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Glasner S, Chokron Garneau H, Ang A, Ray L, Venegas A, Rawson R, Kalichman S. Preliminary Efficacy of a Cognitive Behavioral Therapy Text Messaging Intervention Targeting Alcohol Use and Antiretroviral Therapy Adherence: A Randomized Clinical Trial. PLoS One 2020; 15:e0229557. [PMID: 32163431 PMCID: PMC7067560 DOI: 10.1371/journal.pone.0229557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov, NCT02603471.
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Affiliation(s)
- Suzette Glasner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Helene Chokron Garneau
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Alfonso Ang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Lara Ray
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Alexandra Venegas
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Richard Rawson
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
- Department of Psychiatry, Center for Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
| | - Seth Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Mansfield, Connecticut, United States of America
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102
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Magidson JF, Andersen LS, Satinsky EN, Myers B, Kagee A, Anvari M, Joska JA. "Too much boredom isn't a good thing": Adapting behavioral activation for substance use in a resource-limited South African HIV care setting. Psychotherapy (Chic) 2020; 57:107-118. [PMID: 31670529 PMCID: PMC7069775 DOI: 10.1037/pst0000257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South
African Medical Research Council; Division of Addiction Psychiatry, Department of
Psychiatry and Mental Health, University of Cape Town
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University
| | - Morgan Anvari
- Department of Psychology, University of Maryland, College
Park
| | - John A. Joska
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
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103
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Ghodrati S, Shahabinezhad Z, SeyedAlinaghi S. Association Between Immunologic and Virologic Functioning and Health-Related Quality of Life Among People Living with HIV, Tehran, Iran. Infect Disord Drug Targets 2020; 19:297-303. [PMID: 30574855 DOI: 10.2174/1871526519666181221123932] [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: 04/22/2018] [Revised: 07/11/2018] [Accepted: 12/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND With recent progress in the treatment of people living with HIV (PLWH) and their increased rate of survival, health-related quality of life (HRQoL) has become an important issue. OBJECTIVE In the present study, we aimed to investigate the association of current CD4 cell count, baseline CD4 cell count, nadir CD4 cell count, and plasma viral load with health-related quality of life in PLWH. METHODS Participants were 67 PLWH who were under the treatment of antiretroviral therapy (ART) in Imam Khomeini Hospital of Tehran, Iran in 2016. Participants were divided into the two groups with high and low levels of current CD4 cell count, baseline CD4 cell count, nadir CD4 cell count and plasma viral load. We used independent sample t-test for data analysis using SPSS 22 software. RESULTS Our results demonstrated that for current CD4 cell count, the group differences were significant for total scores of HRQoL (P=0.028), also in the components of physical functioning (P=0.032), role limitation due to physical health problems (P=0.006), and role limitation due to emotional problems (P=0.009). Our data analysis showed that for baseline CD4 cell count (P=0.62), nadir CD4 cell count (P=0.29), and viral load group (P=0.78), the differences were not significant for HRQoL. CONCLUSION Knowing the association between current CD4 count and health-related quality of life, adherence to ART might be a motivator for PLWH to enhance their health-related quality of life.
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Affiliation(s)
- Saeed Ghodrati
- Shahid Beheshti University, Institute for Cognitive and Brain Sciences, Tehran, Iran
| | | | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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104
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Dworkin MS, Panchal P, Wiebel W, Garofalo R, Jimenez A, Haberer JE. Experience with antiretroviral electronic adherence monitoring among young African American men who have sex with men living with HIV: findings to inform a triaged real-time alert intervention. AIDS Care 2020; 32:1092-1101. [PMID: 31941360 DOI: 10.1080/09540121.2020.1713975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We performed a pilot study among young African-American men who have sex with men (AAMSM) of real-time electronic adherence monitoring (EAM) in Chicago to explore acceptability and feasibility of EAM and to inform intervention development. We recruited 40 young AAMSM living with HIV on ART to participate in up to 3 months of monitoring with the Wisepill device. Participants were interviewed at baseline, in response to the first true adjudicated 1-dose, 3-day, and 7-day misses, and at the end of monitoring. Reasons for missing doses and the acceptability and feasibility of electronic monitoring were assessed using mixed methods. The median participant observation time was 90 days (N = 40). For 21 participants with 90 days of follow-up, <90% and <80% adherence occurred in 82% and 79%, respectively in at least one of their monitored months (n = 63 monitored months). The participants generally found the proposed intervention acceptable and useful. Although seven participants said the device attracted attention, none said it led to disclosure of their HIV status. This study found real-time EAM to be generally acceptable and feasible among YAAMSM living with HIV in Chicago. Future work will develop a triaged real-time EAM intervention including text alerts following detection of nonadherence.
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Affiliation(s)
- Mark S Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Palak Panchal
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Wayne Wiebel
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Antonio Jimenez
- Community Outreach Intervention Projects, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Jessica E Haberer
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
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105
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Peng Z, Yu Y, Wei W, Hou Y, Sun Z, Wang Y, Zhang L, Zhou Y, Wang Q, Cai Y. Reliability and Validity of the LifeWindows Information-Motivation-Behavioral Skills Antiretroviral Therapy Adherence Questionnaire Among HIV+ Patients in Shanghai. Patient Prefer Adherence 2020; 14:507-515. [PMID: 32184577 PMCID: PMC7062391 DOI: 10.2147/ppa.s234041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this article was to examine the validity and reliability of the LifeWindows Information-Motivation-Behavioral Skills Antiretroviral Therapy (ART) Adherence Questionnaire (LW-IMB-AAQ) among HIV+ patients in Shanghai. METHODS We surveyed 426 HIV+ patients in Shanghai's Putuo District to examine the validity and reliability of the questionnaire. The questionnaire includes self-reported demographic characteristics, the modified version of the Community Programs for Clinical Research on AIDS Antiretroviral Medication Self-Report (CPCRA) and LW-IMB-AAQ. CPCRA was used to calculate ART adherence. LW-IMB-AAQ, including the information section, the motivation section and the behavioral skills section, was used to analyze patients' ART adherence. We analyzed data by means, standard deviation, critical ratio, and item-total correlation. Reliability was assessed by internal consistency, split-half reliability, and test-retest reliability. Validity was assessed by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity and discriminant validity. RESULTS Item analysis showed that except for motivation item 1, all items were acceptable. For reliability, Cronbach's alpha coefficients for the three sections and the total scale were all higher than 0.7, with interclass correlation coefficients (ICC) all higher than 0.6 (p<0.001). The Spearman-Brown coefficient for the total scale was 0.825. For validity, results showed that the information section could be divided into two subscales, motivation section and behavioral skills section could be divided into three and two subscales, respectively. The final model demonstrated good validity (p=0.471, χ 2/df=0.960, CFI=1.000, GFI=0.994 and RMSEA<0.001) without motivation item 4. CONCLUSION Excluding motivation items 1 and 4, the LifeWindows Information-Motivation-Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ) demonstrated good validity and reliability among HIV+ patients in Shanghai.
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Affiliation(s)
- Zihe Peng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yuelin Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Wei
- Putuo District Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Yongchun Hou
- Putuo District Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Zhenyu Sun
- Taopu Town Community Health Service Center, Shanghai, People’s Republic of China
| | - Ying Wang
- Yichuan Street Community Health Service Center, Shanghai, People’s Republic of China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Shanghai, People’s Republic of China
| | - Ying Zhou
- Shanghai Public Health Clinical Center, Shanghai, People’s Republic of China
| | - Qian Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Yong Cai; Qian Wang School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of ChinaTel +86 13611677244; +86 133219663565 Email ;
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106
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Saberi P, Chakravarty D, Ming K, Legnitto D, Gandhi M, Johnson MO, Neilands TB. Moving Antiretroviral Adherence Assessments to the Modern Era: Correlations Among Three Novel Measures of Adherence. AIDS Behav 2020; 24:284-290. [PMID: 31758349 PMCID: PMC6996539 DOI: 10.1007/s10461-019-02744-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is no gold standard for estimating antiretroviral therapy (ART) adherence. Feasible, acceptable, and objective measures that are cost- and time-effective are needed. US adults (N = 93) on ART for ≥ 3 months, having access to a mobile phone and internet, and willing to mail in self-collected hair samples, were recruited into a pilot study of remote adherence data collection methods. We examined the correlation of self-reported adherence and three objective remotely collected adherence measures: text-messaged photographs of pharmacy refill dates for pharmacy-refill-based adherence, text-messaged photographs of pills for pill-count-based adherence, and assays of home-collected hair samples for pharmacologic-based adherence. All measures were positively correlated. The strongest correlation was between pill-count- and pharmacy-refill-based adherence (r = 0.68; p < 0.001), and the weakest correlation was between self-reported adherence and hair drug concentrations (r = 0.14, p = 0.34). The three measures provide objective adherence data, are easy to collect, and are viable candidates for future HIV treatment and prevention research.
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107
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Ekop E, Okechukwu A. Disclosure of status among Human Immunodeficiency Virus-infected adolescents. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_66_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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108
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Etefia E, Ben S, Inyang-Etoh P. Assessments of the level of adherence to antiretroviral therapy and the health status of people living with HIV in Calabar, Nigeria. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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109
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Exploring the Important Attributes of Human Immunodeficiency Virus and Generating Decision Rules. Symmetry (Basel) 2020. [DOI: 10.3390/sym12010067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acquired Immunodeficiency Syndrome (AIDS) is the most severe phase of Human Immunodeficiency Virus (HIV) infection. Living with HIV results in a weakened immune system, with AIDS being the final stage of HIV and puzzling the world. The current medical environment remains unable to effectively cure AIDS, with treatment depending on long-term antiretroviral therapy (ART). To effectively treat and prevent HIV, it is important to elucidate the key factors of HIV propagation. This study proposes a rough set classifier based on adding recency (R) (i.e., the last physician visit), frequency (F) (i.e., the frequency of medical visits), and monetary (M) (i.e., medication adherence) attributes and integrated attribute selection methods to generate discriminatory rules and find the core attributes of HIV. The collected data consist of 1308 HIV infection records from Taiwan. From the experimental results, the frequency of CD4+ cells in the peripheral blood is able to determine patient medication, treatment willingness, and HIV infection stages, because HIV patients are less likely to be willing to receive long-term ART. Furthermore, drug abuse is found to be the greatest cause of HIV infection. These results show that the additional RFM attributes can improve classification accuracy, with the core attributes being M, R, plasma viral load (PVL) and age. Hence, we suggest that clinical physicians use these core attributes to understand the HIV infection stages.
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110
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Galárraga O, Enimil A, Bosomtwe D, Cao W, Barker DH. Group-based economic incentives to improve adherence to antiretroviral therapy among youth living with HIV: safety and preliminary efficacy from a pilot trial. VULNERABLE CHILDREN AND YOUTH STUDIES 2019; 15:257-268. [PMID: 33281920 PMCID: PMC7717062 DOI: 10.1080/17450128.2019.1709678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/23/2019] [Indexed: 06/12/2023]
Abstract
Poor adherence to antiretroviral therapy (ART) has significant consequences for adolescents. Conditional economic incentives (CEI) is an approach that may help address this challenge. This study evaluated the safety and preliminary efficacy of a group-based CEI program for ART adherence improvement among a sample of adolescents living in Ghana. A total of 35 adolescents (mean age: 14.7 years) on ART, though still with detectable viral load, were recruited from an HIV clinic and divided into 5 balanced groups to participate in peer-led group-based CEI activities during routine clinic visits. Four assessments were conducted across four visits at baseline and 3-, 6-, and 9-month follow-up, respectively. Main outcomes were ART adherence and viral load. Linear mixed models and thematic analysis were used for data analyses. The majority (91.4%) of the participants attended all four intervention activities. Participants reported missing an average of 1.06, 0.50, 0.91, 0.55 doses of ART in the past 7 days at baseline, 3-, 6-, and 9-month assessments, respectively. Most viral loads were ≥5,000 copies/ml at both baseline (68.6%) and 6-month assessments (54.3%). The incentive was divided between individual compensation for attending clinic and completing the assessment ($5 each, $20 in total) and a group-based compensation valued at $40 that was distributed during the 9-month assessment according to average group attendance (A≥90%, B≥75%, C≥60%, D<60%) and group-average viral load (A=undetectable, B=50-499, C=500-4999, D≥5,000). The mean earnings for the participants was $46.70 (77.8% of possible earning). Qualitative data suggested that the CEI helped ART adherence through gaining personal and group benefits. Participants reported no teasing, bullying, or other undesirable behaviors from group members. They liked getting money for attending clinics/group meetings and obtaining undetectable viral load. We concluded that a group-based CEI was safe and had the potential to improve ART adherence and reduce viral load among Ghanaian adolescents.
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Affiliation(s)
- Omar Galárraga
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, United States
| | - Anthony Enimil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dennis Bosomtwe
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Wangnan Cao
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, United States
| | - David H. Barker
- Department of Psychiatry, Rhode Island Hospital, Providence, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, United States
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111
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Hiregoudar V, Bellara R, Goud TG. Proportion and Determinants of Adherence to Antiretroviral Therapy among HIV Positive People Registered Under ART Center in South India. Int J Prev Med 2019; 10:206. [PMID: 31921398 PMCID: PMC6941307 DOI: 10.4103/ijpvm.ijpvm_7_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background: Antiretroviral therapy (ART) significantly delays the progression from HIV to AIDS. Adherence to ART is the second strongest predictor of progression to AIDS and death, after CD4 count. A very high level of adherence (≥95%) is required for ART to be effective on a long term and to prevent the emergence of resistant viral strains and prevent comorbidities. Methods: A case series study was undertaken at an ART center for a period of 6 months. Non-probability purposive sampling was adapted to select HIV-positive subjects aged >15 years on ART for more than 6 months. A predesigned semi-structured questionnaire was used to obtain the data. Treatment compliance was assessed by self-reported 1-week recall method. Results: A total of 536 HIV-positive people were interviewed, among which 315 (58.8%) of them were males and 214 (39.9%) were females. Nearly two third of the participants (359, 67.0%) reported ≥95% adherence to treatment. Personal commitments (51, 28.8%) and working time inconvenience (42, 23.7%) were the common reasons for less adherence. On bivariate analysis, married people (OR: 1.586, CI: 1.097-2.292), participants residing in rural area (OR: 1.628, CI: 1.130-2.345), participants not having side effects of drugs (OR: 5.324, CI: 3.491-8.181), participants equipped with better knowledge about ART (OR: 2.019, CI: 1.377-2.961), and participants having support of friends and family members (OR: 1.612, CI: 1.019-2.540) showed a higher level of adherence to ART. Conclusions: Demographic factors such as marital status, residing in rural area, and other personal factors like having good knowledge about ART, without side effects to drugs, and having support of friends and family members were found to show a high level of adherence to ART.
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Affiliation(s)
- Vandana Hiregoudar
- Department of Community Medicine, SDMCMS&H, Sattur, Dharwad, Karnataka, India
| | - Raghavendra Bellara
- Department of Community Medicine, SDMCMS&H, Sattur, Dharwad, Karnataka, India
| | - T Gangadhar Goud
- Department of Community Medicine, SDMCMS&H, Sattur, Dharwad, Karnataka, India
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112
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Accompagnement médical et communautaire dans un essai de prévention biomédicale : vers une nouvelle forme d’éducation ? PRAT PSYCHOL 2019. [DOI: 10.1016/j.prps.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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113
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Ramsey S, Ames E, Uber J, Habib S, Clark S. A Mobile Health App to Improve HIV Medication Adherence: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e15356. [PMID: 31719030 PMCID: PMC6881780 DOI: 10.2196/15356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/31/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence. OBJECTIVE The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes. METHODS This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations. RESULTS Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020. CONCLUSIONS This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus. TRIAL REGISTRATION ClinicalTrials.gov NCT02676128; https://clinicaltrials.gov/ct2/show/NCT02676128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15356.
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Affiliation(s)
- Susan Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | - Evan Ames
- Rhode Island Hospital, Providence, RI, United States
| | - Julia Uber
- Rhode Island Hospital, Providence, RI, United States
| | - Samia Habib
- Rhode Island Hospital, Providence, RI, United States
| | - Seth Clark
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
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114
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McMahon JM, Braksmajer A, Zhang C, Leblanc N, Chen M, Aidala A, Simmons J. Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men. AIDS Res Ther 2019; 16:32. [PMID: 31706357 PMCID: PMC6842154 DOI: 10.1186/s12981-019-0248-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suboptimal adherence to HIV antiretroviral therapy (ART) and concomitant lack of viral control can have severe consequences for health and onward transmission among persons living with HIV. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men. METHODS Structural equation modeling (SEM) was performed to test a theory-derived model of ART adherence using data from a cross-sectional sample of 317 HIV-positive self-identified heterosexual men residing in New York City. We assessed a conceptual model in which mental health (depression, anxiety) and substance use dependence mediated the effects of socio-structural factors (HIV-related stigma, social support) on ART adherence, and subsequently, undetectable viral load. RESULTS Structural equation modeling analyses indicated that men who reported higher levels of HIV-related stigma tended to experience higher levels of general anxiety, which in turn was associated with reduced probability of optimal ART adherence. Moreover, men who reported higher levels of social support tended to exhibit less dependence on illicit substance use, which in turn was associated with increased probability of optimal ART adherence. African-American men reported lower ART adherence compared to other racial/ethnic groups. CONCLUSIONS Our findings support the hypothesis that substance use dependence and mental health problems, particularly anxiety, may be primary drivers of suboptimal ART adherence among heterosexual men, and that socio-structural factors such as HIV-related stigma and social support are potential modifiable antecedents of these drivers.
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115
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Ssewamala FM, Byansi W, Bahar OS, Nabunya P, Neilands TB, Mellins C, McKay M, Namuwonge F, Mukasa M, Makumbi FE, Nakigozi G. Suubi+Adherence study protocol: A family economic empowerment intervention addressing HIV treatment adherence for perinatally infected adolescents. Contemp Clin Trials Commun 2019; 16:100463. [PMID: 31872152 PMCID: PMC6915750 DOI: 10.1016/j.conctc.2019.100463] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Globally, 1.8 million children<15 years are living with HIV. Sub-Saharan Africa (SSA), as a region, is heavily burdened by HIV, with 90% of new infections among children happening there. Within SSA, Uganda has an HIV prevalence of 7.2% among 15-49-year-olds, with high prevalence in Masaka region (12%). Uganda also reports unprecedented numbers of perinatally HIV-infected children, with close to 150,000 children (ages 0–14) living with HIV (CLHA). However adherence to antiretroviral therapy (ART) among children and youth is poor, and has been attributed to economic insecurity, including lack of finances for transportation to clinic appointments, inadequate meals to support medication consumption, and resource prioritization towards school expenses. Yet, few programs aimed at addressing ART adherence have applied combination interventions to address economic stability and ART Adherence within the traditional framework of health education and HIV care. This paper describes a study protocol for a 5-year, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) funded, cluster randomized-controlled trial to evaluate a combination intervention, titled Suubi + Adherence, aimed at improving ART adherence among HIV perinatally infected adolescents (ages 10–16 at study enrollment) in Uganda. Methods Suubi + Adherence was evaluated via a two-arm cluster randomized-controlled trial design in 39 health clinics, with a total enrollment of 702 HIV + adolescents (ages 10–16 at enrollment). The study addresses two primary outcomes: 1) adherence to HIV treatment regimen and 2) HIV knowledge and attitudes. Secondary outcomes include family functioning, sexual risk-taking behavior, and financial savings behavior. For potential scale-up, cost effectiveness analysis was employed to compare the relative costs and outcomes associated with each study arm: family economic strengthening comprising matched savings accounts, financial management training and small business development, all intended for family economic security versus bolstered usual care (SOC) comprising enhanced adherence sessions to ensure more standardized and sufficient adherence counseling. Discussion This study aims to advance knowledge and inform the development of the next generation of programs aimed at increasing adherence to HIV treatment for HIV + adolescents in low-resource regions such as SSA. To our knowledge, the proposed study is the first to integrate and test family economic empowerment and stability-focused interventions for HIV + adolescents in Uganda (and much of SSA)—so families would have the necessary finances to manage HIV/AIDS as a chronic illness. The study would provide crucial evidence about the effects of an economic empowerment program on short and long-term impact, which is essential if such interventions are to be taken to scale. Trial registration This trial was registered with ClinicalTrials.gov (registration number: NCT01790373) on 13 February 2013.
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Affiliation(s)
- Fred M. Ssewamala
- Washington University in St. Louis, Brown School, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, United States
- Corresponding author.
| | | | | | | | | | | | - Mary McKay
- Washington University in St. Louis, MO, United States
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Miriam Mukasa
- International Center for Child Health and Development, Masaka, Uganda
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116
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Schreiner N, Perazzo J, Digenarro S, Currie J, Daly B, Webel A. Examining the Association between Item Specific Treatment Burden and Adherence in People Living with HIV. West J Nurs Res 2019; 42:495-502. [PMID: 31585518 DOI: 10.1177/0193945919880317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For the 1.1 million people with HIV (PWH) in the United States, adherence to a HIV anti-retroviral medication regimen, engagement in regular physical activity, and eating a healthy diet are essential for maintaining optimal health. However, treatment burden can increase the risk for self-management non-adherence. We analyzed data of 103 men and women diagnosed with HIV to examine the relationship between medication, physical activity, and diet-related treatment burden to corresponding measures of self-management adherence. Multivariate analysis demonstrated that one medication treatment burden item explained 11% (p=.01) of self-reported 30-day HIV anti-retroviral medication adherence; physical activity treatment burden, along with physical functioning, explained 25% (p<.001) of physical activity, measured by daily average steps; and diet-specific treatment burden was non-significant in maintaining a healthy diet, measured by a total Healthy Eating Index-2010 score. Findings demonstrate that specific treatment burden items can predict specific self-management outcome behavior in PWH.
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Affiliation(s)
- Nathanial Schreiner
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Joseph Perazzo
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Sarah Digenarro
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Jackson Currie
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Barbara Daly
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Allison Webel
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
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117
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Ramsey SE, Ames EG, Uber J, Habib S, Clark S, Waldrop-Valverde D. Same-Day Associations Between Substance Use and Medication Nonadherence Among Persons Living with HIV. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819878751. [PMID: 31619922 PMCID: PMC6777050 DOI: 10.1177/1178221819878751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022]
Abstract
Objectives: To examine the same-day associations between substance use and objectively
measured antiretroviral therapy (ART) nonadherence among persons living with
HIV (PLWH). Methods: PLWH (N = 53) were given an electronic pill box (EPB), and
their ART adherence was monitored for 14 days. During a follow-up interview,
participants were asked about any alcohol or drug use that occurred during
those same 14 days. Results: Daily heavy drinking (⩾5 drinks for males and ⩾4 drinks for females) was
associated with a nearly five times greater likelihood of same-day ART
nonadherence (OR = 4.90, 95% CI = 1.79-13.36, P = .002).
Further, drug use was associated with a nearly two times greater likelihood
of ART nonadherence on the same day (OR = 1.80, 95% CI = 1.14-2.85,
P = .012). Conclusions: These results highlight the importance of continuing to pursue interventions
to effectively address heavy drinking and drug use among PLWH in order to
improve ART adherence.
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Affiliation(s)
- Susan E Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Rhode Island Hospital, Providence, RI, USA
| | | | - Julia Uber
- Rhode Island Hospital, Providence, RI, USA
| | | | - Seth Clark
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Rhode Island Hospital, Providence, RI, USA
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118
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Emotional Communication in HIV Care: An Observational Study of Patients' Expressed Emotions and Clinician Response. AIDS Behav 2019; 23:2816-2828. [PMID: 30895426 DOI: 10.1007/s10461-019-02466-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle 'cues' vs. more explicit 'concerns'), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising clinician awareness of subtle emotional expressions, the emotional content of medically-related issues, and racial differences in clinician response.
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119
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Sherman E, Clauson KA, Elrod S, Eckardt P, Alkhateeb F, Jacobs R. Patient Perceptions of Text Messaging to Improve Antiretroviral Therapy Adherence: A Qualitative Study of Patients in a Ryan White Clinic. J Int Assoc Provid AIDS Care 2019; 17:2325958218759209. [PMID: 29473483 PMCID: PMC6748548 DOI: 10.1177/2325958218759209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Evidence on the use of short message service (SMS) to improve medication adherence in people living with HIV (PLHIV) is mounting, yet qualitative research on patient perceptions regarding SMS content and utility for HIV/AIDS remains nascent. To explore the experience of receiving medication reminders via SMS among PLHIV, 45 uninsured and underinsured PLHIV nested within the intervention arm of a larger study received daily, 1-way SMS adherence reminders. Qualitative data were collected by face-to-face, structured interview and were analyzed using conventional content analysis methods. Three main themes emerged from the data: (1) reminders helping with adherence, (2) concerns about delivery modes, and (3) the need for confidentiality. Study findings offer enhanced focus on an emerging strategy in patient-centered HIV care: Equipped with greater context on the experiences of PLHIV using SMS adherence reminders, health-care providers can offer more targeted support and thereby maximize the benefits of this popular and powerful technology.
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Affiliation(s)
- Elizabeth Sherman
- 1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA.,4 Division of Infectious Diseases, Memorial Physician Group, Hollywood, FL, USA
| | | | - Shara Elrod
- 3 University of North Texas System College of Pharmacy, Fort Worth, TX, USA
| | - Paula Eckardt
- 4 Division of Infectious Diseases, Memorial Physician Group, Hollywood, FL, USA
| | - Fadi Alkhateeb
- 5 University of Texas at Tyler College of Pharmacy, Tyler, TX, USA
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120
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Moosa A, Gengiah TN, Lewis L, Naidoo K. Long-term adherence to antiretroviral therapy in a South African adult patient cohort: a retrospective study. BMC Infect Dis 2019; 19:775. [PMID: 31488063 PMCID: PMC6727323 DOI: 10.1186/s12879-019-4410-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background South Africa has the highest HIV prevalence and supports the largest antiretroviral therapy (ART) programme globally. With the introduction of a test and treat policy, ensuring long term optimal adherence to ART (≥95%) is essential for successful patient and public health outcomes. The aim of this study was to assess long-term ART adherence to inform best practices for chronic HIV care. Method Long-term ART adherence was retrospectively analysed over a median duration of 5 years (interquartile range [IQR]: 5.3–6.5) in patients initially enrolled in a randomised controlled trial assessing tuberculosis and HIV treatment integration and subsequently followed post-trial in an observational cohort study in Durban, South Africa. The association between baseline patient characteristics and adherence over time was estimated using generalized estimating equations (GEE). Adherence was assessed using pharmacy pill counts conducted at each study visit and compared to 6 monthly viral load measurements. A Kaplan Meier survival analysis was used to estimate time to treatment failure. The McNemar test (with exact p-values) was used to determine the effect of pill burden and concurrent ART and tuberculosis treatment on adherence. Results Of the 270 patients included in the analysis; 54.8% were female, median age was 34 years (IQR:29–40) and median time on ART was 70 months (IQR = 64–78). Mean adherence was ≥95% for each year on ART. Stable patients provided with an extended 3-month ART supply maintained adherence > 99%. At study end, 96 and 94% of patients were optimally adherent and virologically suppressed, respectively. Time since ART initiation, female gender and primary breadwinner status were significantly associated with ≥95% adherence to ART. The cumulative probability of treatment failure was 10.7% at 5 years after ART initiation. Concurrent ART and tuberculosis treatment, or switching to a second line ART regimen with higher pill burden, did not impair ART adherence. Conclusion Optimal long-term adherence with successful treatment outcomes are possible within a structured ART programme with close adherence monitoring. This adherence support approach is relevant to a resource limited setting adopting a test and treat strategy.
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Affiliation(s)
- Atika Moosa
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Tanuja N Gengiah
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Lara Lewis
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Kogieleum Naidoo
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment, Research Unit, Nelson R Mandela School of Medicine, Doris Duke Medical Research Institute (2nd floor), University of KwaZulu-Natal, 719 Umbilo Road, Private Bag X7, Congella, Durban, 4013, South Africa
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121
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Minja L, Cichowitz C, Knettel BA, Mahande MJ, Kisigo G, Knippler ET, Ngocho JS, Mmbaga BT, Watt MH. Attitudes Toward Long-Term Use of Antiretroviral Therapy Among HIV-Infected Pregnant Women in Moshi, Tanzania: A Longitudinal Study. AIDS Behav 2019; 23:2610-2617. [PMID: 31377894 PMCID: PMC7467083 DOI: 10.1007/s10461-019-02622-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Adherence to antiretroviral therapy (ART) during pregnancy and the postpartum period is necessary to prevent vertical HIV transmission and to secure the long-term health of an HIV-infected woman. Health behavior theory suggests that patients' attitudes towards medication can predict their medication-taking behaviour. This study sought to understand how women's attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6 months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interventions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depression screening and treatment should be integrated into PMTCT services. This study emphasizes the importance of early attention to attitudes towards ART, in order to establish a trajectory of sustained care engagement.
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Affiliation(s)
- Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Cody Cichowitz
- Massachusetts General Hospital, Department of Medicine, Center for Global Health, Boston, USA
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
| | | | - Godfrey Kisigo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
| | - Elizabeth T Knippler
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
| | - James S Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA.
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122
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Moucheraud C, Stern AF, Ahearn C, Ismail A, Nsubuga-Nyombi T, Ngonyani MM, Mvungi J, Ssensamba J. Barriers to HIV Treatment Adherence: A Qualitative Study of Discrepancies Between Perceptions of Patients and Health Providers in Tanzania and Uganda. AIDS Patient Care STDS 2019; 33:406-413. [PMID: 31517526 PMCID: PMC6745526 DOI: 10.1089/apc.2019.0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous qualitative studies about antiretroviral therapy (ART) adherence have largely focused on patient experiences. Less is known about the perspective of health care providers-particularly in low-income countries-who serve as gatekeepers and influencers of patients' HIV care experiences. This study explored patients' and providers' perceptions of important ART adherence determinants. Interviews were conducted at HIV treatment sites in Tanzania and Uganda, with adult patients on ART (n = 148), and with health care providers (n = 49). Patients were asked about their experiences with ART adherence, and providers were asked about their perceptions of what adherence challenges are faced by their patients. All interviews were conducted in local languages; transcripts were translated into English and analyzed using a codebook informed by the social ecological model. Themes were examined across and within countries. Adherence-related challenges were frequently reported, but patients and providers did not often agree about the reasons. Many patients cited challenges related to being away from home and therefore away from their pill supply; and, in Uganda, challenges picking up refills (access to care) and related to food sufficiency/diet. Providers also identified these access to care barriers, but otherwise focused on different key determinants (e.g., they rarely mentioned food/diet); instead, providers were more likely to mention alcohol/alcoholism, stigma, and lack of understanding about the importance of adhering. These findings suggest areas of opportunity for future research and for improving clinical care by aligning perceptions of adherence challenges, to deliver better-informed and useful ART counseling and support.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, California
| | - Amy F. Stern
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Chevy Chase, Maryland
| | - Canice Ahearn
- Division of HIV, Infectious Diseases & Global Medicine, Department of Medicine, University of California, San Francisco, California
| | - Anisa Ismail
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Chevy Chase, Maryland
| | - Tamara Nsubuga-Nyombi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Kampala, Uganda
| | - Monica M. Ngonyani
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Dar es Salaam, Tanzania
| | - Jane Mvungi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Dar es Salaam, Tanzania
| | - Jude Ssensamba
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Kampala, Uganda
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123
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Ibrahim IM, Bade AN, Lin Z, Soni D, Wojtkiewicz M, Dyavar Shetty BL, Gautam N, McMillan JM, Alnouti Y, Edagwa BJ, Gendelman HE. Synthesis and characterization of a long-acting emtricitabine prodrug nanoformulation. Int J Nanomedicine 2019; 14:6231-6247. [PMID: 31496683 PMCID: PMC6689761 DOI: 10.2147/ijn.s215447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose A palmitoylated prodrug of emtricitabine (FTC) was synthesized to extend the drug’s half-life, antiretroviral activities and biodistribution. Methods A modified FTC prodrug (MFTC) was synthesized by palmitoyl chloride esterification. MFTC’s chemical structure was evaluated by nuclear magnetic resonance. The created hydrophobic prodrug nanocrystals were encased into a poloxamer surfactant and the pharmacokinetics (PK), biodistribution and antiretroviral activities of the nanoformulation (NMFTC) were assessed. The conversion of MFTC to FTC triphosphates was evaluated. Results MFTC coated with poloxamer formed stable nanocrystals (NMFTC). NMFTC demonstrated an average particle size, polydispersity index and zeta potential of 350 nm, 0.24 and −20 mV, respectively. Drug encapsulation efficiency was 90%. NMFTC was readily taken up by human monocyte-derived macrophages yielding readily detected intracellular FTC triphosphates and an extended PK profile. Conclusion NMFTC shows improved antiretroviral activities over native FTC. This is coordinate with its extended apparent half-life. The work represents an incremental advance in the development of a long-acting FTC formulation.
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Affiliation(s)
- Ibrahim M Ibrahim
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pharmacology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aditya N Bade
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zhiyi Lin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dhruvkumar Soni
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melinda Wojtkiewicz
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bhagya Laxmi Dyavar Shetty
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nagsen Gautam
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - JoEllyn M McMillan
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yazen Alnouti
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Benson J Edagwa
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
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124
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Saravia A, Mueller R. Demand and Supply Motivations for Antiretroviral Drugs in Illicit Street Markets: The Case of Atlanta, Georgia. AIDS Behav 2019; 23:2079-2087. [PMID: 30535835 DOI: 10.1007/s10461-018-2359-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We studied the motivations behind supply and demand of antiretroviral drugs (ARVs) in the illicit street markets of the metropolitan statistical area of Atlanta, Sandy Springs, and Roswell, Georgia. We found that these two market actions were largely interdependent: 39.53% of participants said that they sold their ARVs to pay for personal needs, and 20.93% said that they bought ARVs because they had previously sold them to pay for personal needs. The pattern that emerged suggests that illicit street markets have become mechanisms through which HIV patients cooperate to achieve competing goals: cover personal needs and keep up, however imperfectly, with their medication regime. We also found that HIV patients used illicit street markets because they faced institutional deficiencies, such as exclusion from the Ryan White/ADAP program, long waiting times to see a doctor, and prescription delays.
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125
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Edwards RJ, Cyrus E, Bhatt C, Lyons N, Lavia LO, Boyce G. Viral suppression among persons living with HIV in Trinidad & Tobago: Implications for targeted prevention programmes. Glob Public Health 2019; 14:1569-1577. [PMID: 31258000 DOI: 10.1080/17441692.2019.1633379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In Trinidad and Tobago, despite persons living with HIV (PLHIV) having access to subsidised treatment and care, only 47% PLHIV attain viral suppression. The study assessed the role of individual-level factors on viral suppression among PLHIV in Trinidad and Tobago. Data from 9,629 PLHIV who attended an HIV clinic between 2016 and 2018 were analysed. Cases were aged ≥18 who met the CDC HIV case definition. Viral suppression defined as a viral load of <200 copies/ml at last assessment. The chi-square test of association determined statistically significant relationships between individual factors and viral suppression. Logistic regression was used to estimate odds ratios (OR) for viral suppression. PLHIV who were males (OR = 0.76, 95% CI 0.67-0.87), men who have sex with men (MSM) (OR = 0.82, 95% CI 0.67-0.99), single/unmarried (OR = 0.69, 95% CI 0.55-0.87), aged 18-24 years (OR = 0.66, 95% CI 0.49-0.89), aged 25-49 years (OR = 0.81, 95% CI 0.70-0.94) were less likely to achieve viral suppression. These study findings demonstrate that retention/adherence programmes must urgently identify and target vulnerable PLHIV populations in Trinidad and Tobago to improve viral suppression. Further research examining community and societal factors, such as stigma and discrimination, is warranted.
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Affiliation(s)
- R Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
| | - Elena Cyrus
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Chintan Bhatt
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA.,Center for Advanced Analytics, Baptist Health South Florida , Coral Gables , FL , USA
| | - Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
| | - Leon-Omari Lavia
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
| | - Gregory Boyce
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
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"Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:61-69. [PMID: 31082664 DOI: 10.1016/j.drugpo.2018.11.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022]
Abstract
South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a "siloed treatment experience"), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting.
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Masa R, Chowa G, Nyirenda V. <i>Chuma na Uchizi</i>: A Livelihood Intervention to Increase Food Security of People Living with HIV in Rural Zambia. J Health Care Poor Underserved 2019; 29:349-372. [PMID: 29503305 DOI: 10.1353/hpu.2018.0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The objective of this study was to evaluate the impact of Chuma na Uchizi, a livelihood intervention for people living with HIV (PLHIV) in rural Eastern Province, Zambia, on food security. The intervention included cash transfers to purchase income-generating assets, access to a savings account, and life-skills training. The study employed a non-equivalent groups design to compare intervention (n = 50) and control participants (n = 51) who were receiving outpatient care from two comparable health facilities in distinct constituencies in the same geographic area. We collected data before and after implementation of the intervention. Chuma na Uchizi improved access to food. At follow-up, the intervention group reported lower food insecurity scores compared with the control group (β = -5.65; 95% CI - 10.85 --0.45). Livelihood programs for PLHIV are practical and may be a promising approach to address food insecurity and its adverse effects.
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Mongo-Delis A, Mombo LE, Mickala P, Bouassa W, Bouedy WS, M'batchi B, Bisseye C. Factors associated with adherence to ARV treatment in people living with HIV/AIDS in a rural area (Koula-Moutou) in East Gabon. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:51-57. [PMID: 30880584 DOI: 10.2989/16085906.2018.1552878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The goal of this study was to evaluate the impact of socio-clinical factors on adherence to antiretroviral treatment in people living with HIV/AIDS in Koula-Moutou (a rural area of Gabon). Two adherence assessment methods based on patient declaration and compliance with pharmacy visits were used to determine qualitative and quantitative aspects of adherence to antiretroviral therapy (ART). The quantitative (82.2%) and qualitative (79.5%) adherences to ART declared by patients were higher than those obtained through pharmacy visit assessment methods (15.8% and 45.2%, respectively). Moreover, the declarative and pharmacy visit compliance methods showed fair agreement (quantitative Kappa = 0.317; qualitative Kappa = 0.311). A better quantitative or qualitative declarative adherence was associated with a lower level of education (P = 0.05 and P = 0.025 respectively). This study reported for the first time the factors influencing adherence to ART in a rural area of East Gabon. We recommend further investigations in a large cohort to better assess the impact of socio-clinical factors on ART adherence in a vulnerable group of patients.
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Affiliation(s)
- Arnaud Mongo-Delis
- a HIV/AIDS Outpatient Treatment Centre of Koula-Moutou , Koula-Moutou , Gabon
| | - Landry E Mombo
- b Laboratory of Molecular and Cellular Biology , University of Science and Technology of Masuku , Franceville , Gabon
| | - Patrick Mickala
- b Laboratory of Molecular and Cellular Biology , University of Science and Technology of Masuku , Franceville , Gabon
| | - Wenceslas Bouassa
- a HIV/AIDS Outpatient Treatment Centre of Koula-Moutou , Koula-Moutou , Gabon
| | - Wilfried S Bouedy
- a HIV/AIDS Outpatient Treatment Centre of Koula-Moutou , Koula-Moutou , Gabon
| | - Bertrand M'batchi
- b Laboratory of Molecular and Cellular Biology , University of Science and Technology of Masuku , Franceville , Gabon
| | - Cyrille Bisseye
- b Laboratory of Molecular and Cellular Biology , University of Science and Technology of Masuku , Franceville , Gabon
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Angdembe MR, Rai A, Bam K, Pandey SR. Predictors of mortality in adult people living with HIV on antiretroviral therapy in Nepal: A retrospective cohort study, 2004-2013. PLoS One 2019; 14:e0215776. [PMID: 31013320 PMCID: PMC6481250 DOI: 10.1371/journal.pone.0215776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background In Nepal, since 2004, 19,388 people living with HIV (PLHIV) have been
enrolled on antiretroviral therapy (ART). The aim of this study was to
measure mortality rate and to identify predictors of mortality in adult (≥15
years) PLHIV who initiated ART between 2004 and 2013 in five large ART
centers of Nepal. Methods This retrospective cohort study of 3,799 (60.5% male) adult PLHIV uses
secondary data collected from standard ART registers. Time from ART
initiation (baseline) to death or censoring (loss to follow-up or December
31, 2013) was assessed. Mortality rates per 100 person-years were
calculated. Kaplan-Meier models were used to estimate the probability of
mortality over time. Predictors of mortality were determined using
Cox-regression models. Results The overall mortality rate was 6.98 (95% CI: 6.46–7.54) per 100 person-years,
4.11 (95% CI: 3.53–4.79) in females and 9.14 (95% CI: 8.36–9.99) in males.
Mortality rates were higher in early months after ART initiation,
particularly in the first three months. Baseline predictors of mortality
were ART center, male gender (adjusted HR = 2.08, 95% CI: 1.69–2.57),
residence outside the ART district (AHR = 1.45, 95% CI:1.19–1.76), World
Health Organization clinical stage III (AHR = 1.67, 95% CI: 1.13–2.46) and
IV (AHR = 2.21, 95% CI: 1.45–3.36), bedridden <50% time in the last month
(AHR = 1.92, 95% CI: 1.52–2.41), bedridden >50% time in the last month
(AHR = 3.82, 95% CI: 2.95–4.94), lower bodyweight/kg (AHR = 1.04, 95% CI:
1.03–1.05), CD4 count <150 cell/mm3 (AHR = 2.14, 95% CI:
1.05–4.34) and treatment not switched to second-line regimen (AHR = 3.05,
95% CI: 1.35–6.90). Conclusions Mortality rates were higher soon after ART initiation, particularly in males
and gradually decreased over time. Poor baseline clinical characteristics
were significantly associated with higher mortality. Increased ART coverage
with decentralization of sites to lower levels including community
dispensing, differentiated and improved service delivery and initiation of
ART at a less advanced disease stage may reduce early mortality.
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Affiliation(s)
| | - Anjana Rai
- Saath-Saath Project, Nepal, Kathmandu,
Nepal
| | - Kiran Bam
- Saath-Saath Project, Nepal, Kathmandu,
Nepal
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DeSilva M, Vu CN, Bonawitz R, Hai LT, Van Lam N, Yen LT, Gifford AL, Haberer J, Linh DT, Sabin L. The Supporting Adolescent Adherence in Vietnam (SAAV) study: study protocol for a randomized controlled trial assessing an mHealth approach to improving adherence for adolescents living with HIV in Vietnam. Trials 2019; 20:150. [PMID: 30819228 PMCID: PMC6394014 DOI: 10.1186/s13063-019-3239-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The overall goal of the Supporting Adolescent Adherence in Vietnam (SAAV) study is to improve understanding of an adherence feedback mHealth intervention designed to help adolescents living with HIV (ALHIV) maintain high adherence to antiretroviral therapy (ART), critical to effective treatment. Specifically, we aim to: (1) conduct formative research with Vietnamese ALHIV and their caregivers to better understand adherence challenges and refine the personalized mHealth intervention package; and (2) assess the feasibility, acceptability, and efficacy of the intervention to improve ART adherence by implementing a randomized controlled trial (RCT). METHODS The study will utilize mixed methods. The formative phase will include 40 in-depth interviews (IDIs) with 20 adolescent (12-17 years)/caregiver dyads and eight focus group discussions with adolescents, caregivers, and clinicians at the National Hospital for Pediatrics (NHP) in Hanoi, Vietnam. We will also conduct 20 IDIs with older adolescents (18-21 years) who have transitioned to adult care at outpatient clinics in Hanoi. We will then implement a seven-month RCT at NHP. We will recruit 80 adolescents on ART, monitor their adherence for one month to establish baseline adherence using a wireless pill container (WPC), and then randomize participants to intervention versus control within optimal (≥ 95% on-time doses) versus suboptimal (< 95% on-time doses) baseline adherence strata. Intervention participants will receive a reminder of their choice (cellphone text message/call or bottle-based flash/alarm), triggered when they miss a dose, and engage in monthly counseling informed by their adherence data. Comparison participants will receive usual care and offer of counseling at routine monthly clinic visits. After six months, we will compare ART adherence, CD4 count, and HIV viral suppression between arms, in addition to acceptability and feasibility of the intervention. DISCUSSION Findings will contribute valuable information on perceived barriers and facilitators affecting adolescents' ART adherence, mHealth approaches as adherence support tools for ALHIV, and factors affecting adolescents' ART adherence. This information will be useful to researchers, medical personnel, and policy-makers as they develop and implement adherence programs for ALHIV, with potential relevance to other chronic diseases during transition from adolescent to adult care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03031197 . Registered on 21 January 2017.
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Affiliation(s)
- Mary DeSilva
- Westbrook College of Health Professions, University of New England, 716 Stevens Ave, Portland, ME 04103 USA
| | - Cong Nguyen Vu
- Institute for Population Health and Development, No.18, Lane 132, Hoa Bang Str., Cau Giay District, Hanoi, 122667 Vietnam
| | - Rachael Bonawitz
- Center for Global Health & Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA 02118 USA
| | - Le Thanh Hai
- National Hospital for Pediatrics, 18/879 La Thành, Đống Đa, Hanoi, Vietnam
| | - Nguyen Van Lam
- Department of Infectious Disease (ID), National Hospital for Pediatrics, 18/879 La Thành, Đống Đa, Hanoi, Vietnam
| | - Le Thi Yen
- Department of Infectious Disease (ID), National Hospital for Pediatrics, 18/879 La Thành, Đống Đa, Hanoi, Vietnam
| | - Allen L. Gifford
- Department of Health Law, Policy and Management, Boston University Schools of Medicine and Public Health, 725 Albany Street, Talbot T247W, Boston, MA 02118 USA
| | - Jessica Haberer
- Massachusetts General Hospital Global Health, 125 Nashua St, Suite 722, Boston, MA 02114 USA
| | - Dang Thuy Linh
- Institute for Population Health and Development, No.18, Lane 132, Hoa Bang Str., Cau Giay District, Hanoi, 122667 Vietnam
| | - Lora Sabin
- Center for Global Health & Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA 02118 USA
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Experienced HIV-Related Stigma in Health Care and Community Settings: Mediated Associations With Psychosocial and Health Outcomes. J Acquir Immune Defic Syndr 2019; 77:257-263. [PMID: 29140873 DOI: 10.1097/qai.0000000000001590] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION There are multiple dimensions of HIV-related stigma that can compromise the mental and physical health of people living with HIV. We focused on the dimension of experienced stigma, defined as exposure to acts of discrimination, devaluation, and prejudice, and investigated its relationship with HIV health and psychosocial outcomes. METHODS We examined associations between experienced stigma in the community and health care settings and psychosocial and health outcomes for people living with HIV (N = 203) receiving care at an urban HIV clinic in the Southeastern United States. We also investigated whether those effects are unique to experienced stigma or are mediated by other dimensions of HIV-related stigma. RESULTS Experienced stigma was associated with suboptimal clinical outcomes such as viral nonsuppression, as well as poor affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, and blame coping) and interpersonal outcomes such as social support and physician trust. Furthermore, serial mediation models suggested significant indirect effects of experienced stigma through internalized stigma and anticipated stigma from various theoretically expected sources of stigma (eg, community members, friends and family, and health care workers), with varying effects depending on the source. CONCLUSIONS These findings suggest nuanced mechanisms for the effects of experienced HIV-related stigma, especially in health care settings, and may be used to inform stigma-reduction interventions. Interventions designed to address experienced stigma in health care settings might be more tailored to specific outcomes, such as depression and physician trust, than interventions designed to address experienced stigma in the community.
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132
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Hassan AS, Bibby DF, Mwaringa SM, Agutu CA, Ndirangu KK, Sanders EJ, Cane PA, Mbisa JL, Berkley JA. Presence, persistence and effects of pre-treatment HIV-1 drug resistance variants detected using next generation sequencing: A Retrospective longitudinal study from rural coastal Kenya. PLoS One 2019; 14:e0210559. [PMID: 30759103 PMCID: PMC6373901 DOI: 10.1371/journal.pone.0210559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 12/27/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The epidemiology of HIV-1 drug resistance (HIVDR) determined by Sanger capillary sequencing, has been widely studied. However, much less is known about HIVDR detected using next generation sequencing (NGS) methods. We aimed to determine the presence, persistence and effect of pre-treatment HIVDR variants detected using NGS in HIV-1 infected antiretroviral treatment (ART) naïve participants from rural Coastal Kenya. METHODS In a retrospective longitudinal study, samples from HIV-1 infected participants collected prior [n = 2 time-points] and after [n = 1 time-point] ART initiation were considered. An ultra-deep amplicon-based NGS assay, calling for nucleotide variants at >2.0% frequency of viral population, was used. Suspected virologic failure (sVF) was defined as a one-off HIV-1 viral load of >1000 copies/ml whilst on ART. RESULTS Of the 50 eligible participants, 12 (24.0% [95% CI: 13.1-38.2]) had at least one detectable pre-treatment HIVDR variant against Protease Inhibitors (PIs, n = 6 [12%]), Nucleoside Reverse Transcriptase Inhibitors (NRTIs, n = 4 [8.0%]) and Non-NRTIs (n = 3 [6.0%]). Overall, 15 pre-treatment resistance variants were detected (frequency, range: 2.3-92.0%). A positive correlation was observed between mutation frequency and absolute load for NRTI and/or NNRTI variants (r = 0.761 [p = 0.028]), but not for PI variants (r = -0.117 [p = 0.803]). Participants with pre-treatment NRTI and/or NNRTI resistance had increased odds of sVF (OR = 6.0; 95% CI = 1.0-36.9; p = 0.054). CONCLUSIONS Using NGS, pre-treatment resistance variants were common, though observed PI variants were unlikely transmitted, but rather probably generated de novo. Even when detected from a low frequency, pre-treatment NRTI and/or NNRTI resistance variants may adversely affect treatment outcomes.
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Affiliation(s)
| | - David F. Bibby
- Virus Reference Department, Public Health England, London, United Kingdom
| | | | | | | | - Eduard J. Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
| | - Patricia A. Cane
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Jean L. Mbisa
- Virus Reference Department, Public Health England, London, United Kingdom
| | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
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133
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George Dalmida S, Kraemer KR, Ungvary S, Di Valerio E, Koenig HG, Holstad MM. The Psychosocial and Clinical Well-Being of Women Living with Human Immunodeficiency Virus/AIDS. Nurs Clin North Am 2019; 53:203-225. [PMID: 29779514 DOI: 10.1016/j.cnur.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined factors impacting the psychological well-being of women living with human immunodeficiency virus/AIDS and the impact of depression on clinical outcomes. Nearly two-thirds of participants in this cross-sectional study reported significant depressive symptoms. Compared with women living with human immunodeficiency virus/AIDS without depressive symptoms, those with depression reported significantly poorer health outcomes. Health care providers should regularly screen these women for and adequately treat depression, and must collaborate with mental health providers and pastoral care counselors to address the mental health needs of women living with human immunodeficiency virus/AIDS to optimize their human immunodeficiency virus-related outcomes.
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Affiliation(s)
- Safiya George Dalmida
- University of Alabama, Capstone College of Nursing, 650 University Boulevard, Tuscaloosa, AL 35487, USA.
| | - Kyle R Kraemer
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Stephen Ungvary
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Elizabeth Di Valerio
- Department of Biological Sciences, University of Alabama, Box 870344, Tuscaloosa, AL 35487, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA; Department of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Marcia McDonnell Holstad
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
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134
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Capetti A, Rizzardini G. Choosing appropriate pharmacotherapy for drug-resistant HIV. Expert Opin Pharmacother 2019; 20:667-678. [DOI: 10.1080/14656566.2019.1570131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Amedeo Capetti
- Divisione Malattie Infettive, Aziende Socio Sanitarie Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Giuliano Rizzardini
- Divisione Malattie Infettive, Aziende Socio Sanitarie Territoriale Fatebenefratelli Sacco, Milano, Italy
- Faculty of Health Sciences, School of Clinical Medicine, Whitwaterstrand University, Johannesburg, South Africa
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135
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Saberi P, Ming K, Legnitto D, Neilands TB, Gandhi M, Johnson MO. Feasibility and acceptability of novel methods to estimate antiretroviral adherence: A longitudinal study. PLoS One 2019; 14:e0210791. [PMID: 30645641 PMCID: PMC6333375 DOI: 10.1371/journal.pone.0210791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/02/2019] [Indexed: 11/25/2022] Open
Abstract
Due to marked reductions in morbidity and mortality, antiretroviral (ARV) adherence monitoring is of high interest. Researchers and clinicians often resort to the most feasible and cost-effective adherence methods possible, which may result in biased or inaccurate estimates and require the physical presence of a participant at a research or clinic site. The objective of our study was to evaluate the feasibility and acceptability of three objective, innovative, and remote methods to estimate ARV adherence which may be conducted with less time and financial resources in a wide range of clinic and research settings. These three methods included: (a) text-messaged photographs of pharmacy refill dates to measure refill-based adherence, (b) text-messaged photographs of ARV medications to estimate pill-count-based adherence, and (c) home-collected hair samples for the measurement of ARV concentration to determine pharmacologic-based adherence. We conducted a pilot study from March through October 2017 to examine the feasibility and acceptability of these three adherence measures and the remotely conducted study procedures in 93 adults living with HIV nationwide. From our diverse national sample of participants, 95.7% were retained until the end of the study, 89.9% sent all text messages, and 84.3% sent all hair samples. Approximately 74.2% of participants reported excellent overall experience with the study, 60.2% were very or extremely satisfied with participating in a hair collection study, and 76.3% noted extremely high likelihood of participating in a similar study including text messaging pictures of medications or refill dates. We noted high levels of feasibility and acceptability with the remote study methodology, collection of photographed and text messaged pharmacy refill dates and pill counts, and home-collected hair samples. Here we describe the feasibility and acceptability metrics, results from the exit qualitative interviews with the participants, and lessons learned. These adherence measures represent innovative approaches to expand monitoring tools for HIV treatment and prevention adherence in future research.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Kristin Ming
- Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Dominique Legnitto
- Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Torsten B. Neilands
- Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Mallory O. Johnson
- Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA, United States of America
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136
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Hines DM, Ding Y, Wade RL, Beaubrun A, Cohen JP. Treatment Adherence And Persistence Among HIV-1 Patients Newly Starting Treatment. Patient Prefer Adherence 2019; 13:1927-1939. [PMID: 31806941 PMCID: PMC6844203 DOI: 10.2147/ppa.s207908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/01/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess adherence and persistence with first-line single-tablet regimen (STR) and multi-tablet regimen (MTR) antiretroviral therapy (ART) in newly treated HIV-1 patients. METHODS Retrospective analysis of longitudinal pharmacy claims among US patients initiating ART between 1/1/2016 and 5/31/2016 (index date was defined by first ART claim for STRs, and fill date for the last therapy in the regimen for MTRs). Adherence was assessed over a 12-month period and reported as the proportion of adherent or non-adherent (defined as ≤5-day and > a 5-day gap between successive fills, respectively) patients. Sensitivity analysis using ≤7-day and ≤14-day gap thresholds to define adherence was performed. Persistence was assessed as the number of days on therapy from index until treatment discontinuation (>90 day gap in therapy). Kaplan-Meier curves and Cox Proportional Hazard models were generated to evaluate discontinuation rates. Assessments were performed on STRs vs MTRs overall and by regimen. RESULTS Patients initiating ART (STR: n=10,623; MTR: n=2504) had a mean age of 42.8 years; 76.0% were male. STR patients were >2 times more likely to be adherent over 12 months than MTR patients (24.9% vs 11.7%, respectively). Patients using EVG/COBI/FTC/TAF had greater adherence than those using other STRs. Among MTRs, patients were more adherent with FTC/TDF+DTG (15.1%) than other MTRs. Persistence was also greater with STRs, with MTR patients being 61% more likely to discontinue therapy. Persistence was best for FTC/TAF-based regimens. Predictors of treatment discontinuation included younger age, female gender, and Medicare or Medicaid insurance type. CONCLUSION Patients receiving STRs were significantly less likely to discontinue therapy and were more adherent with their regimens, providing further evidence of greater adherence and persistence with STRs versus MTRs. However, there was a large proportion of patients who interrupted or discontinued treatment. Further research examining treatment patterns beyond first line is warranted.
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Affiliation(s)
- Dionne M Hines
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
| | - Yao Ding
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
| | - Rolin L Wade
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
- Correspondence: Rolin L Wade IQVIA Inc., One IMS Drive, Plymouth Meeting, PA19462, USATel +1 215 434 812 2958 Email
| | - Anne Beaubrun
- Health Economics and Outcomes Research, Gilead Sciences Inc, Foster City, CA, USA
| | - Joshua P Cohen
- Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, MA, USA
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137
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Wang H, Chen ACC, Wan S, Chen H. Status and associated factors of self-management in people living with HIV/AIDS in Liangshan area, China: a cross-sectional study. Patient Prefer Adherence 2019; 13:863-870. [PMID: 31213780 PMCID: PMC6538009 DOI: 10.2147/ppa.s203799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023] Open
Abstract
Background: HIV self-management is a lifetime and central task for people living with HIV/AIDS (PLWH). To date, there is little evidence to identify the related factors of self-management in PLWH from China. Purpose: This study aimed to investigate the status and related factors of self-management in PLWH from the Liangshan area of Sichuan Province, China. Patients and methods: A total of 322 PLWH were recruited from August to December 2017 in the study. Demographics characteristics and disease-related data were documented for each participant, social support was measured by the Medical Outcomes Study Social Support Survey (MOS-SSS-C), and self-management was evaluated by the HIV Self-Management Scale. Descriptive statistics analysis, independent Student's t-test, one-way ANOVA, Spearman rank correlation, and multiple regression analysis were used to analyze the data. Results: The total score of HIV self-management was 38.26±7.17. Significant differences in self-management scores were found among the subgroups of different education level, marital status, nation, religion, resident place, occupation, infection route, symptom, research site, and household per capita monthly income. Self-management was positively significantly correlated with social support. Multiple regression analysis identified that nation, resident place, gender, marital status, and social support were the contributors of HIV self-management. Conclusion: The study demostrated that self-management in Yi Autonomous Prefecture was relatively low. The results indicate that the associated factors of self-management should be considered to develop effective intervention to improve the self-management of PLWH.
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Affiliation(s)
- Huan Wang
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Angela Chia-Chen Chen
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Shaoping Wan
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Correspondence: Hong ChenWest China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, No. 37, Guoxuexiang, Wuhou District, Chengdu, Sichuan Province, People’s Republic of ChinaTel +861 898 060 1733Email
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138
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Vreeman RC, Scanlon ML, Tu W, Slaven J, Ayaya S, Nyandiko W. Validation of a Short Adherence Questionnaire for Children Living with HIV on Antiretroviral Therapy in Kenya. J Int Assoc Provid AIDS Care 2018. [PMCID: PMC6748462 DOI: 10.1177/2325958218820329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: There are few validated tools to measure adherence for children living with HIV. We identified questionnaire items for caregivers of Kenyan children aged <15 years living with HIV. Methods: Caregiver–child dyads were followed for 6 months. At monthly visits, the child’s HIV provider administered a 10-item questionnaire to the caregiver. Children were given electronic dose monitors (Medication Event Monitoring Systems [MEMS]). Correlation between questionnaire items and dichotomized MEMS adherence (≥90% doses taken versus <90%) was investigated using logistic regression models. Results: In 95 caregiver–child dyads, mean age of children (40% female) was 8.3 years. Items associated with higher odds of MEMS adherence in multivariable analysis included the father giving the child medication, being enrolled in a nutrition program, and the caregiver reporting no difficulties giving the child medication. Conclusion: Providers typically ask about missed doses, but asking about caregiver responsibilities and difficulties in giving the child medication may better detect suboptimal adherence.
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Affiliation(s)
- Rachel Christine Vreeman
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Michael Lawrence Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Kapadia SN, Grant RR, German SB, Singh B, Davidow AL, Swaminathan S, Hodder S. HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens. SAGE Open Med 2018; 6:2050312118816919. [PMID: 30574301 PMCID: PMC6295695 DOI: 10.1177/2050312118816919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Single-tablet regimens are preferred prescription choices for HIV treatment, but there are limited outcomes data comparing single-tablet regimens to multiple-tablet regimens. Methods We retrospectively assessed treatment-naïve patients at a single urban HIV clinic in the United States for viral load suppression at 6 and 12 months after initiating either single-tablet or multiple-tablet regimens. Multivariate regression was performed to obtain relative risks and adjust for potential confounders. Results Of 218 patients, 47% were on single-tablet regimens and 53% on multiple-tablet regimens; 77% of single-tablet regimen patients had undetectable viral load at 6 months compared to 61% of multiple-tablet regimen patients (p = 0.012). At 12 months, 82% on single-tablet regimens and 66% on multiple-tablet regimens (p = 0.019) had undetectable viral load. Relative risk of any detectable viral load was 1.6 (95% confidence interval: 1.1-2.5) for patients on multiple-tablet regimens compared to single-tablet regimens at 6 months, and 2.2 (95% confidence interval: 1.2-4.0) at 12 months. Conclusion Single-tablet regimens may provide better virologic control than multiple-tablet regimens in urban HIV-infected persons.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | | | - Susan B German
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Amy L Davidow
- Department of Biostatistics, Rutgers School of Public Health, Newark, NJ, USA
| | - Shobha Swaminathan
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, USA
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Mueller S, Wilke T, Gorasso V, Erhart M, Kittner JM. Adaption and validation of the adherence barriers questionnaire for HIV patients on antiretroviral therapy (ABQ-HIV). BMC Infect Dis 2018; 18:599. [PMID: 30486795 PMCID: PMC6264035 DOI: 10.1186/s12879-018-3530-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite substantial advances in antiretroviral therapy (ART) for human immunodeficiency virus (HIV) in the last decades, non-adherence (NA) continues to be a major challenge in the real-life treatment. To meet this challenge, adherence-promoting interventions with a tailored approach towards patient-specific adherence barriers that are identified using a reliable and practicable questionnaire are needed. The aim of this investigation was to develop and validate a respective questionnaire (Adherence Barriers Questionnaire for HIV: ABQ-HIV), based on an earlier version of the ABQ. METHODS The existing ABQ was discussed by an expert panel and revised according to the specifications of ART therapy for HIV patients. Initially, the ABQ-HIV consisted of 17 items formulated as statements (4-point-Likert-scale ranging from "strongly agree" to "strongly disagree"). A higher score indicates a higher influence of a certain barrier on patient's perceptions. The ABQ-HIV was applied in a cross-sectional survey of German HIV patients. Evaluation of the questionnaire included an assessment of internal consistency as well as factor analysis. Convergent validity was assessed by comparing the ABQ-HIV score with the degree of self-reported adherence measured by the 8-item Morisky Medication Adherence Scale (MMAS-8©). RESULTS Three hundred seventy patients were able to be included in all validation analyses. The included patients had a mean age of 51.2 years, and 15.7% were female. The mean HIV infection time was 11.7 years, and the mean duration of treatment since first starting ART was 8.7 years. Twenty-five patients - excluded from all further analyses - were not able/willing to answer all ABQ-HIV questions. The results of the reliability analysis showed a Cronbach's α of 0.708 for the initial 17-items in the ABQ-HIV draft. Two items were eliminated from the initial questionnaire, resulting in a Cronbach's α of 0.720 and a split-half reliability of 0.724 (Spearman-Brown coefficient). Based on the reduced 15-item scale, the factor analysis resulted in three different components of the questionnaire. Component 1, with seven items, represents the unintentional adherence barriers. The second component, which contains five items, can be labelled as a subscale describing barriers associated with disease/treatment knowledge. Finally, three items, which can be summarized as intentional adherence barriers, show maximum loading in the third component. The score of the reduced 15-item ABQ-HIV scale, as well as the scores of the three subscales, correlated significantly with the MMAS score. All correlation coefficients were negative, indicating that higher burdens of adherence barriers measured by ABQ-HIV or its subscales were associated with a lower MMAS score and thus, with a lower adherence level. The ROC analysis using the MMAS low adherence classification as its state variable provided a cut-off for the ABQ-HIV scale of > 28 (sensitivity: 61.5%, specificity: 83.3%). In our sample, 85 patients (23.0%) reached a score of > 28 and appeared to face a high non-adherence risk. CONCLUSIONS The ABQ-HIV is a practical, reliable, and valid instrument for identifying patient-specific barriers to adherence in the HIV treatment. It is also useful in identifying HIV patient subgroups, according to adherence barriers specific to these patients.
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Affiliation(s)
| | | | | | - Marc Erhart
- Universitaetmedizin Mainz, Universitaetsmedizin, Germany
| | - Jens M. Kittner
- Universitaetmedizin Mainz, Universitaetsmedizin, Germany
- Klinikum Darmstadt, Universitaetsmedizin, Germany
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141
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LaRowe LR, Chilcott LN, Zvolensky MJ, Vanable PA, Flood K, Ditre JW. Associations between Pain-Related Anxiety, Gender, and Prescription Opioid Misuse among Tobacco Smokers Living with HIV/AIDS. Subst Use Misuse 2018; 53:2210-2219. [PMID: 29708450 PMCID: PMC6126665 DOI: 10.1080/10826084.2018.1464028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) who smoke cigarettes are vulnerable to greater pain and aberrant use of prescription pain medications. Prescription opioid misuse is highly prevalent among PLWHA and can lead to a variety of adverse outcomes. Pain-related anxiety, which has been implicated in the maintenance of both pain and tobacco dependence, may also play a role in prescription pain medication misuse. OBJECTIVES This study aimed to test associations between pain-related anxiety and prescription opioid misuse. We hypothesized that, among those prescribed opioid medication, pain-related anxiety would be positively associated with current opioid misuse, and stated intentions to misuse prescription opioids in the future. We further hypothesized that these relations would be more pronounced among males (vs. females). METHODS Participants included 61 PLWHA daily tobacco smokers with pain. Hierarchical regressions were used to test interactions between gender and pain-related anxiety on current and intended opioid misuse among those prescribed opioid medications. RESULTS There was a significant interactive effect of pain-related anxiety and gender on opioid misuse, such that pain-related anxiety was positively associated with current opioid misuse among male (but not female) participants who were prescribed opioid medications. Among both males and females, pain-related anxiety was positively associated with intention to misuse prescription pain medications in the future. Conclusions/Importance: Additional research into the role of pain-related anxiety in prescription opioid misuse is warranted. This type of work may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.
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Affiliation(s)
| | | | | | | | - Kelley Flood
- Immune Health Services, Upstate Medical University
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Shukla S, Muchomba FM, McCoyd JLM. 'Drug adherence levels are falling down again': health worker perceptions of women's service utilization before and after integration of HIV/AIDS services into general care in India. Health Policy Plan 2018; 33:623-632. [PMID: 29590366 DOI: 10.1093/heapol/czy024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 11/13/2022] Open
Abstract
Integrated models of HIV/AIDS service delivery are believed to have advantages over stand-alone models of care from health planners' and providers' perspectives. Integration models differ, yet there is little information about the influence of differing models on workers' beliefs about models' efficacy. Here, we examine the effect of integration of HIV care into the general health system in India. In 2014, India replaced its stand-alone model of HIV service delivery-Community Care Centers (CCCs)-with a purported integrated model that delivers HIV medical services at general hospitals and HIV psychosocial services at nearby Care and Support Centers (CSCs). We examine 15 health workers' perceptions of how change from the earlier stand-alone model to the current model impacted women's care in a district in Uttar Pradesh, India. Results indicate that (1) Women's antiretroviral (ART) adherence and utilization of psychosocial support service for HIV/AIDS suffered when services were not provided at one site; (2) Provision of inpatient care in the CCC model offered women living in poverty personal safety in accessing HIV health services and promoted chances of competent ART usage and repeat service utilization; and (3) Although integration of HIV services with the general health system was perceived to improve patient anonymity and decrease chances of HIV-related stigma and discrimination, resource shortages continued to plague the integrated system while shifting costs of time and money to the patients. Findings suggest that integration efforts need to consider the context of service provision and the gendered nature of access to HIV care.
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Affiliation(s)
- Shrivridhi Shukla
- Rutgers, The State University of New Jersey, School of Social Work, New Brunswick, NJ, USA
| | - Felix M Muchomba
- Rutgers, The State University of New Jersey, School of Social Work, New Brunswick, NJ, USA
| | - Judith L M McCoyd
- Rutgers, The State University of New Jersey, School of Social Work, New Brunswick, NJ, USA
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143
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Fredericksen RJ, Yang FM, Gibbons LE, Edwards TC, Brown S, Fitzsimmons E, Alperovitz-Bichell K, Godfrey M, Wang A, Church A, Gutierrez C, Paez E, Dant L, Loo S, Walcott M, Mugavero MJ, Mayer KH, Mathews WC, Patrick DL, Crane PK, Crane HM. Development and content validation of measures assessing adherence barriers and behaviors for use in clinical care. Res Social Adm Pharm 2018; 15:1168-1176. [PMID: 30327183 DOI: 10.1016/j.sapharm.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Providers are often unaware of poor adherence to prescribed medications for their patients with chronic diseases. OBJECTIVE To develop brief, computer-administered patient-reported measures in English and Spanish assessing adherence behaviors and barriers. Design, Participants, and Main Measures: Item pools were constructed from existing measures of medication adherence behaviors and barriers, which informed development of a patient concept elicitation interview guide to identify medication adherence behavior and barrier-related concepts. Two hundred six patients either living with HIV (PLWH) or without were interviewed. Interviews were coded, concepts matched to item pool content, and new items were developed for novel concepts. A provider/investigator team highlighted clinically relevant items. Cognitive interviews were conducted with patients on final candidate items (n = 37). The instruments were administered to 2081 PLWH. KEY RESULTS Behavioral themes from concept elicitation interviews included routines incorporating time of day, placement, visual cues, and intentionality to miss or skip doses. Barrier themes included health-related (e.g. depressed mood, feeling ill), attitudes/beliefs (e.g., need for medication), access (e.g., cost/insurance problems), and circumstantial barriers (e.g., lack of privacy, disruption of daily routine). The final instruments included 6 behavior items, and 1 barrier item with up to 23 response options. PLWH endorsed a mean (SD) of 3.5 (1.1) behaviors. The 201 PLWH who missed ≥2 doses in the previous week endorsed a mean (SD) of 3.1 (2.5) barriers. The intraclass correlation coefficient (ICC) for the numbers of behaviors endorsed in 61 PLWH after 4-16 days was 0.54 and for the number of barriers for the 20 PLWH with ≥2 missed doses the ICC was 0.89, representing fair and excellent test-retest reliability. CONCLUSION Measures of medication adherence behaviors and barriers were developed for use with patients living with chronic diseases focusing on clinical relevance, brevity, and content validity for use in clinical care.
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Affiliation(s)
- R J Fredericksen
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA.
| | - F M Yang
- Augusta University, 1120 15th Street Augusta, GA, 30912, USA
| | - L E Gibbons
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - T C Edwards
- University of Washington, Quality of Life Group, Box 359455, Seattle, WA, 98195, USA
| | - S Brown
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - E Fitzsimmons
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | | | - M Godfrey
- Beaufort Jasper Hampton Comprehensive Health Services, 1520 Grays Highway, Ridgeland, SC, 29936, USA
| | - A Wang
- Chase Brexton Health Care, 5500 Knoll N Dr #370, Columbia, MD, 21045, USA
| | - A Church
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - C Gutierrez
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - E Paez
- University of California-San Diego, The Owen Clinic, 4168 Front Street, San Diego, CA, 92103, USA
| | - L Dant
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - S Loo
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - M Walcott
- University of Alabama-Birmingham, 1917 Clinic, Community Care Building, 908 South 20th Street, Birmingham, AL, 35294, USA
| | - M J Mugavero
- University of Alabama-Birmingham, 1917 Clinic, Community Care Building, 908 South 20th Street, Birmingham, AL, 35294, USA
| | - K H Mayer
- Fenway Community Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - W C Mathews
- University of California-San Diego, The Owen Clinic, 4168 Front Street, San Diego, CA, 92103, USA
| | - D L Patrick
- University of Washington, Quality of Life Group, Box 359455, Seattle, WA, 98195, USA
| | - P K Crane
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
| | - H M Crane
- University of Washington, Center for AIDS Research, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104, USA
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Yoong D, Bayoumi AM, Robinson L, Rachlis B, Antoniou T. Public prescription drug plan coverage for antiretrovirals and the potential cost to people living with HIV in Canada: a descriptive study. CMAJ Open 2018; 6:E551-E560. [PMID: 30482757 PMCID: PMC6276936 DOI: 10.9778/cmajo.20180058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antiretrovirals are expensive and people living with HIV may experience a range of financial burdens when accessing these medications. Our aim was to describe the policy of all Canadian public drug insurance programs for antiretroviral drugs and illustrated how these policies might affect patients' annual out-of-pocket expenditures. METHODS In December 2017, we reviewed public drug programs offering antiretroviral coverage in Canada using government websites to summarize eligibility criteria. We estimated the annual out-of-pocket costs incurred by people living with HIV by applying the cost-sharing rules to 2 hypothetical cases, a single man and a married woman with a net household income of $39 000 and $80 000, respectively, receiving identical prescriptions in different jurisdictions. RESULTS We observed substantial variation in the subsidy provided based mainly on geography, income and age. All 5 federal programs and 6 of 13 provincial and territorial jurisdictions offered universal coverage. In the remaining regions, patients spend up to several thousand dollars annually depending on income (Manitoba), age and income (Ontario, Saskatchewan) and age, income and drug costs (Quebec and Newfoundland and Labrador). We found the greatest variation for our higher income case, with out-of-pocket expenses ranging from 0 to over 50% of the antiretroviral cost. INTERPRETATION There is considerable inter- and intra-jurisdiction heterogeneity in the cost-sharing policies for antiretrovirals across Canada's public drug programs. Policy reforms that either eliminate or set national standards for copayments, deductibles or premiums would minimize variation and could reduce the risk of cost-associated non-adherence to HIV therapy.
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Affiliation(s)
- Deborah Yoong
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont.
| | - Ahmed M Bayoumi
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Linda Robinson
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Beth Rachlis
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Medicine (Bayoumi), University of Toronto, Toronto, Ont.; Department of Pharmacy (Robinson), Windsor Regional Hospital, Windsor, Ont.; Ontario HIV Treatment Network (Rachlis), Toronto, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital and University of Toronto, Toronto, Ont.; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital, Toronto, Ont
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Nichols JS, Kyriakides TC, Antwi S, Renner L, Lartey M, Seaneke OA, Obeng R, Catlin AC, Gan G, Reynolds NR, Paintsil E. High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana. AIDS Care 2018; 31:25-34. [PMID: 30235940 DOI: 10.1080/09540121.2018.1524113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adherence to antiretroviral therapy (ART) remains one of the greatest obstacles in pediatric HIV care. We sought to determine the prevalence of adherence to ART among undisclosed HIV-infected children and adolescents in Ghana. We analyzed baseline data from HIV-infected children and adolescents aged 7-18 years old enrolled in the SANKOFA Pediatric HIV disclosure intervention study in Ghana. Antiretroviral medication adherence was measured using caregiver 3-day recall; child 3-day recall; and pharmacy records for antiretroviral time-to-refill. Four hundred and twenty child-caregiver dyads were enrolled from January 2013 to June 2016. The median adherence (interquartile range), as measured by time-to-refill, was 93.2% (68.0%-100.0%). However, only 47.5% of children had ≥95% adherence ("good adherence") using time-to-refill data. Children of caregivers who had received secondary or higher level of education versus no school (aOR, 2.90, 95% Confidence Interval, CI 1.29-6.56), p = 0.010) or elementary education only (aOR, 2.20, CI, 1.24-3.88, p = 0.007) were more likely to have "good adherence" (≥95%). In this cohort of children unaware of their HIV positive status, median ART adherence rate was sub-optimal (by World Health Organization definition) while 38% had poor adherence (<85%).
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Affiliation(s)
- Justin S Nichols
- a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA
| | - Tassos C Kyriakides
- b Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Sampson Antwi
- c Department of Child Health , School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Lorna Renner
- d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Margaret Lartey
- e Department of Medicine , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Obedia A Seaneke
- d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Raphael Obeng
- c Department of Child Health , School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Ann C Catlin
- f Rosen Center for Advanced Computing , Purdue University , West Lafayette , IN , USA
| | - Geliang Gan
- b Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA
| | | | - Elijah Paintsil
- a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA
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- a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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147
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Mbuagbaw L, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Thabane L. Strategies to improve adherence to antiretroviral therapy and retention in care for people living with HIV in high-income countries: a protocol for an overview of systematic reviews. BMJ Open 2018; 8:e022982. [PMID: 30206089 PMCID: PMC6144485 DOI: 10.1136/bmjopen-2018-022982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION While access to antiretroviral therapy (ART) for people living with HIV has expanded in recent years, additional efforts are required to support adherence to medication and retention in care. Interventions should be applicable in real-world settings and amenable to widespread use. The objectives of this overview are to identify effective pragmatic interventions that increase adherence to ART and retention in care for people living with HIV at high risk for suboptimal adherence and retention in high-income countries. METHODS AND ANALYSIS We will conduct an overview of systematic reviews of studies on interventions which target improved adherence to medication and retention in care among high-risk people living with HIV in high-income countries (men who have sex with men, African, Caribbean and black people, sex workers, people who inject drugs, indigenous people and other socially marginalised groups). We will search the following databases: PubMed, EMBASE (Exerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Web of Science and the Cochrane Library. We will conduct screening, data extraction and assessment of methodological quality of the systematic reviews. Analysis will be narrative. Our findings will be interpreted in light of the certainty of the evidence, level of pragmatism, setting and population of interest. ETHICS AND DISSEMINATION Only published secondary data will be used in this study, and therefore ethics approval is not required. Our findings will be disseminated as peer-reviewed manuscripts, conference abstracts and through community activities. The findings from this overview will inform a mixed-methods study among people living with HIV and health workers in Ontario, Canada.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women’s College Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Dignitas International, Toronto, Ontario, Canada
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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148
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Caballero J, Ownby RL, Jacobs RJ, Thomas JE, Schweizer MS. Association Between Cognitive Tests and Antiretroviral Medication Adherence in Older Adults With HIV. Ann Pharmacother 2018; 53:151-158. [PMID: 30175588 DOI: 10.1177/1060028018798327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND One of the fastest growing populations living with HIV is older adults especially those 65 years of age or older. Current antiretroviral therapy (ART) has prolonged life expectancy of persons with HIV. However, for therapy to be effective, patients need to be adherent. Over time, older persons with HIV may experience HIV-associated neurocognitive disorders or other factors that could affect ART adherence. The use of expedient cognitive tests that help measure medication adherence may be useful for the optimal care of these patients. OBJECTIVE To investigate the association between cognitive tests and ART adherence. METHODS This was a prospective study evaluating patients 65 years of age or older with HIV. Cognitive tests used included the Executive Clock-Drawing Task (CLOX) 1 and 2, Trail Making Test parts A and B, and Grooved Pegboard Test (GPB). The medication event monitoring system cap over 1 month was used as the primary measure for adherence. RESULTS CLOX 1 and GPB were significantly related to adherence ( P < 0.05). Comparison of the magnitude of each measure's relation to adherence suggests that the GPB is a better indicator of ability to adhere ( R = 0.514 vs R = 0.381). Conclusion and Relevance: CLOX 1 and GPB demonstrated an association with adherence in patients 65 years of age or older with HIV. Although the use of these tests to measure adherence in older persons with HIV seems promising, more research is needed to ascertain their ultimate utility.
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149
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Faytell MP, Doyle KL, Naar-King S, Outlaw AY, Nichols SL, Twamley EW, Woods SP. Calendaring and alarms can improve naturalistic time-based prospective memory for youth infected with HIV. Neuropsychol Rehabil 2018; 28:1038-1051. [PMID: 27687290 PMCID: PMC5374028 DOI: 10.1080/09602011.2016.1236733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Individuals with HIV disease often evidence deficits in prospective memory (PM), which interfere with daily functioning and increase the risk of suboptimal health behaviours. This study examined the benefits of simple encoding and cueing supports on naturalistic time-based PM in 47 HIV-positive young adults. All participants completed a naturalistic time-based PM task in which they were instructed to text the examiner once per day for seven days at a specified time. Participants were randomised into (1) a Calendaring condition in which they created a calendar event in their mobile telephone for the specified texting time; (2) an Alarm condition in which they programmed an alarm into their mobile telephone for the specified texting time; (3) a Combined calendaring and alarm condition; and (4) a Control condition. Participants in the Combined condition demonstrated significantly better naturalistic PM performance than participants in the Control and Calendaring conditions. Findings indicate that HIV-positive young people may benefit from a combined calendaring and alarm supportive strategy for successful execution of future intentions in daily life.
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Affiliation(s)
| | - Katie L. Doyle
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, USA
| | - Sylvie Naar-King
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA
| | - Angulique Y. Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA
| | - Sharon L. Nichols
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, U SA
- Department of Psychiatry, University of California, San Diego, CA, USA
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150
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Amram O, Shoveller J, Hogg R, Wang L, Sereda P, Barrios R, Montaner J, Lima V. Distance to HIV care and treatment adherence: Adjusting for socio-demographic and geographical heterogeneity. Spat Spatiotemporal Epidemiol 2018; 27:29-35. [PMID: 30409374 DOI: 10.1016/j.sste.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Distance to health services plays an important role in determining access to care and an individual's health. This study aims to examine the relationship between distance to antiretroviral therapy (ART) prescribing physician and adherence to HIV treatment in British Columbia, Canada. Only participants who provided highly accurate locational data for both place of residence and their physician were used in the analysis. Using logistic regression, a multivariable confounder model was created to assess the association between distance and adherence. A geographically weighted logistic regression was also performed to adjust for spatial dependency. There were 1528 participants in the analysis, for a median distance of 17.85km. The final model showed further away from ART prescribing physician had a higher chance of incomplete adherence to ART (adjusted odds ratio 1.31; 95% Confidence Interval 1.04-1.65). Mobile services could potentially increase adherence rates for population residing further away from their ART prescribing physician.
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Affiliation(s)
- O Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA.
| | - J Shoveller
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - R Hogg
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - L Wang
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - P Sereda
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - R Barrios
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - J Montaner
- British Columbia centre for excellence in HIV/AIDS, University of British Columbia, 613 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
| | - V Lima
- Epidemiology and population health program, British Columbia centre for excellence in HIV/AIDS, 608 - 1081 Burrard street, Vancouver, British Columbia, Canada v6z 1y6.
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