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Using Machine Learning to Predict Young People's Internet Health and Social Service Information Seeking. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:1173-1184. [PMID: 33974226 DOI: 10.1007/s11121-021-01255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Machine learning creates new opportunities to design digital health interventions for youth at risk for acquiring HIV (YARH), capitalizing on YARH's health information seeking on the internet. To date, researchers have focused on descriptive analyses that associate individual factors with health-seeking behaviors, without estimating of the strength of these predictive models. We developed predictive models by applying machine learning methods (i.e., elastic net and lasso regression models) to YARH's self-reports of internet use. The YARH were aged 14-24 years old (N = 1287) from Los Angeles and New Orleans. Models were fit to three binary indicators of YARH's lifetime internet searches for general health, sexual and reproductive health (SRH), and social service information. YARH responses regarding internet health information seeking were fed into machine learning models with potential predictor variables based on findings from previous research, including sociodemographic characteristics, sexual and gender minority identity, healthcare access and engagement, sexual behavior, substance use, and mental health. About half of the YARH reported seeking general health and SRH information and 26% sought social service information. Areas under the ROC curve (≥ .75) indicated strong predictive models and results were consistent with the existing literature. For example, higher education and sexual minority identification was associated with seeking general health, SRH, and social service information. New findings also emerged. Cisgender identity versus transgender and non-binary identities was associated with lower odds of general health, SRH, and social service information seeking. Experiencing intimate partner violence was associated with higher odds of seeking general health, SRH, and social service information. Findings demonstrate the ability to develop predictive models to inform targeted health information dissemination strategies but underscore the need to better understand health disparities that can be operationalized as predictors in machine learning algorithms.
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Dickson-Gomez J, McAuliffe T, Quinn K, Spector A, Toepfer P, Bendixen A, DiFranceisco W. The comparative effectiveness of different models of permanent supportive housing on problematic substance use, depression, and anxiety symptoms over time. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 91:514-523. [PMID: 33939448 PMCID: PMC8370390 DOI: 10.1037/ort0000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare the effectiveness of different models of permanent supportive housing (PSH), housing configuration, and service provision model on substance use, depression, and anxiety symptoms among residents over time. METHODS Linear mixed model regression was used with 888 residents of PSH to investigate the relationship between supportive housing type, service model, and housing configuration and change in mental health and substance use at baseline, 6-, 12-, and 18-month follow-up. RESULTS There were few significant differences in problematic substance use, depression, or anxiety symptoms among those in different PSH types, different housing configuration models, or different service provision models. Similarly, there were no significant differences in PSH type, housing configuration, or service delivery model among those with severe mental illness (SMI), substance use disorder (SUD), or those with dual diagnoses. CONCLUSIONS There is little evidence that different models of PSH result in differences in mental health and substance use outcomes. Future research should consider the number of services clients receive and critical periods in PSH residency in improving mental health and substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Katherine Quinn
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Antoinette Spector
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Wayne DiFranceisco
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
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Wilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW, Portela M, Srivastava A, Li Y, McCarthy ML. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:1359-1370. [PMID: 33515188 PMCID: PMC8131473 DOI: 10.1007/s11606-020-06447-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA. METHODS We conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases: PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively. RESULTS A total of 3137 unduplicated abstracts were identified from our database searches. A total of 173 were selected for full text review after evaluating the abstract. A total of 29 articles were included for this systematic review. Economic-related SDH factors and MA were mostly commonly examined. The meta-analysis revealed a significant relationship between food insecurity (aOR = 0.56; 95% CI 0.42-0.7), housing instability (aOR = 0.64; 95% CI 0.44-0.93), and social determinants overall (aOR = 0.75; 95% CI 0.65-0.88) and medication adherence. DISCUSSION Food insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.
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Affiliation(s)
- Marcee E Wilder
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.
| | - Paige Kulie
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Caroline Jensen
- Anesthesiology Residency Program, Columbia University, New York, NY, USA
| | - Paul Levett
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC, USA
| | - Janice Blanchard
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Luis W Dominguez
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Maria Portela
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Aneil Srivastava
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Melissa L McCarthy
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.,Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Crable EL, Blue TR, McKenzie M, Rich JD, Gordon MS. Effect of Case Management on HIV Outcomes for Community Corrections Population: Results of an 18-Month Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 87:755-762. [PMID: 33492021 PMCID: PMC8026504 DOI: 10.1097/qai.0000000000002624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based interventions that engage community-dwelling, justice-involved, people living with HIV (PLWH) in care are urgently needed. Project Bridge, an intensive case management intervention, has demonstrated efficacy for linking PLWH to care transitioning from prison to the community. We assessed whether a modified Project Bridge model was effective for increasing rates of HIV treatment engagement, antiretroviral therapy receipt, and adherence for community-dwelling individuals supervised on probation and parole. SETTING Baltimore, Maryland. METHODS In this study, the 18-month outcomes of a randomized controlled trial in which PLWH were also on probation or parole received either Project Bridge (n = 50) or treatment as usual (n = 50) were assessed. HIV treatment engagement (primary outcome), antiretroviral therapy prescription, and adherence (secondary outcomes) are evaluated using the intent-to-treat approach. RESULTS There were no statistically significant differences in rates of HIV treatment engagement, antiretroviral therapy prescription receipt, or adherence between groups over the 18-month study period. Across groups, participants were 5.6 times more likely to receive HIV care, 5.8 times more likely to receive an antiretroviral therapy prescription, and 4 times more likely to report antiretroviral therapy adherence at each follow-up period. CONCLUSIONS Future research is needed to identify potentially less-intensive interventions that target the unique needs of PLWH under community supervision.
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Affiliation(s)
- Erika L. Crable
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | | | - Michelle McKenzie
- The Miriam Hospital, Providence, RI, USA
- Center for Prisoner Health and Human Rights, Brown University, Providence, RI, USA
| | - Josiah D. Rich
- The Miriam Hospital, Providence, RI, USA
- Center for Prisoner Health and Human Rights, Brown University, Providence, RI, USA
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Tureson K, Byrd DA, Guzman V, Summers AC, Morris EP, Mindt MR. The impact of sociocultural factors on prospective memory performance in HIV+ Latinx adults. Neuropsychology 2021; 35:411-422. [PMID: 34043391 PMCID: PMC10284210 DOI: 10.1037/neu0000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Prospective memory (PM), a salient component of neurocognitive functioning for people living with HIV (PLH), is necessary for planning and coordinating health-related behaviors and instrumental tasks of daily living. However, little is known regarding the impact of sociocultural factors on PM in diverse populations, particularly Latinx PLH. The aim of this study was to examine ethnic group differences and sociocultural factors related to PM. METHOD The sample of 127 PLH (91 Latinx and 36 non-Latinx white) completed measures of quality of education, socioeconomic status (SES), and a validated PM measure, the Memory for Intentions Screening Test (MIST). The Latinx group also completed a bicultural acculturation measure. RESULTS Results revealed the Latinx and the non-Latinx white groups did not significantly differ in overall MIST performance (all p > .05). In the entire sample, better quality of education was associated with better MIST performance (all p < .05). Within the Latinx group, higher Latinx acculturation was associated with worse MIST performance (p = .02), whereas higher U.S. acculturation was associated with better MIST performance at a trend level (p = .07). Multivariate regressions revealed quality of education and Latinx acculturation significantly predicted MIST performance and PM errors (all p < .05). SES was not related to the MIST (all p > .10). CONCLUSIONS In sum, clinicians must take sociocultural factors into consideration when working with Latinx PLH, as these factors influence cognitive functions (i.e., PM) vital to health-related behaviors. Integrating culturally-informed psychoeducation into care plans is an imperative first step. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Desiree A. Byrd
- Department of Psychology, Queens College, Queens, NY
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vanessa Guzman
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Angela C. Summers
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Emily P. Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Monica Rivera Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
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Fletcher-Hildebrand S, Alimezelli H, Carr T, Lawson K, Ali A, Groot G. Understanding the impact of a residential housing programme for people living with HIV/AIDS: a realist evaluation protocol. BMJ Open 2021; 11:e044522. [PMID: 33820789 PMCID: PMC8030488 DOI: 10.1136/bmjopen-2020-044522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Housing instability and homelessness are significant barriers to medical treatment for people living with HIV/AIDS. For these individuals, lack of stable housing and stigma is associated with insufficient access to care, poor adherence to medication and higher cost burdens to the healthcare system. This protocol reports on the efforts to evaluate Sanctum V.1.0, a hospice and transitional care home for adults with HIV/AIDS in Saskatoon, Saskatchewan, Canada. The current project was developed out of a need to identify how Sanctum V.1.0 produces varying programme outcomes to assist in endeavours to replicate the programme in other geographic locations. METHODS AND ANALYSIS A realist evaluation will be conducted to explore how and why Sanctum V.1.0 is successful or unsuccessful, in which circumstances and for whom. Rather than explore the degree to which a programme is effective, realist evaluations seek to uncover mechanisms that explain processual links between programme inputs and outcomes. The completed first phase of the project involved the development of an initial realist programme theory. Phases 2 and 3 will consist of methods to test, refine and validate the initial theory using various data sources. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional review board at the University of Saskatchewan on 2 July 2020. Results will be disseminated according to stakeholders' desires.
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Affiliation(s)
| | - Hubert Alimezelli
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tracey Carr
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Karen Lawson
- Psychology, University of Saskatchewan College of Arts and Science, Saskatoon, Saskatchewan, Canada
| | - Anum Ali
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Quinn KG, DiFranceisco W, Spector A, Bendixen A, Peters A, Dickson-Gomez J. The Effect of Various Supportive Housing Models on ART Adherence Among Persons Living With HIV in Supportive Housing. Med Care 2021; 59:S124-S131. [PMID: 33710084 PMCID: PMC7958970 DOI: 10.1097/mlr.0000000000001336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providing permanent supportive housing to chronically homeless persons living with human immunodeficiency virus (PLH) contributes to improved human immunodeficiency virus (HIV) outcomes, including adherence to antiretroviral therapy (ART). This study seeks to understand whether certain components of housing, namely intensity of case management and specialized HIV housing programs, affects ART adherence for PLH in supportive housing. METHODS From 2015 to 2019 we conducted quantitative assessments with 157 PLH in supportive housing at baseline, 6-, 12-, and 18-month postbaseline to identify factors associated with ART adherence. General Estimating Equations for repeated measures were performed to assess bivariate and multivariate measures. RESULTS Two thirds of PLH in supportive housing reported 95% or greater adherence to ART. Multivariate analyses indicate that neither intensity of case management services nor specialized housing for PLH were associated with greater ART adherence. Greater time since diagnosis was positively associated with ART adherence. Greater depressive symptoms and African American race were negatively associated with ART adherence. CONCLUSIONS Study findings reveal that although prior research has established the importance of receipt of housing for homeless PLH, the type or intensity of case management services associated with that housing may not be as important as simply being housed. Our results highlight the importance of considering mental health and more recent HIV diagnosis when developing treatment and case management plans to enhance residents' ART adherence.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research
| | - Wayne DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research
| | - Antoinette Spector
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Julia Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
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Sullivan PS, Knox J, Jones J, Taussig J, Valentine Graves M, Millett G, Luisi N, Hall E, Sanchez TH, Del Rio C, Kelley C, Rosenberg ES, Guest JL. Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia. J Int AIDS Soc 2021; 24:e25689. [PMID: 33821554 PMCID: PMC8022103 DOI: 10.1002/jia2.25689] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community-based cohort of Black and white MSM living with HIV in Atlanta, GA. METHODS We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. RESULTS Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age-adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). CONCLUSIONS Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual-level interventions to reduce racial disparities.
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Affiliation(s)
- Patrick S Sullivan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Justin Knox
- Department of PsychiatryColumbia UniversityNew YorkNYUSA
| | - Jeb Jones
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Jennifer Taussig
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | - Greg Millett
- American Foundation for AIDS ResearchWashingtonDCUSA
| | - Nicole Luisi
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Eric Hall
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Travis H Sanchez
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Carlos Del Rio
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
| | - Colleen Kelley
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
| | | | - Jodie L Guest
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
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Abstract
Purpose of Review With the expanded roll-out of antiretrovirals for treatment and prevention of HIV during the last decade, the emergence of HIV drug resistance (HIVDR) has become a growing challenge. This review provides an overview of the epidemiology and trajectory of HIVDR globally with an emphasis on pediatric and adolescent populations. Recent Findings HIVDR is associated with suboptimal virologic suppression and treatment failure, leading to an increased risk of HIV transmission to uninfected people and increased morbidity and mortality among people living with HIV. High rates of HIVDR to non-nucleoside reverse transcriptase inhibitors globally are expected to decline with the introduction of the integrase strand transfer inhibitors and long-acting combination regimens, while challenge remains for HIVDR to other classes of antiretroviral drugs. Summary We highlight several solutions including increased HIV viral load monitoring, expanded HIVDR surveillance, and adopting antiretroviral regimens with a high-resistance barrier to decrease HIVDR. Implementation studies and programmatic changes are needed to determine the best approach to prevent and combat the development of HIVDR.
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Abbott MM, McBain R, Wagner L, Liu HH. Cost evaluation of integrating local HIV and housing data to facilitate service coordination in four demonstration sites. AIDS Care 2021; 34:746-752. [PMID: 33657927 DOI: 10.1080/09540121.2021.1894317] [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: 10/22/2022]
Abstract
As part of the evaluation of a federal initiative to integrate HIV medical and housing data at four local jurisdictions in the U.S., we estimated the financial costs of implementing data integration occurring from June 2016 to August 2018. We collected data on labor, non-labor, and overhead expenses based on invoices and surveys of staff time, staff compensation, and non-labor expenses. Non-labor expenses were directly charged or allocated to the project using the number of full-time equivalents as the allocation basis. Reported indirect cost rates were used to estimate overhead expenses. Demonstration sites spent an average of $273,656 over the full 27-month period, with an average monthly spending of $10,010 in 2018 U.S. dollars. There was sizable variation in the data integration costs across sites, implementation phases, and data integration models. Findings may help policymakers and potential adopters of similar data integration efforts customize parameters for local conditions and estimate resources required.
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Affiliation(s)
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- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, DC, USA
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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112
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Kherghehpoush S, McKeirnan KC. Pharmacist-led HIV and hepatitis C point-of-care testing and risk mitigation counseling in individuals experiencing homelessness. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 1:100007. [PMID: 35479505 PMCID: PMC9031368 DOI: 10.1016/j.rcsop.2021.100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Over half a million people experience homelessness on any given night in the United States. As a result of increased exposure to disease, violence, stigma, substance misuse and limited accessibility to health services, individuals experiencing homelessness are disproportionately affected by communicable diseases such as HIV and HCV with prevalence estimates as high as 21% and 36%, respectively. Pharmacists, being some of the most trusted and accessible healthcare providers, are in a unique position to have a significant impact on the nationwide initiatives in Ending the HIV Epidemic: A Plan for America and the National Viral Hepatitis Plan by offering preventative testing services and patient-centered risk mitigation counseling and education. This research looks to assess the health impacts associated with pharmacist-led HIV and HCV screening coupled with comprehensive education and risk mitigation counseling in adults experiencing homelessness. Methods This study was conducted in a single independent community pharmacy in Spokane, Washington which specializes in mental health services and serves a large proportion of patients who are experiencing homelessness. Study participants are walk-in patients of the pharmacy, over the age of 18, are currently experiencing homelessness, and have not received an HIV or HCV screening within the past 6 months. The study intervention includes a Risk Determination interview, administration of HIV and HCV point-of-care antibody test, comprehensive diseases state education and personalized risk mitigation counseling. Participants are then referred to a local health clinic for confirmatory testing, anonymous partner notification, and evaluation for pre-exposure prophylaxis if indicated. Results A total of 10 participants were included in the final data analysis. Majority of study participants were male (80%), heterosexual (90%) and over the age 30 (90%). A total of 8 participants (80%) had a reactive HCV screening and there were no reactive HIV screenings. Many of participants reported IV drug use with methamphetamine being the most used illicit substance. Half of all participants (50%) admitted to borrowing a needle for injection drug use within the past 6 months. Two participants admitted to having sexual intercourse with a partner who was known to be HCV-positive and both participants had a reactive HCV screening. All study participants reported at least one serious mental illness diagnosis and ongoing recreational drug use was cited as a coping mechanism in all participants. Conclusion Since efficacy of treatment is no longer the limiting factor in eradicating HCV and suppressing HIV viral load, public health efforts need to be refocused on patient engagement through preventative services in an environment that is less stigmatized than traditional testing sites, such as community pharmacies. Study participants were highly receptive to pharmacist-provided point-of-care screening services in the community pharmacy. Combining HIV and HCV point-of-care testing with comprehensive patient-centered education and risk mitigation counseling may result in lower rates of community transmission, improve linkage to care and may lead to long-term retention of marginalized populations such as those experiencing homelessness.
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Affiliation(s)
- Sorosh Kherghehpoush
- Washington State University College of Pharmacy and Pharmaceutical Sciences, USA
| | - Kimberly C McKeirnan
- Washington State University College of Pharmacy and Pharmaceutical Sciences, USA
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Trajectories of Viral Suppression in People Living With HIV Receiving Coordinated Care: Differences by Comorbidities. J Acquir Immune Defic Syndr 2021; 84:387-395. [PMID: 32598118 DOI: 10.1097/qai.0000000000002351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND In March of 2013, the Los Angeles County (LAC) Division of HIV and STD Programs implemented a clinic-based Medical Care Coordination (MCC) Program to increase viral suppression (VS) (<200 c/mL) among people living with HIV (PLWH) at high risk for poor health outcomes. OBJECTIVE This study aimed to estimate trajectories of VS and to assess whether these trajectories differed by stimulant use, housing instability, and depressive symptom severity as reported by PLWH participating in MCC. METHODS Data represent 6408 PLWH in LAC receiving services from the MCC Program and were obtained from LAC HIV surveillance data matched to behavioral assessments obtained across 35 Ryan White Program clinics participating in MCC. Piecewise mixed-effects logistic regression with a random intercept estimated probabilities of VS from 12 months before MCC enrollment through 36 months after enrollment, accounting for time by covariate interactions for 3 comorbid conditions: housing instability, stimulant use, and depressive symptoms. RESULTS The overall probability of VS increased from 0.35 to 0.77 within the first 6 months in the MCC Program, and this probability was maintained up to 36 months after enrollment. Those who reported housing instability, stimulant use, or multiple comorbid conditions did not achieve the same probability of VS by 36 months as those with none of those comorbidities. CONCLUSIONS Findings suggest that MCC improved the probability of VS for all patient groups regardless of the presence of comorbidities. However, those with comorbid conditions will still require increased support from patient-centered programs to address disparities in VS.
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Kanazawa JT, Saberi P, Sauceda JA, Dubé K. The LAIs Are Coming! Implementation Science Considerations for Long-Acting Injectable Antiretroviral Therapy in the United States: A Scoping Review. AIDS Res Hum Retroviruses 2021; 37:75-88. [PMID: 33176429 PMCID: PMC8020525 DOI: 10.1089/aid.2020.0126] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI-ART) is one of the latest advancements in HIV control with the potential to overcome oral ART barriers to adherence. The objective of this article is to anticipate and examine implementation considerations for LAI-ART using components of the PRISM model, a Practical, Robust Implementation and Sustainability Model for integrating research findings into practice. We conducted a scoping review from January to August 2020 of the growing literature on LAI-ART implementation and other fields using LAI therapies. Key considerations regarding LAI-ART were parsed from the searches and entered into the PRISM implementation science framework. The PRISM framework posed multiple questions for consideration in the development of an optimal implementation strategy for LAI-ART in the United States. These questions revealed the necessity for more data, including acceptability of LAI-ART among many different subgroups of people living with HIV (PLWH), cost effectiveness, patient satisfaction, and patient-reported outcomes, as well as more detailed information related to the external environment for optimal LAI-ART implementation. Ethical considerations of LAI-ART will also need to be considered. The anticipation of, and excitement for, LAI-ART represent the hope for a new direction for HIV treatment that reduces adherence barriers and improves prognoses for PLWH. We have a unique window of opportunity to anticipate implementation considerations for LAI-ART, so this new therapy can be used to its fullest potential. Outstanding questions remain, however, that need to be addressed to help achieve HIV suppression goals in diverse populations.
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Affiliation(s)
- John T. Kanazawa
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
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115
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Aquino G, Byrne M, Dorsey K, Siegel M, Mitchell O, Grant S, Fox A, Lum G, Allston A, Monroe A, Doshi R. Examining Retention in HIV Care and HIV Suppression on Housing Services Intake at a Washington, DC Community Based Organization. J Community Health 2021; 46:861-868. [PMID: 33507489 DOI: 10.1007/s10900-020-00959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
In Washington, DC, 2% of residents are living with HIV, with 15.3% of them experiencing homelessness. Additionally, over half of DC-area renters are paying over 30% of their income for housing. The primary objective of this study was to describe HIV outcomes at initial intake at Housing Counseling Services (HCS). This retrospective study included adults with HIV completing HCS intake between 2015 and 2018 and linked HCS data with DC Department of Health (DOH) HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) surveillance data. Proportions of individuals with retention in care (RIC) and viral suppression (VS) were compared across client subgroups using chi-square or rank sum tests. The sample of 734 participants was mostly male (67%), Non-Hispanic Black (89%), had MSM as the HIV transmission risk factor (44%) and had rental housing (60%). Most participants (634/734, 86%) were RIC at HCS intake. A majority of participants (477/621 or 77%) had VS at intake. Older age was associated with VS (p = 0.0007). Homeless individuals (with intake from the street) were less likely to be VS (4.8% vs. 11.1%, p < 0.0045). Our results suggest that PWH who have unstable housing or who are homeless may need additional support services for maintaining RIC and VS, as the proportion meeting those benchmarks was not at goal when they sought services at HCS.
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Affiliation(s)
- Gabrielle Aquino
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA
| | - Kerri Dorsey
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
| | | | | | - Sherita Grant
- District of Columbia Department of Health, Washington, DC, USA
| | - Anthony Fox
- District of Columbia Department of Health, Washington, DC, USA
| | - Garrett Lum
- District of Columbia Department of Health, Washington, DC, USA
| | - Adam Allston
- District of Columbia Department of Health, Washington, DC, USA
| | - Anne Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.
| | - Rupali Doshi
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
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Lewis TJ. We the People: A Black Strategy to End the HIV Epidemic in the United States of America. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:173-192. [PMID: 36818216 PMCID: PMC9930506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The two previous United States presidential administrations implemented efforts to combat HIV/AIDS, recently leading to a plan to end this epidemic by 2030. Although the plan outlines a biomedical framework of key areas to address, it does not prioritize the core systemic and social issues that have caused the disease to devastate Black communities. The Black AIDS Institute (BAI) responded directly to this gap with "We the People: A Black Strategy to End HIV." BAI connected with Black community members across the country and conducted key informant interviews, held town hall meetings, and hosted a community forum in the U.S. Conference on AIDS. Based on this extensive community-level input, BAI, along with a diverse group of social justice partners, finalized the plan's strategic direction and recommendations. The efforts culminated in the "We the People" framework's four key pillars directly informing all of BAI's policy work, to include radically reimagining housing, health care, and criminalization systems that perpetuate the HIV/AIDS crisis among Black Americans. "We the People" outlines a clear path to engage policymakers and ensure all communities can effectively access and utilize the treatment and prevention advances that have the potential to soon end this epidemic..
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117
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Saleem HT, Likindikoki S, Silberg C, Mbwambo J, Latkin C. Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania: A time geography perspective. Soc Sci Med 2021; 268:113379. [PMID: 32979773 PMCID: PMC7755686 DOI: 10.1016/j.socscimed.2020.113379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
Timely initiation and sustained adherence to antiretroviral therapy (ART) are essential to improving the health outcomes of people living with HIV and preventing onward HIV transmission. However, women who use heroin often face challenges to initiating and adhering to ART. In this paper we identify spatial, temporal, and social factors that affect HIV treatment engagement among women who use heroin, drawing from a time geography framework. We conducted in-depth interviews with 30 heroin-using women living with HIV in Dar es Salaam, Tanzania between January and March 2019. We found that unstable housing, high mobility, HIV-related stigma, and unpredictable daily paths due to heroin use and involvement in sex work spatially and temporally constrained women who use heroin from incorporating HIV treatment behaviors into daily routines. Some women, however, were able to overcome these time-space constraints to HIV treatment engagement through social support and social role performance. Time geography, including concepts of time-space constraints and daily paths, is a useful framework for identifying barriers to ART engagement. Structural, relational, and individual interventions aimed at eliminating time-space constraints hold the potential to improve HIV treatment engagement among particularly vulnerable and mobile populations.
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Affiliation(s)
- Haneefa T Saleem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5033, Baltimore, MD, USA, 21205.
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Claire Silberg
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA, 21205.
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, School of Medicine, Muhmbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway Avenue, Hampton House Room 737, Baltimore, MD, USA, 21205.
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118
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Callejo-Black P, Biederman D, Douglas C, Silberberg M. Eviction as a Disruptive Factor in Health Care Utilization: Impact on Hospital Readmissions and No-show Rates. J Health Care Poor Underserved 2021; 32:386-396. [PMID: 33678703 DOI: 10.1353/hpu.2021.0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Residential eviction is a component of housing instability that negatively affects physical and mental health, but the effect of eviction on health care utilization, specifically hospital readmissions and outpatient no-show rates, is not known. METHODS We conducted a retrospective review of health care utilization of individuals evicted from public housing between January 2013 and December 2017, investigating hospital readmissions and no-show rates one year before and after eviction. RESULTS 131 individuals who had been evicted had one year of data pre-and post-eviction. The majority were African American (97.7%) and female (80.9%). There was no significant change in 30-, 60-, and 90-day hospital readmissions (p>.05). No-show rate decreased from 27.57 per person per year to 20.13 (p=.05). CONCLUSIONS For our study population, health care utilization was not disrupted. The decreased no-show rate represents an opportunity for health systems to engage with patients on social factors affecting their health post-eviction.
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119
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Mohammed DY, Koumoulos LM, Martin E, Slim J. Annual and durable HIV retention in care and viral suppression among patients of Peter Ho Clinic, 2013-2017. PLoS One 2020; 15:e0244376. [PMID: 33373385 PMCID: PMC7771864 DOI: 10.1371/journal.pone.0244376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives To determine rates of annual and durable retention in medical care and viral suppression among patients enrolled in the Peter Ho Clinic, from 2013–2017. Methods This is a retrospective review of medical record data in an urban clinic, located in Newark, New Jersey, a high prevalence area of persons living with HIV. Viral load data were electronically downloaded, in rolling 1-year intervals, in two-month increments, from January 1, 2013 to December 31, 2019. Three teams were established, and every two months, they were provided with an updated list of patients with virologic failure. Retention and viral suppression rates were first calculated for each calendar-year. After patients were determined to be retained/suppressed annually, the proportion of patients with durable retention and viral suppression were calculated in two, three, four, five and six-year periods. Descriptive statistics were used to summarize sample characteristics by retention in care, virologic failure and viral suppression with Pearson Chi-square; p-value <0.05 was statistically significant. Multiple logistic regression models identified patient characteristics associated with retention in medical care, virologic failure and suppression. Results As of December 31, 2017, 1000 (57%) patients were retained in medical care of whom 870 (87%) were suppressed. Between 2013 and 2016, decreases in annual (85% to 77%) and durable retention in care were noted: two-year (72% to 70%) and three-year (63% to 59%) periods. However, increases were noted for 2017, in annual (89%) and durable retention in the two-year period (79%). In the adjusted model, when compared to current patients, retention in care was less likely among patients reengaging in medical care (adjusted Odds Ratio (aOR): 0.77, 95% CI: 0.61–0.98) but more likely among those newly diagnosed from 2014–2017 (aOR: 1.57, 95% CI: 1.08–2.29), compared to those in care since 2013. A higher proportion of patients re-engaging in medical care had virologic failure than current patients (56% vs. 47%, p < 0.0001). As age decreased, virologic failure was more likely (p<0.0001). Between 2013 and 2017, increases in annual (74% to 87%) and durable viral suppression were noted: two-year (59% to 73%) and three-year (49% to 58%) periods. Viral suppression was more likely among patients retained in medical care up to 2017 versus those who were not (aOR: 5.52, 95% CI: 4.08–7.46). Those less likely to be suppressed were 20–29 vs. 60 years or older (aOR: 0.52, 95% CI: 0.28–0.97), had public vs. private insurance (aOR: 0.29, 95% CI: 0.15–0.55) and public vs. private housing (aOR: 0.59, 95% CI: 0.40–0.87). Conclusions Restructuring clinical services at this urban clinic was associated with improved viral suppression. However, concurrent interventions to ensure retention in medical care were not implemented. Both retention in care and viral suppression interventions should be implemented in tandem to achieve an end to the epidemic. Retention in care and viral suppression should be measured longitudinally, instead of cross-sectional yearly evaluations, to capture dynamic changes in these indicators.
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Affiliation(s)
- Debbie Y. Mohammed
- Department of Nursing, William Paterson University, Wayne, New Jersey, United States of America
- Division of Infectious Diseases, Saint Michael’s Medical Center, Newark, New Jersey, United States of America
- * E-mail:
| | - Lisa Marie Koumoulos
- Department of Nursing, William Paterson University, Wayne, New Jersey, United States of America
- Department of Quality, Palisades Medical Center, Hackensack Meridian Health, North Bergen, New Jersey, United States of America
| | - Eugene Martin
- Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey, United States of America
| | - Jihad Slim
- Division of Infectious Diseases, Saint Michael’s Medical Center, Newark, New Jersey, United States of America
- New York Medical College, Valhalla, New York, United States of America
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120
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Morris MD, Yen IH, Shiboski S, Evans JL, Page K. Housing Stability and Hepatitis C Infection for Young Adults Who Inject Drugs: Examining the Relationship of Consistent and Intermittent Housing Status on HCV Infection Risk. J Urban Health 2020; 97:831-844. [PMID: 32901411 PMCID: PMC7704865 DOI: 10.1007/s11524-020-00445-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Housing status affects drug using behaviors, but less is known about the relationship between housing patterns and hepatitis C virus (HCV) infection. HCV-negative young people who inject drugs (PWID) were enrolled into a prospective cohort (2003-2019) with quarterly study visits. We used Cox regression to estimate the independent association of recent housing status (housed vs. unhoused, housing stability, and housing trajectory) on HCV incidence. Among 712 participants, 245 incident HCV infections occurred over 963.8 person-years (py) (cumulative incidence 24.4/100 py). An inverse relationship between time housed and HCV incidence was observed (always unhoused 45.0/100 py, 95% confidence interval (CI) 37.1, 54.5; variably housed 18.0/100 py, 95% CI 15.0, 21.3; and always housed 7.0/100 py, 95% CI 3.0, 17.3). In Cox regression models controlling for confounders, those unhoused versus housed at baseline had a 1.9-fold increased infection risk (95% CI 1.4, 2.6). Those always unhoused versus always housed had a 1.5 times greater risk of HCV (95% CI 1.0, 2.3), and those spending a portion of time in stable housing a lower risk (adjusted relative hazard 0.05, 95% CI 0.3, 0.9) with a similar trend for those being housed for less time. Young adult PWID experiencing both recent and chronic states of being unhoused are at elevated risk for HCV infection. Importantly for this group of PWID, our findings indicate that some frequency of residential housing significantly reduces HCV infection risk.
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Affiliation(s)
- Meghan D Morris
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94153-1224, USA.
| | - Irene H Yen
- Department of Public Health, School of Social Sciences, Humanities & Arts, University of California, Merced, Merced, CA, USA
| | - Steve Shiboski
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94153-1224, USA
| | - Jennifer L Evans
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94153-1224, USA
| | - Kimberly Page
- Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
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121
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Pinheiro RS, Carvalho PMRDS, Matos MAD, Caetano KAA, Paula ACD, Carneiro MADS, Reis MNDG, Martins RMB, Stefani MMDA, Teles SA. Human immunodeficiency virus infection and syphilis among homeless people in a large city of Central-Western Brazil: prevalence, risk factors, human immunodeficiency virus-1 genetic diversity, and drug resistance mutations. Braz J Infect Dis 2020; 25:101036. [PMID: 33248020 PMCID: PMC9392128 DOI: 10.1016/j.bjid.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022] Open
Abstract
Homeless people are at high risk for sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV) infection and syphilis. We investigated the epidemiology of HIV-1 infection and syphilis among homeless individuals in a large city in Central-Western Brazil. In this cross-sectional study, we interviewed and tested 355 individuals from September 2014 to August 2015. Rapid test samples positive for syphilis were retested using the Venereal Disease Research Laboratory (VDRL) test. Blood samples from HIV-infected participants were collected for POL sequencing using HIV-1 RNA extracted from plasma, reverse transcription, and nested polymerase chain reaction. Anti-HIV-1-positive samples were subtyped by sequencing the nucleotides of HIV-1 protease and part of the HIV-1 reverse transcriptase genes. Transmitted and acquired drug resistance mutations and susceptibility to antiretroviral drugs were also analyzed. Anti-HIV was positive in 14 patients (3.9%; 95% confidence interval [CI]: 2.3–6.4). HIV-1 RNA was detected in 8 of the 14 samples. Two of the eight (25%) isolates showed HIV-1 drug resistance mutations. Furthermore, 78 (22%; 95% CI: 17.9–26.5) and 29 (8.2%; 95% CI: 5.6–11.4) homeless individuals tested positive for syphilis using the rapid test and VDRL test, respectively. Two individuals were anti-HIV-1 and VDRL test positive. Daily alcohol use (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.0–10.4), sex with people living with HIV (PLWH) infection (AOR: 6.8, 95% CI: 1.9–25.0), and sex with people of the same sex (AOR: 5.4, 95% CI: 1.7–17.5) were predictors of HIV infection. Age ≤35 years (AOR: 3.8, 95% CI: 1.4–10.8), previous syphilis testing (AOR: 3.5, 95% CI: 1.4–8.4), history of genital lesions (AOR: 4.9, 95% CI: 1.3–19.1), and crack use in the last six months (AOR: 3.1, 95% CI: 1.3–7.6) were predictors of syphilis. Our findings highlight the importance of STI prevention and control strategies among the homeless.
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Affiliation(s)
| | | | | | | | | | | | | | - Regina Maria Bringel Martins
- Universidade Federal de Goiás (UFG), Instituto de Patologia Tropical e Saúde Pública (IPTSP), Goiânia, GO, Brazil
| | | | - Sheila Araujo Teles
- Universidade Federal de Goiás (UFG), Faculdade de Enfermagem, Goiânia, GO, Brazil.
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Quinn B, Gorbach PM, Okafor CN, Heinzerling KG, Shoptaw S. Investigating possible syndemic relationships between structural and drug use factors, sexual HIV transmission and viral load among men of colour who have sex with men in Los Angeles County. Drug Alcohol Rev 2020; 39:116-127. [PMID: 32012373 DOI: 10.1111/dar.13026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 11/02/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Past research investigating syndemic factors and HIV-related outcomes has overlooked the impact of structural conditions on behaviours linked with HIV transmission and disease progression. Given prevalent substance use among our sample, we explored whether four structural conditions indicative of social marginalisation and previously correlated with increased risk for HIV infection demonstrated syndemic (additive/synergistic) effects on: (i) HIV viral suppression; and (ii) self-reported involvement in sexual HIV transmission behaviours among a prospective cohort mostly comprising men of colour who have sex with men (MCSM; i.e. Latino/Hispanic and African American/black men) in Los Angeles County. DESIGN AND METHODS Data were collected between August 2014 and March 2017. The structural conditions of interest were: current unemployment, recent (≤6 months) incarceration history, 'unstable' accommodation (past month) and remote (>6 months) contact with health-care providers. Generalised estimating equations assessed possible additive effects of experiencing multiple structural conditions, and possible synergistic effects on the HIV-related outcomes. RESULTS Of 428 participants, nearly half (49%) were HIV-positive at baseline. Involvement in sexual HIV transmission risk behaviours varied over follow-up (22-30%). Reporting ≥2 structural syndemic conditions was significantly associated with reporting sexual HIV transmission risk behaviours among HIV-negative participants, and detectable viral load among HIV-positive participants. Frequent methamphetamine use was consistently associated with the HIV-related outcomes across the final multivariate models. DISCUSSION AND CONCLUSIONS When developing initiatives to address HIV transmission among marginalised sub-populations including MCSM, we must holistically consider systemic and structural issues (e.g. unemployment and homelessness), especially in the context of prevalent substance use.
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Affiliation(s)
- Brendan Quinn
- Center for Behavioural and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, USA.,Behaviours and Health Risks and Disease Elimination Programs, Burnet Institute, Melbourne, Australia
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, USA
| | - Keith G Heinzerling
- Center for Behavioural and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
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Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder. AIDS Behav 2020; 24:3252-3263. [PMID: 32180090 DOI: 10.1007/s10461-020-02810-8] [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: 11/27/2022]
Abstract
Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.
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124
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Hotton AL, Perloff J, Paul J, Parker C, Ducheny K, Holloway T, Johnson AK, Garofalo R, Swartz J, Kuhns LM. Patterns of Exposure to Socio-structural Stressors and HIV Care Engagement Among Transgender Women of Color. AIDS Behav 2020; 24:3155-3163. [PMID: 32335760 DOI: 10.1007/s10461-020-02874-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Transgender women are disproportionately affected by HIV and experiences of social adversity that may interfere with engagement in care and viral suppression. We used latent class analysis to examine patterns of social adversity and their impact on HIV care continuum outcomes in an urban sample of transgender women of color. Participants (n = 224) were median age 29 and 86% non-Hispanic Black. Lack of resources, unemployment, and housing instability were reported by over 50%, and 41% reported history of incarceration. Latent class analysis identified 2 distinct classes representing higher and lower levels of social adversity. In latent class regression, membership in the higher social adversity class was associated with statistically significantly lower odds of viral suppression and HIV care engagement in univariate analysis; when adjusted for age, race, and recruitment site the association remained statistically significant for viral suppression (aOR 0.38, 95% CI 0.18-0.79; chi-square = 6.681, d.f. = 1, p = 0.010), though not for HIV care engagement. Our findings highlight the impact of socio-structural barriers on engagement in the HIV care continuum among transgender women.
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Affiliation(s)
- Anna L Hotton
- Section of Infectious Diseases and Global Health & The Chicago Center for HIV Elimination, The University of Chicago Medicine, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA.
| | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, IL, USA
| | - Josie Paul
- Chicago House and Social Service Agency, Chicago, IL, USA
| | - Channyn Parker
- Chicago House and Social Service Agency, Chicago, IL, USA
| | | | | | - Amy K Johnson
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Garofalo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James Swartz
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL, USA
| | - Lisa M Kuhns
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Maranhão TA, Alencar CH, Magalhães MDAFM, Sousa GJB, Ribeiro LM, Abreu WCD, Pereira MLD. Mortality due to acquired immunodeficiency syndrome and associated social factors: a spatial analysis. Rev Bras Enferm 2020; 73:e20200002. [PMID: 33027500 DOI: 10.1590/0034-7167-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the spatial pattern of AIDS mortality and social factors associated with its occurrence. METHODS An ecological study that considered 955 AIDS deaths of residents in Piauí, reported in the Mortality Information System (MIS) from 2007 to 2015. Non-spatial and spatial regression models were used to identify social determinants of AIDS mortality, with a significance of 5%. RESULTS The predictors of AIDS mortality were illiteracy rate in males (p = 0.020), proportion of households with water supply (p = 0.015), percentage of people in households with inadequate walls (p = 0.022), percentage of people in households vulnerable to poverty and in whom no one has completed primary education (p = 0.000) and percentage of people in households vulnerable to poverty and dependent on the elderly (p = 0.009). CONCLUSION Social indicators related to education, job and income generation and housing were associated with AIDS mortality.
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Frakt AB, Jha AK, Glied S. Pivoting from decomposing correlates to developing solutions: An evidence-based agenda to address drivers of health. Health Serv Res 2020; 55 Suppl 2:781-786. [PMID: 32776528 PMCID: PMC7518812 DOI: 10.1111/1475-6773.13539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Health is influenced by many factors outside the health system. This is often expressed by decomposing contributors to health into factors that sum to 100 percent. In this commentary, we assess the (few) strengths and (many) limitations of such decompositions. We conclude that they fail to be useful for policy guidance. We conclude by proposing an alternative approach to assessing how various factors affect health: evaluations of interventions.
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Affiliation(s)
- Austin B. Frakt
- VA Boston Healthcare SystemBoston University School of Public HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ashish K. Jha
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Sherry Glied
- New York University's Robert F. Wagner Graduate School of Public ServiceNew York CityNew YorkUSA
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Hotton AL, Chen YT, Schumm P, Khanna AS, Brewer R, Skaathun B, Issema RS, Ramani S, Ramachandran A, Ozik J, Fujimoto K, Harawa NT, Schneider JA. Socio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender Women. J Urban Health 2020; 97:623-634. [PMID: 32180129 PMCID: PMC7560631 DOI: 10.1007/s11524-020-00428-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.
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Affiliation(s)
- Anna L Hotton
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA.
| | - Yen-Tyng Chen
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Phil Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Russell Brewer
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Rodal S Issema
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Santhoshini Ramani
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Arthi Ramachandran
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave, L-038, Chicago, IL, 60637, USA
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA.,Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | | | | | - John A Schneider
- Departments of Medicine and Public Health Sciences, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
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Disproportionate burden of coronavirus disease 2019 among racial minorities and those in congregate settings among a large cohort of people with HIV. AIDS 2020; 34:1781-1787. [PMID: 32604138 PMCID: PMC7499878 DOI: 10.1097/qad.0000000000002607] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Many people living with HIV (PLWH) have comorbidities which are risk factors for severe coronavirus disease 2019 (COVID-19) or have exposures that may lead to acquisition of severe acute respiratory distress syndrome coronavirus 2. There are few studies, however, on the demographics, comorbidities, clinical presentation, or outcomes of COVID-19 in people with HIV. Objective: To evaluate risk factors, clinical manifestations, and outcomes in a large cohort of PLWH with COVID-19. Methods: We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from 3 March to 26 April 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis. Results: We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing. Conclusion: In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.
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129
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Park E, Stockman JK, Thrift B, Nicole A, Smith LR. Structural Barriers to Women's Sustained Engagement in HIV Care in Southern California. AIDS Behav 2020; 24:2966-2974. [PMID: 32323105 PMCID: PMC7790164 DOI: 10.1007/s10461-020-02847-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Since the introduction of antiretroviral therapy, the number of women living with HIV (WLHIV) continues to increase. Despite the decrease in HIV diagnosis among women in California, less than half of WLHIV are retained in HIV care. Structural barriers put women at increased risk for delayed HIV diagnosis, delayed entry into HIV care, and poorer treatment outcomes. The objective of this qualitative analysis is to identify how structural barriers negatively impact women's sustained engagement in HIV care in Southern California. WLHIV accessing local HIV support services participated in a qualitative study by completing a semi-structured interview and brief survey between January and April 2015 (n = 30). Poverty, unemployment, housing instability, and needs for transportation emerged as the dominant structural barriers for women when discussing their challenges with sustained engagement in HIV care. System-level interventions that decrease these noted barriers may help improve HIV care continuum for women living in Southern California.
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Affiliation(s)
- Eunhee Park
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Briana Thrift
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
- Division of Epidemiology, San Diego State University Graduate School of Public Health, San Diego, CA, USA
| | - Ava Nicole
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.
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Chandran A, Edmonds A, Benning L, Wentz E, Adedimeji A, Wilson TE, Blair-Spence A, Palar K, Cohen M, Adimora A. Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS. AIDS Behav 2020; 24:2811-2818. [PMID: 32170507 PMCID: PMC7483905 DOI: 10.1007/s10461-020-02830-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.
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Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amanda Blair-Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease and Global Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Mardge Cohen
- Cook County Health and Hospital System, Chicago, IL, USA
| | - Adaora Adimora
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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131
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Rajabiun S, Davis-Plourde K, Tinsley M, Quinn EK, Borne D, Maskay MH, Giordano TP, Cabral HJ. Pathways to housing stability and viral suppression for people living with HIV/AIDS: Findings from the Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations initiative. PLoS One 2020; 15:e0239190. [PMID: 33001986 PMCID: PMC7529314 DOI: 10.1371/journal.pone.0239190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background People with HIV with co-occurring substance use and mental health diagnoses who are unstably housed have poorer outcomes for retention in care and viral suppression. Navigation models are a potential strategy to help this vulnerable population obtain the necessary medical and non-medical services across multiple service systems. The Health Resources and Services Administration’s Special Projects of National Significance: “Building a Medical Home for Multiply-Diagnosed HIV-positive Homeless Populations initiative 2012–2017 found that navigation models may be an effective intervention to support people with HIV with unstable housing improve HIV health outcomes. However, there is limited information about the mechanisms by which this intervention works. In this article, we explore the participant and program factors for achieving stable housing at 6 months and how these factors influence HIV health outcomes. Methods and findings This was a prospective study of 471 unstably housed people with HIV enrolled in a navigation intervention across nine sites in the United Stated from 2013–2017. All sites provided HIV primary medical care. Eight sites were located in urban areas and one site served a predominantly rural population. Two sites were federally qualified health centers, three were city or county health departments, one site was a comprehensive HIV/AIDS service organization, and three sites were outpatient or mobile clinics affiliated with a university -based or hospital system. Data were collected via interview and medical chart review at baseline, post 6 and 12 months. Type and dose of navigation activities were collected via a standardized encounter form. We used a path analysis model with housing stability at 6 months as the mediator to examine the direct and indirect effects of participant’s socio-demographics and risk factors and navigation on viral suppression and retention in care at 12 months. Housing stability at 6 months was associated with male gender, younger age, viral suppression at baseline, having a lower risk for opiate use, recent homelessness, lower risk of food insecurity, and a longer length of time living with HIV. Participants who increased self-efficacy with obtaining help by 6 months had significantly higher odds of achieving housing stability. Stable housing, fewer unmet needs, moderate to high risk for opiate use, and viral suppression at baseline had a direct effect on viral suppression at 12 months. The intensity of navigation contact had no direct effect on housing stability and a mixed direct effect on viral suppression. Recent diagnosis with HIV, women, greater social support, increased self-efficacy and higher intensity of navigation contact had a direct effect on improved retention in HIV primary care at 12 months. Conclusions In this sample of people with HIV who are experiencing homelessness, housing stability had a significant direct path to viral suppression. Navigation activities did not have a direct effect on the path to housing stability but were directly related to retention in care. These results identify key populations and factors to target resources and policies for addressing the health and social unmet needs of people with HIV to achieve housing stability and HIV health outcomes.
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Affiliation(s)
- Serena Rajabiun
- Department of Public Health, Zuckerberg College of Health Sciences, Univeristy of Massachusetts, Lowell, Lowell, MA, United States of America
- * E-mail:
| | - Kendra Davis-Plourde
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Melinda Tinsley
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD, United States of America
| | - Emily K. Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Deborah Borne
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | | | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, The Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, and Thomas Street Health Center, Harris Health System, Houston, Texas, United States of America
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
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132
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Martin EG, MacDonald RH, Gordon DE, Swain CA, O'Donnell T, Helmeset J, Dwicaksono A, Tesoriero JM. Simulating the End of AIDS in New York: Using Participatory Dynamic Modeling to Improve Implementation of the Ending the Epidemic Initiative. Public Health Rep 2020; 135:158S-171S. [PMID: 32735199 DOI: 10.1177/0033354920935069] [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: 01/18/2023] Open
Abstract
OBJECTIVES In 2014, the governor of New York announced the Ending the Epidemic (ETE) plan to reduce annual new HIV infections from 3000 to 750, achieve a first-ever decrease in HIV prevalence, and reduce AIDS progression by the end of 2020. The state health department undertook participatory simulation modeling to develop a baseline for comparing epidemic trends and feedback on ETE strategies. METHODS A dynamic compartmental model projected the individual and combined effects of 3 ETE initiatives: enhanced linkage to and retention in HIV treatment, increased preexposure prophylaxis (PrEP) among men who have sex with men, and expanded housing assistance. Data inputs for model calibration and low-, medium-, and high-implementation scenarios (stakeholders' rollout predictions, and lower and upper bounds) came from surveillance and program data through 2014, the literature, and expert judgment. RESULTS Without ETE (baseline scenario), new HIV infections would decline but remain >750, and HIV prevalence would continue to increase by 2020. Concurrently implementing the 3 programs would lower annual new HIV infections by 16.0%, 28.1%, and 45.7% compared with baseline in the low-, medium-, and high-implementation scenarios, respectively. In all concurrent implementation scenarios, although annual new HIV infections would remain >750, there would be fewer new HIV infections than deaths, yielding the first-ever decrease in HIV prevalence. PrEP and enhanced linkage and retention would confer the largest population-level changes. CONCLUSIONS New York State will achieve 1 ETE benchmark under the most realistic (medium) implementation scenario. Findings facilitated framing of ETE goals and underscored the need to prioritize men who have sex with men and maintain ETE's multipronged approach, including other programs not modeled here.
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Affiliation(s)
- Erika G Martin
- 1084 Department of Public Administration and Policy, University at Albany, Albany, NY, USA.,Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA
| | - Roderick H MacDonald
- 3745 School of Integrated Science, James Madison University, Harrisonburg, VA, USA
| | - Daniel E Gordon
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA
| | - Carol-Ann Swain
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA
| | - Travis O'Donnell
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA
| | - John Helmeset
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA
| | - Adenantera Dwicaksono
- 1084 Department of Public Administration and Policy, University at Albany, Albany, NY, USA.,School of Architecture, Planning, and Policy Development, Institut Teknologi Bandung, Indonesia
| | - James M Tesoriero
- Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA.,1094 AIDS Institute, New York State Department of Health, Albany, NY, USA
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Dickson-Gomez J, Quinn K, McAuliffe T, Bendixen A, Ohlrich J. Placement of chronically homeless into different types of permanent supportive housing before and after a coordinated entry system: The influence of severe mental illness, substance use disorder, and dual diagnosis on housing configuration and intensity of services. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2410-2427. [PMID: 32789923 DOI: 10.1002/jcop.22428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
AIMS Permanent supportive housing (PSH) is designed to house people who experience chronic homelessness with one or more of the following: serious mental illness (SMI), substance use disorders (SUD) or human immunodeficiency virus. The Department of Housing and Urban Development has required major metropolitan areas to develop a coordinated entry system (CES) to prioritize access to PSH to those who need it the most. The aim of this paper is to determine whether PSH residents with SMI, SUD, or dual diagnosis were more likely to be housed after implementation of CES and were more likely to be housed in housing models with more intensive services provided. METHODS A cross-sectional survey with 855 residents of different PSH models. RESULTS Those with SMI, SUD, or dual diagnosis were not more likely to be housed using the CES but were more likely to be housed in higher intensity service programs. CONCLUSIONS Those with SMI are more likely to be housed in PSH with high-intensity services.
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Affiliation(s)
- Julia Dickson-Gomez
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Quinn
- Department of Psychiatry, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy McAuliffe
- Department of Psychiatry, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Arturo Bendixen
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jessica Ohlrich
- Division of Epidemiology, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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134
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Freeman R, Gwadz M, Wilton L, Collins LM, Dorsen C, Hawkins RL, Silverman E, Martinez BY, Leonard NR, Applegate A, Cluesman S. Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: a qualitative exploration through the lens of symbolic violence. Int J Equity Health 2020; 19:146. [PMID: 32859191 PMCID: PMC7453370 DOI: 10.1186/s12939-020-01253-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/05/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about the experience of living with and managing HIV over decades. The present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical violence manifested in the power differential between social groups. We focused on adult African American/Black and Latinx (AABL) PLWH from low-SES backgrounds. METHODS Data were drawn from two studies with AABL PLWH in New York City (N = 59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. RESULTS Participants in the two studies were comparable on sociodemographic and background characteristics. They had lived with HIV for 20 years, on average (range 3-33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and discontinuation of HIV medications. We organized results into five sub-themes: (1) participants were "ground down" over time by material, social, and emotional challenges and this diminished self-worth and, at times, the will to live; (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as stigma-avoidance strategies and mechanisms of social exclusion; (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, along with (4) restricted autonomy in HIV care and other settings (e.g., parole) reduced engagement; and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was evident throughout the five sub-themes. CONCLUSIONS Symbolic violence is a useful framework for understanding long-term HIV management and survivorship among AABL PLWH from low-SES backgrounds. Indeed, forms of symbolic violence are internalized over time (e.g., experiencing devaluation, dehumanization, loss of self-worth, and anticipated stigma), thereby impeding successful HIV management, in part because avoiding HIV care and discontinuing HIV medications are primary coping strategies. Results have implications for interventions in community and health care settings.
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Affiliation(s)
- Robert Freeman
- Independent Consultant, 205 Clinton Avenue, Brooklyn, NY, 11205, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA
- Faculty of Humanities, University of Johannesburg, PO Box 524, Auckland Park, Johannesburg, 2006, South Africa
| | - Linda M Collins
- Department of Human Development and Family Studies, The Methodology Center, The Pennsylvania State University, 435 Health and Human Development Building, University Park, PA, 16802, USA
| | - Caroline Dorsen
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, USA
| | - Robert L Hawkins
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Elizabeth Silverman
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Belkis Y Martinez
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Noelle R Leonard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
| | - Amanda Applegate
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Sabrina Cluesman
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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135
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Djiadeu P, Yusuf A, Ongolo-Zogo C, Nguemo J, Odhiambo AJ, Mukandoli C, Lightfoot D, Mbuagbaw L, Nelson LE. Barriers in accessing HIV care for Francophone African, Caribbean and Black people living with HIV in Canada: a scoping review. BMJ Open 2020; 10:e036885. [PMID: 32859664 PMCID: PMC7454192 DOI: 10.1136/bmjopen-2020-036885] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In 2001, 50%-55% of French-speaking minority communities did not have access to health services in French in Canada. Although Canada is officially a bilingual country, reports indicate that many healthcare services offered in French in Anglophone provinces are insufficient or substandard, leading to healthcare discrepancies among Canada's minority Francophone communities. OBJECTIVES The primary aim of this scoping systematic review was to identify existing gaps in HIV-care delivery to Francophone minorities living with HIV in Canada. STUDY DESIGN Scoping systematic review. DATA SOURCES Search for studies published between 1990 and November 2019 reporting on health and healthcare in Francophone populations in Canada. Nine databases were searched, including Medline, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the National Health Service Economic Development Database, Global Health, PsychInfo, PubMed, Scopus and Web of Science. STUDY SELECTION English or French language studies that include data on French-speaking people with HIV in an Anglophone majority Canadian province. RESULTS The literature search resulted in 294 studies. A total of 230 studies were excluded after duplicates were removed. The full texts of 43 potentially relevant papers were retrieved for evaluation and data extraction. Forty-one studies were further excluded based on failure to meet the inclusion criteria leaving two qualitative studies that met our inclusion criteria. These two studies reported on barriers on access to specialised care by Francophone and highlighted difficulties experienced by healthcare professionals in providing quality healthcare to Francophone patients in Ontario and Manitoba. CONCLUSION The findings of this scoping systematic review highlight the need for more HIV research on linguistic minority communities and should inform health policymaking and HIV/AIDS community organisations in providing HIV care to Francophone immigrants and Canadians.
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Affiliation(s)
- Pascal Djiadeu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Yale University School of Nursing, Yale University, West Haven, Connecticut, USA
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Abban Yusuf
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Clémence Ongolo-Zogo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Centre Province, Cameroon
| | - Joseph Nguemo
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Apondi J Odhiambo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Chantal Mukandoli
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- AFRICANS IN PARTNERSHIP AGAINST AIDS (APAA), Toronto, Ontario, Canada
| | - David Lightfoot
- St Michael's Health Sciences Library, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Centre Province, Cameroon
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - LaRon E Nelson
- Yale University School of Nursing, Yale University, West Haven, Connecticut, USA
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
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136
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Tying Structural Racism to Human Immunodeficiency Virus Viral Suppression. Clin Infect Dis 2020; 72:e646-e648. [DOI: 10.1093/cid/ciaa1252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 11/14/2022] Open
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137
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Wilson TE, Massiah C, Radigan R, DeHovitz J, Govindarajulu US, Holman S, Melendez M, Yusuff J, Taylor T. The positive affect, promoting Positive Engagement, and Adherence for Life (APPEAL) feasibility trial: Design and rationale. Health Psychol 2020; 39:767-775. [PMID: 32833478 DOI: 10.1037/hea0000880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe development of the Positive Affect, Promoting Positive Engagement, and Adherence for Life (APPEAL) program. METHOD APPEAL is intended to increase HIV medication adherence through promotion of positive affect, and was developed through an iterative process involving 6 focus groups (N = 34) that elicited feedback on intervention content, followed by an individually administered prepilot of the entire intervention (N = 7). RESULTS Participants provided feedback on important potential moderator variables, including depression, on mode of intervention administration, and on anticipated barriers and benefits to participation. Insights gained were used to finalize study procedures in preparation for a feasibility trial. For the feasibility trial, a total of 80 participants who, in the past 6 months have had at least one plasma HIV RNA >200 copies/mL, will be randomized to receive APPEAL or standard of care (N = 40 per group). Intervention group participants will receive 3 monthly, individually administered sessions, and all participants will have their medication adherence monitored and complete structured interviews at baseline and at 3 and 6 months. CONCLUSION The APPEAL program is innovative in that it focuses on promoting self-regulation of positive emotions, an understudied approach to promoting chronic disease self-management behaviors such as HIV medication adherence. Findings from the feasibility trial will gauge suitability of the APPEAL intervention and evaluation methods for subsequent testing in a confirmatory trial and will examine changes in positive affect, the primary mechanism of change targeted in the intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tracey E Wilson
- Department of Community Health Sciences and Medicine, State University of New York, Downstate Health Sciences University
| | - Chanée Massiah
- Department of Epidemiology and Biostatistics, State University of New York, Downstate Health Sciences University
| | - Rachel Radigan
- Department of Epidemiology and Biostatistics, State University of New York, Downstate Health Sciences University
| | - Jack DeHovitz
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Usha S Govindarajulu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Susan Holman
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Michelle Melendez
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Jameela Yusuff
- Department of Medicine, State University of New York, Downstate Health Sciences University
| | - Tonya Taylor
- Department of Medicine, State University of New York, Downstate Health Sciences University
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138
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Zhang X, Oman RF, Larson TA, Christiansen EJ, Granner ML, Lu M, Yang Y. Healthcare Utilization, Unmet Service Needs, and Medication Adherence Among People Living with HIV/AIDS. Curr HIV Res 2020; 18:436-442. [PMID: 32807058 DOI: 10.2174/1570162x18666200817112255] [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: 04/08/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA's service utilization, unmet service needs, and ART adherence. METHODS PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence. RESULTS Only 12 (7.5%) participants reported they received all the needed services. The ART nonadherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence. CONCLUSION The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.
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Affiliation(s)
- Xiangjun Zhang
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Roy F Oman
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Trudy A Larson
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Elizabeth J Christiansen
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Michelle L Granner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Minggen Lu
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Yueran Yang
- Department of Psychology, University of Nevada, Reno , 1664 N. Virginia St. Mail Stop 0296, United States
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139
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Nhunzvi C, Langhaug L, Mavindidze E, Harding R, Galvaan R. Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review. BMJ Open 2020; 10:e036916. [PMID: 32784258 PMCID: PMC7418773 DOI: 10.1136/bmjopen-2020-036916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore ways in which occupational justice and social inclusion are conceptualised, defined and operationalised in highly stigmatised and chronic conditions of mental illness and HIV. DESIGN This scoping review protocol followed Arksey and O'Malley's (2005) Scoping Review Framework. DATA SOURCES AND ELIGIBILITY The following databases were searched for the period January 1997 to January 2019: Medline via PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX and grey literature.Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV. STUDY APPRAISAL AND SYNTHESIS We undertook a three-part article screening process. Screening and data extraction were undertaken independently by two researchers. Arksey's framework and thematic analysis informed the collation and synthesis of included papers. RESULTS From 3352 records, we reviewed 139 full articles and retained 27 for this scoping review. Definitions of social inclusion and occupational justice in the domains of mental illness and HIV were heterogeneous and lacked definitional clarity. The two concepts were conceptualised as either processes or personal experiences, with key features of community participation, respect for human rights and establishment and maintenance of healthy relationships. Conceptual commonalities between social inclusion and occupational justice were premised on social justice. CONCLUSIONS To address lack of clarity, we propose further and concurrent exploration of these concepts, specifically with reference to persons with comorbid mental health disorders such as substance use disorders and HIV living in low-income countries. This should reflect contextual realities influencing community participation, respect for human rights and meaningful occupational participation. From this broadened understanding, quantitative measures should be applied to improve the standardisation of measurements for occupational justice and social inclusion in policy, research and practice.
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Affiliation(s)
- Clement Nhunzvi
- College of Health Sciences, Rehabilitation Department, University of Zimbabwe, Harare, Zimbabwe
| | - Lisa Langhaug
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, African Mental Health Research Initiative (AMARI), Harare, Zimbabwe
| | - Edwin Mavindidze
- Occupational Therapy, Ingutsheni Central Hospital, Bulawayo, Zimbabwe
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Roshan Galvaan
- Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
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140
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McCree DH, Byrd KK, Johnston M, Gaines M, Weidle PJ. Roles for Pharmacists in the "Ending the HIV Epidemic: A Plan for America" Initiative. Public Health Rep 2020; 135:547-554. [PMID: 32780671 DOI: 10.1177/0033354920941184] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In 2019, President Trump announced a new initiative, Ending the HIV Epidemic: A Plan for America (EHE). EHE will use 3 key strategies-diagnose, treat, and prevent-to reduce new HIV infections at least 90% by 2030, as well as new laboratory methods and epidemiological techniques to respond quickly to potential outbreaks. Partnerships are an important component in the initiative's success. Pharmacists and pharmacies can play important roles in EHE, including dispensing antiretroviral therapy and providing HIV screening, adherence counseling, medication therapy management, preexposure prophylaxis, and nonprescription syringe sales. The objective of this report is to discuss potential roles that pharmacists and pharmacies can play under the key strategies of EHE.
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Affiliation(s)
- Donna Hubbard McCree
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathy K Byrd
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie Johnston
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Malendie Gaines
- 17215 Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Paul J Weidle
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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141
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McCree DH, Chesson H, Bradley ELP, Williams A, Gant Z, Geter A. Exploring Changes in Racial/Ethnic Disparities of HIV Diagnosis Rates Under the "Ending the HIV Epidemic: A Plan for America" Initiative. Public Health Rep 2020; 135:685-690. [PMID: 32762633 DOI: 10.1177/0033354920943526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Racial/ethnic disparities in HIV diagnosis rates remain despite the availability of effective treatment and prevention tools in the United States. In 2019, President Trump announced the "Ending the HIV Epidemic: A Plan for America" (EHE) initiative to reduce new HIV infections in the United States at least 75% by 2025 and at least 90% by 2030. The objective of this study was to show the potential effect of the EHE initiative on racial/ethnic disparities in HIV diagnosis rates at the national level. METHODS We used 2017 HIV diagnoses data from the Centers for Disease Control and Prevention National HIV Surveillance System. We developed a counterfactual scenario to determine changes in racial/ethnic disparities if the 2017 HIV diagnosis rates were reduced by 75% in the geographic regions targeted by the EHE initiative. We used 4 measures to calculate results: rate ratio, population-attributable proportion (PAP), Gini coefficient, and Index of Disparity. RESULTS The relative measures of racial/ethnic disparity decreased by 9%-21% in the EHE scenario compared with the 2017 HIV diagnoses data. The largest decrease was in the Hispanic/Latino:white rate ratio (-20.6%) and in the black:white rate ratio (-18.2%). The PAP measure decreased by 11.5%. The absolute versions of the Index of Disparity (unweighted and weighted) were approximately 50% lower in the EHE scenario than in the 2017 HIV diagnoses data. CONCLUSIONS EHE efforts could reduce but will not eliminate racial/ethnic disparities in HIV diagnosis rates. Efforts to address racial/ethnic disparities should continue, and innovative approaches, specifically those that focus on social and structural factors, should be developed and implemented for populations that are disproportionately affected by HIV in the United States.
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Affiliation(s)
- Donna Hubbard McCree
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Harrell Chesson
- 1242 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin L P Bradley
- 17215 Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Zanetta Gant
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angelica Geter
- 17215 Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention, Atlanta, GA, USA
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142
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McCree DH, Beer L, Fugerson AG, Tie Y, Bradley ELP. Social and Structural Factors Associated with Sustained Viral Suppression Among Heterosexual Black Men with Diagnosed HIV in the United States, 2015-2017. AIDS Behav 2020; 24:2451-2460. [PMID: 32020509 DOI: 10.1007/s10461-020-02805-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper describes sociodemographic, sexual risk behavior, and clinical care factors associated with sustained viral suppression (SVS) among heterosexual Black men with diagnosed HIV in the US. Sample was 968 men, 2015-2017 cycles of Medical Monitoring Project. We used prevalence ratios and a multivariable logistic regression model to identify independent predictors of SVS. About 9% of sexually active men had sex that carries a risk of HIV transmission. Nearly 2/3 lived at or below the poverty level, 13% were under or uninsured, 1/4 experienced food insecurity and 15% reported recent homelessness. About 26% were not engaged in HIV care, 8% not currently taking antiretroviral therapy (ART) and 59% had SVS. Among men taking ART, care engagement and adherence were the only significant independent predictors of SVS. Efforts to increase VS should focus on increasing ART use, care engagement, and ART adherence, and include strategies that address the social and structural factors that influence them.
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Affiliation(s)
- Donna Hubbard McCree
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yunfeng Tie
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin L P Bradley
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
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143
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Pan Y, Metsch LR, Wang W, Philbin M, Kyle TL, Gooden LK, Feaster DJ. The Relationship Between Housing Status and Substance Use and Sexual Risk Behaviors Among People Currently Seeking or Receiving Services in Substance Use Disorder Treatment Programs. J Prim Prev 2020; 41:363-382. [PMID: 32617888 PMCID: PMC7384551 DOI: 10.1007/s10935-020-00597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although HIV risk behaviors such as substance use and condomless sex are prevalent among people currently seeking or receiving services at substance use disorder (SUD) treatment programs, associations with housing status in this population have not been well studied. We examined the associations between housing status, substance use and HIV-related sexual risk behaviors among 1281 participants from 12 US community-based SUD programs. In addition, substance use was examined as a potential mediator of the relationship between housing status and sexual risk behaviors. We conducted Chi-square, univariate and multivariate logistic regression models on data from the National Drug Abuse Treatment Clinical Trials Network HIV Rapid Testing and Counseling study. Path analysis was used to test the mediation and indirect effects. Unstable housing was significantly associated with having multiple concurrent condomless sex partners, condomless sex with non-primary partners, and partners of unknown HIV serostatus. Homelessness was significantly associated with condomless vaginal sex and condomless sex with any substance use. The path between unstable housing and sexual risk behaviors was mediated by problematic drug use, particularly by cocaine, opioids, and marijuana use. Because housing status impacts HIV risk behaviors for individuals in SUD treatment programs, both housing status and substance use behaviors should be assessed upon program entry in order to identify and mitigate risk behaviors.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Center for Research on US Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Morgan Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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145
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Maloney KM, Beer L, Tie Y, Dasgupta S. Prevalence of Non-medical Amphetamine Use Among Men with Diagnosed HIV Infection Who Have Sex with Men in the United States, 2015-2016. AIDS Behav 2020; 24:1865-1875. [PMID: 31834542 PMCID: PMC11299047 DOI: 10.1007/s10461-019-02761-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Amphetamine use is higher among men who have sex with men (MSM) compared with other men, and is associated with sexual behavior linked to HIV transmission. No national estimates of amphetamine use among MSM with HIV have been published. We used data from the Medical Monitoring Project, a nationally representative sample of persons with diagnosed HIV, to describe patterns in amphetamine use in the past 12 months among MSM during 2015-2016 (N = 3796). Prevalence of amphetamine use in this population was 9.6% (95% CI 7.6, 11.6%) in the past 12 months. MSM who used amphetamines were more likely to have condomless sex with partners without HIV or of unknown serostatus (PR 1.87; 95% CI 1.62, 2.16) and less likely to be durably virally suppressed (PR 0.81; 95% CI 0.71, 0.91). Interventions to address amphetamine use and associated transmission risk behaviors among MSM living with HIV may decrease transmission.
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Affiliation(s)
- Kevin M Maloney
- Department of Epidemiology, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA.
| | - Linda Beer
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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146
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Beima-Sofie K, Begnel ER, Golden MR, Moore A, Ramchandani M, Dombrowski JC. "It's Me as a Person, Not Me the Disease": Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs. AIDS Patient Care STDS 2020; 34:267-274. [PMID: 32484744 DOI: 10.1089/apc.2019.0310] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Ending the HIV epidemic will require dedicated efforts to engage the highest need persons living with HIV (PLWH) in treatment. We assessed patient perceptions of a clinic in Seattle, Washington, that is designed for PLWH who do not engage in conventional HIV care. The Max Clinic provides walk-in access to care, incentives for blood draws and achieving viral suppression, and intensive case management. We conducted semistructured individual interviews with 25 patients purposively recruited to obtain diverse viewpoints. Interviews were audio-recorded and transcribed. Analysis used a constant comparative approach to identify major themes related to the components of the program. For many participants, engagement in the Max Clinic was the first time they had success with HIV treatment. Relationships with clinic staff and the ability to receive care on a walk-in basis had the strongest influences on engagement. Participants felt that Max Clinic staff attended to their social circumstances in ways that were distinct from prior care experiences. Walk-in visits removed perceived stigma associated with failure to keep appointments and provided immediate attention to acute concerns. Financial incentives initially motivated participants to attend clinic and take medications, but were less important for supporting ongoing engagement in care. Food incentives motivated patients to seek care and helped them focus on health issues. In summary, patients identified walk-in access to care, monetary and food incentives, and relationships with clinic staff, particularly case managers, as the key elements of an HIV clinic model for high-need PLWH.
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Affiliation(s)
- Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Emily R. Begnel
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Matthew R. Golden
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Allison Moore
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Meena Ramchandani
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Julia C. Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Wainwright JJ, Beer L, Tie Y, Fagan JL, Dean HD. Socioeconomic, Behavioral, and Clinical Characteristics of Persons Living with HIV Who Experience Homelessness in the United States, 2015-2016. AIDS Behav 2020; 24:1701-1708. [PMID: 31628555 PMCID: PMC7165020 DOI: 10.1007/s10461-019-02704-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homelessness is a substantial barrier to consistent, recommended HIV care, access and adherence to antiretroviral therapy (ART), and sustained viral suppression, thus increasing the risk for morbidity and transmission. We used data from the Medical Monitoring Project for June 1, 2015-May 31, 2017 to estimate the weighted prevalence of homelessness among persons with diagnosed HIV (PWH) (N = 7665) overall and by selected sociodemographic, behavioral, and clinical characteristics. Prevalence of homelessness was 8.5%. PWH experiencing homelessness were > 3 times as likely to have needed and not received shelter or housing services (32% vs. 10%), > 4 times as likely to inject drugs (9% vs. 2%), and > 7 times as likely to engage in exchange sex (10% vs. 1%), respectively, compared with PWH who did not experience homelessness. Homelessness was associated with lower HIV care retention, ART dose adherence, and sustained viral suppression. This analysis demonstrates substantial need for enhanced treatment, care, and service delivery for PWH experiencing homelessness. Research has demonstrated that housing assistance programs improve HIV-related outcomes and diminish HIV risk behaviors; therefore, housing assistance for PWH should be prioritized in public health policies and practice.
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Affiliation(s)
- Jacob J Wainwright
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA.
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA
| | - Jennifer L Fagan
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA
| | - Hazel D Dean
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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148
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Ickowicz S, Dong H, Ti L, Nolan S, Fairbairn N, Barrios R, Milloy MJ. Behavioural, social and structural-level risk factors for developing AIDS among HIV-positive people who use injection drugs in a Canadian setting, 1996-2017. AIDS Care 2020; 32:1262-1267. [PMID: 32476442 DOI: 10.1080/09540121.2020.1772955] [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: 10/24/2022]
Abstract
People who use injection drugs (PWID) experience high rates of HIV acquisition and, as a result of lower rates of optimal access and adherence to combination antiretroviral therapy (ART), experience worse HIV treatment outcomes than other key affected populations. However, the incidence and risk factors for the development of AIDS among HIV-positive PWID have not been completely described. We used data from a community-recruited prospective cohort of HIV-positive PWID in Vancouver, Canada, a setting with universal no-cost ART and a comprehensive clinical monitoring registry. We used multivariable extended Cox models to identify factors associated with time to AIDS. Between 1996 and 2017, 396 participants, including 140 (35.4%) women, were followed for a median of 39.0 months (interquartile range: 16.6-76.2), among whom 165 (41.7%) developed AIDS. In a multivariable model, homelessness (Adjusted Hazard Ratio [AHR] = 1.76 (1.18-2.61)) and injection drug use within the preceding six months (AHR = 1.74 (1.17-2.58)) were independently associated with a higher risk of developing AIDS. Despite widespread scale-up of programmes to improve ART utilization, significant risk factors for the development of AIDS remain among HIV-positive PWID in this setting.
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Affiliation(s)
- S Ickowicz
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - H Dong
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - L Ti
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - S Nolan
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - N Fairbairn
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - R Barrios
- BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.,Faculty of Medicine, School of Population and Public Health, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
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149
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Zhong Y, Beattie CM, Rojas J, Farquhar XP, Brown PA, Wiewel EW. Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014-2017. Am J Public Health 2020; 110:1068-1075. [PMID: 32437285 DOI: 10.2105/ajph.2020.305660] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017.Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]).Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length.Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.
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Affiliation(s)
- Yaoyu Zhong
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Christopher M Beattie
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - John Rojas
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - X Pamela Farquhar
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Paul A Brown
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Ellen W Wiewel
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
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150
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Use of Recommended Preventive Health Care Services and Variations in HIV Care Among Women With HIV in the United States, 2013-2014: Opportunities for Expanded Partnerships in Support of Ending the HIV Epidemic. J Acquir Immune Defic Syndr 2020; 82:234-244. [PMID: 31335584 DOI: 10.1097/qai.0000000000002141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite recommendations for preventive health services and routine HIV care for HIV-positive women, limited data are available regarding uptake of recommendations. METHODS We used data from the 2013-2014 data cycles of the Medical Monitoring Project. We calculated weighted estimates and used multivariable logistic regression with adjusted prevalence ratios and 95% confidence intervals to examine associations between preventive health screenings, routine HIV care [based on viral load (VL) and CD4 measures as proxies], and sociodemographic factors. RESULTS Of 2766 women, 47.7% were 50 years and older, 61.7% non-Hispanic black, 37.2% had >high school education, 63.3% had been living with HIV for ≥10 years, 68.4% were living ≤the federal poverty level, 67.3% had public health insurance, 93.8% were prescribed antiretroviral therapy, and 66.1% had sustained/durable suppression (12 months). For women aged 18 years and older, cervical cancer, breast cancer, and sexually transmitted infection screenings were documented for 44.3%, 27.6%, and 34.7%, respectively; 26% did not meet 6-month, and 37% did not meet 12-month, VL and CD4 test measure goals. In multivariable analyses, women with no VLs in the past 6 months were less likely to be durably suppressed, and women who did not have ≥3 CD4 or VL tests (past 12 months) were less likely to be living above the poverty level and more likely to have public insurance compared with private health insurance (P < 0.05). CONCLUSION Receipt of recommended preventive care was suboptimal. Targeted interventions are warranted to help ensure access to comprehensive HIV care and prevention services for women.
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