1994-2012. BMC Public Health 2015; 15:1277. [PMID: 26695971 PMCID: PMC4688953 DOI: 10.1186/s12889-015-2653-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective treatment of HIV since 1996 has reduced morbidity and mortality through virologic suppression. Combination antiretroviral therapy (cART) has been recognized as key to the prevention of drug resistance and the transmission of infection. We used eighteen years of virologic outcomes in a long-standing cohort of women to describe longitudinal viral load trajectories; and examine factors associated with sustained viremia and mortality. METHODS We analyzed data from DC WIHS women with > four semiannual visits using a group-based logistic trajectory analysis approach to identify patterns of HIV RNA detection (>80 copies/mL or lower assay limit, and >1000 copies/mL). We verified findings using cumulative viral load suppression-years, explored group characteristics using generalized linear modeling with generalized estimating equations for repeated measures, and examined survival using the Kaplan-Meier and Cox proportional hazard analyses. RESULTS 329 women contributed 6633 visits between 1994 and 2012 and demonstrated high, moderate, and low probability patterns of HIV RNA detection (>80 copies/mL) in 40.7, 35.6, and 23.7% of participant visits, respectively. Analysis of cumulative years of viral load suppression supported these observations. Kaplan-Meier survival analysis demonstrated high mortality of 31.1% with sustained viremia, but no significant difference in mortality between intermittent viremia and non-viremia patterns, 6.9 and 4.9% respectively. Mortality was associated with higher age, lower CD4+ T lymphocyte count, and sustained viremia by Cox multivariate analysis. CONCLUSIONS This ecologic study demonstrates the effectiveness of viral suppression, and conversely the association between viremia and mortality. In community delivery of cART for HIV care, distinct patterns of sustained viremia, intermittent viremia, and non-viremia were identified over nearly 18 years in the DC WIHS, capturing the dynamics and complexity of sustaining long-term HIV care. Persistent viremia was associated with lower CD4s and mortality, but surprisingly mortality was not different between continuous suppression and intermittent viremia. Classification of long-term virologic patterns such as these observed HIV treatment "careers" may provide a suitable framework to identify modifiable factors associated with treatment resilience and failure. Both individual and population interventions are needed to reduce transmission, prevent the emergence of drug resistance, and improve outcomes of community ART programs.
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Affiliation(s)
- Joanne Michelle F Ocampo
- The Office of the Senior Vice President for Research, Georgetown University, Washington, DC, USA.
| | - Michael Plankey
- The Women's Interagency HIV Study, Georgetown University Medical Center, Washington, DC, USA
| | - Kai Zou
- The Office of the Senior Vice President for Research, Georgetown University, Washington, DC, USA
| | - Jeff Collmann
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, USA
| | - Cuiwei Wang
- The Women's Interagency HIV Study, Georgetown University Medical Center, Washington, DC, USA
| | - Mary A Young
- The Women's Interagency HIV Study, Georgetown University Medical Center, Washington, DC, USA
| | - Chenglong Liu
- The Women's Interagency HIV Study, Georgetown University Medical Center, Washington, DC, USA
| | - Joshua A Ripple
- The Office of the Senior Vice President for Research, Georgetown University, Washington, DC, USA
| | - Seble Kassaye
- The Women's Interagency HIV Study, Georgetown University Medical Center, Washington, DC, USA
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105
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LeGrand S, Reif S, Sullivan K, Murray K, Barlow ML, Whetten K. A Review of Recent Literature on Trauma Among Individuals Living with HIV. Curr HIV/AIDS Rep 2015; 12:397-405. [PMID: 26419376 PMCID: PMC4837695 DOI: 10.1007/s11904-015-0288-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Persons living with HIV (PLWH) report disproportionately high levels of exposure to traumatic events in childhood and adulthood. Traumatic experiences are associated with negative health and behavioral outcomes. Current research in this area seeks to further explicate the myriad health effects of trauma on PLWH and the pathways through which trauma operates. In this paper, we review articles published in English between January 2014 and June 2015 that examine traumatic experiences among PLWH, including intimate partner violence (IPV), domestic abuse, child abuse, and other forms of violence. A selection of studies examining trauma among PLWH and its associations with mental health, antiretroviral medication adherence, clinical outcomes, HIV disclosure, and sexual risk behaviors were included. Studies describing trauma coping strategies and interventions were also included. We conclude with recommendations for care of trauma-exposed PLWH and directions for future research.
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Affiliation(s)
- Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
- Duke Global Health Institute, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Kristen Sullivan
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Kate Murray
- FHI360, 359 Blackwell St., Suite 200, Durham, NC, 27701, USA.
| | - Morgan L Barlow
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
- Duke Global Health Institute, Duke University, 310 Trent Dr., Durham, NC, 27710, USA.
- Sanford School of Public Policy, Duke University, 201 Science Dr, Durham, NC, 27708, USA.
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106
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Abstract
This study examined the difference in dog owning between Japan and the United States, and the effect of these differences on dogs' behavioral characteristics. Behavioral evaluations of privately-owned dogs were obtained by using online questionnaire. We compared background and demographic information from the two countries and analyzed the effects of these differences on behavioral characteristics in dogs. The results indicated that there was a bias in the dog breeds kept in Japan compared to the United States and that Japanese dogs' body weight was lower than the US dogs. The main source of dog acquisition was pet stores in Japan and breeders and/or shelters in the United States. Multiple linear regression analysis found that Japanese dogs showed more aggression to household members and higher energy, restlessness and fear of non-social stimuli than US dogs, while US dogs showed more fear of unfamiliar persons, separation-related behavior and excitability. US dogs also showed higher levels of trainability and attachment to owners. The lower dog's body weight was, the higher the behavioral scores except for trainability were. When dogs that were obtained under 3 months of age were analyzed, the younger the dogs were when their owners obtained them, the higher the scores on some behavioral problem factors were. The higher rates of problem behaviors among Japanese dogs compared with US dogs suggest that the preference for small breed dogs and poor early development environment influenced the behavioral characteristics of dogs.
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107
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Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework. J Behav Med 2015; 39:1-12. [PMID: 26296521 DOI: 10.1007/s10865-015-9670-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
Abstract
We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23 % had moderate levels of all factors (Class 3); 25 % had high mental illness (Class 2); 43 % had moderate substance use/mental illness (Class 1; N = 331). Compared to Classes 1-3, Class 4 was mostly female (p < .05), less likely to achieve viral suppression, and more likely to utilize acute care (p < .05). Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.
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108
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Xavier J, Cajina A. The special projects of national significance women of color initiative. AIDS Patient Care STDS 2015; 29 Suppl 1:S1-3. [PMID: 25458602 DOI: 10.1089/apc.2014.0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Xavier
- US Department of Health and Human Services, Health Resources and Services Administration, HIV-AIDS Bureau, Special Projects of National Significance, Rockville, Maryland
| | - Adan Cajina
- US Department of Health and Human Services, Health Resources and Services Administration, HIV-AIDS Bureau, Special Projects of National Significance, Rockville, Maryland
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109
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Sullivan KA, Schultz K, Ramaiya M, Berger M, Parnell H, Quinlivan EB. Experiences of women of color with a nurse patient navigation program for linkage and engagement in HIV care. AIDS Patient Care STDS 2015; 29 Suppl 1:S49-54. [PMID: 25457920 DOI: 10.1089/apc.2014.0279] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patient navigation, a patient-centered model of care coordination focused on reducing barriers to care, is an emerging strategy for linking patients to and retaining them in HIV care. The Guide to Healing Program (G2H), implemented at the Infectious Diseases Clinic at UNC Chapel Hill, provided patient navigation to women of color (WOC) new to or re-engaging in HIV care through a 'nurse guide' with mental health training and experience. The purpose of this study was to qualitatively explore patients' experiences working with the nurse guide. Twenty-one semi-structured telephone interviews with G2H participants were conducted. Interviews were transcribed and thematic analysis was utilized to identify patterns and themes in the data. Women's experiences with the nurse guide were overwhelmingly positive. They described the nurse guide teaching them critical information and skills, facilitating access to resources, and conveying authentic kindness and concern. The findings suggest that a properly trained nurse in this role can provide critical medical and psychosocial support in order to eliminate barriers to engagement in HIV care, and successfully facilitate patient HIV self-management. The nurse guide model represents a promising approach to patient navigation for WOC living with HIV.
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Affiliation(s)
- Kristen A. Sullivan
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Katherine Schultz
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Megan Ramaiya
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Miriam Berger
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Heather Parnell
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - E. Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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