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Wiginton JM, Amico KR, Hightow-Weidman L, Sullivan P, Horvath KJ. Syndemic Psychosocial Conditions among Youth Living with HIV: a Latent Class Analysis. AIDS Behav 2024; 28:3498-3511. [PMID: 39017755 PMCID: PMC11427513 DOI: 10.1007/s10461-024-04427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/18/2024]
Abstract
Drug use, mental distress, and other psychosocial factors threaten HIV care for youth living with HIV (YLWH). We aimed to identify syndemic psychosocial patterns among YLWH and examine how such patterns shape HIV outcomes. Using baseline data from 208 YLWH enrolled in an HIV treatment adherence intervention, we performed latent class analysis on dichotomized responses to 9 psychosocial indicators (enacted HIV stigma; clinical depression and anxiety; alcohol, marijuana, and illicit drug misuse; food and housing insecurity; legal history). We used multinomial logistic regression to assess latent class-demographic associations and the automatic Bolck-Croon-Hagenaars method to assess HIV outcomes by class. Mean age of participants was 21 years; two thirds identified as cis male, 60% were non-Hispanic Black, and half identified as gay. Three classes emerged: "Polydrug-Socioeconomic Syndemic" (n = 29; 13.9%), "Distress-Socioeconomic Syndemic" (n = 35, 17.1%), and "Syndemic-free" (n = 142, 69.0%). Older, unemployed non-students were overrepresented in the "Polydrug-Socioeconomic Syndemic" class. Missed/no HIV care appointments was significantly higher in the "Polydrug-Socioeconomic Syndemic" class (81.4%) relative to the "Syndemic-free" (32.8%) and "Distress-Socioeconomic Syndemic" (31.0%) classes. HIV treatment nonadherence was significantly higher in the "Polydrug-Socioeconomic Syndemic" class (88.5%) relative to the "Syndemic-free" class (59.4%) but not the "Distress-Socioeconomic Syndemic" class (70.8%). Lack of HIV viral load suppression was non-significantly higher in the "Polydrug-Socioeconomic Syndemic" class (29.7%) relative to the "Syndemic-free" (16.2%) and "Distress-Socioeconomic Syndemic" (15.4%) classes. Polydrug-using, socioeconomically vulnerable YLWH are at risk for adverse HIV outcomes, warranting tailored programming integrated into extant systems of HIV care.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
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Pence BW, Darnell D, Ranna-Stewart M, Psaros C, Gaynes BN, Grimes L, Henderson S, Parman M, Filipowicz TR, Gaddis K, Dorsey S, Mugavero MJ. Provocative Findings From a Transdiagnostic Counseling Intervention to Improve Psychiatric Comorbidity and HIV Care Engagement Among People With HIV: A Pilot Randomized Clinical Trial. J Acquir Immune Defic Syndr 2024; 97:68-77. [PMID: 39116333 PMCID: PMC11315358 DOI: 10.1097/qai.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/19/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Depression, anxiety, post-traumatic stress, and alcohol/substance use disorders are prevalent among people with HIV (PWH), commonly co-occur, and predict worse HIV care outcomes. Transdiagnostic counseling approaches simultaneously address multiple co-occurring mental health disorders. METHODS We conducted a pilot individually randomized trial of the Common Elements Treatment Approach adapted for people with HIV (CETA-PWH), a transdiagnostic counseling intervention, compared with usual care at a large academic medical center in the southern United States. Participants were adults with HIV; at risk for HIV care disengagement; and with elevated symptoms of depression, anxiety, post-traumatic stress, and/or alcohol/substance use. Mental health and HIV care engagement were assessed at 4 and 9 months. RESULTS Among participants (n = 60), follow-up was high at 4 (92%) and 9 (85%) months. Intervention engagement was challenging: 93% attended ≥1 session, 43% attended ≥6 sessions in 3 months ("moderate dose"), and 30% completed treatment. Although not powered for effectiveness, mental health outcomes and HIV appointment attendance improved in CETA-PWH relative to usual care in intent-to-treat analyses; those receiving a moderate dose and completers showed progressively greater improvement. Viral load showed small differences between arms. The dose-response pattern was not explained by differences between those who did and did not complete treatment. CONCLUSIONS This pilot trial provides preliminary evidence for the potential of CETA-PWH to simultaneously address co-occurring mental health comorbidities and support HIV appointment attendance among PWH. Additional strategies may be an important part of ensuring that clients can engage in the full course of treatment and realize its full benefits.
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Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, the University of North Carolina at Chapel Hill
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, the University of Washington
| | | | | | - Bradley N. Gaynes
- Department of Epidemiology, the University of North Carolina at Chapel Hill
- Department of Psychiatry, the University of North Carolina at Chapel Hill
| | - LaKendra Grimes
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Savannah Henderson
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Mariel Parman
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | | | - Kathy Gaddis
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Shannon Dorsey
- Department of Global Health, the University of Washington
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Qian Y, Detels R, Comulada WS, Hidalgo MA, Lee SJ, Biello KB, Yonko EA, Friedman MR, Palella FJ, Plankey MW, Mimiaga MJ. Longitudinal Analysis of Overlapping Psychosocial Factors Predicting Incident Hospitalization Among Mixed HIV Serostatus Men who have Sex with Men in the Multicenter AIDS Cohort Study. AIDS Behav 2024; 28:1-12. [PMID: 38703339 PMCID: PMC11424141 DOI: 10.1007/s10461-024-04356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Men who have sex with men (MSM) are at increased risk for certain types of chronic diseases and mental health problems. Despite having extended survival in the highly active antiretroviral therapy (HAART) era, MSM living with HIV contend with aging-related diseases and complications with treatment. Consequent hospitalizations incur high costs, fear, low quality of life, and frailty. Unlike heterosexual men, MSM experience more structural violence and "syndemics" of psychosocial factors that not only accelerate HIV acquisition and transmission risk but also may increase morbidity, leading to greater rates of hospitalization. We aim to examine the impact of "syndemic" psychosocial factors on the incidence of hospitalization among geographically diverse MSM in the US. Participants were 1760 MSM from the Multicenter AIDS Cohort Study (MACS) between 2004 and 2019. We examined the relationship between six psychosocial factors (depression, stimulant use, smoking, heroin use, childhood sexual abuse, and intimate partner violence) and incident hospitalization (admission to a hospital for treatment). We found a positive dose-response relationship between the number of syndemic factors and hospitalization. MSM reporting five or more syndemic factors had over twice the risk of hospitalization compared to MSM without syndemic factors [aRR = 2.14 (95% CI = 1.56, 2.94)]. Psychosocial factors synergistically increased hospitalizations over time. The positive dose-response relationship between the number of syndemic factors and hospitalization and the synergistic effects of these factors underscore the need for interventions that disentangle the syndemics to reduce hospitalization and related costs and improve the quality of life among MSM.
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Affiliation(s)
- Yuhang Qian
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA.
| | - Roger Detels
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Marco A Hidalgo
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Sung-Jae Lee
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Katie B Biello
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Elizabeth A Yonko
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
| | - M Reuel Friedman
- School of Public Health, Newark, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Frank J Palella
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive, South Box 951772, 71-254 CHS, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
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Kielhold K, Storholm ED, Reynolds HE, Vincent W, Siconolfi DE, Kegeles SM, Pollack L, Campbell CK. "I Don't Feel Judged, I Don't Feel Less of a Person" - Engaged and Supportive Providers in the HIV Care Experiences of Black Sexual Minority Men Living with HIV. Patient Prefer Adherence 2024; 18:1641-1650. [PMID: 39131692 PMCID: PMC11313489 DOI: 10.2147/ppa.s467587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/20/2024] [Indexed: 08/13/2024] Open
Abstract
Background Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South. Methods Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis. Findings Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients' needs, and making patients feel "seen". Less supportive providers were described as making their patients "feel like a number" and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care. Discussion We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.
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Affiliation(s)
- Kirstin Kielhold
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - Hannah E Reynolds
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | | | - Susan M Kegeles
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lance Pollack
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chadwick K Campbell
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Yeom CW, Ha H, Hahm BJ, Hee Lee S, Joong Kim N, Shim EJ. Is fear of disease progression associated with antiretroviral therapy adherence in persons with HIV/AIDS? J Health Psychol 2024; 29:976-988. [PMID: 38251645 DOI: 10.1177/13591053231224177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
We examined the mediating role of depression and anxiety on the relationship between fear of disease progression (FoP) and antiretroviral therapy (ART) adherence and the moderating role of social support in the FoP-depression/anxiety-ART adherence relationship in persons with HIV/AIDS (PWHA). 202 PWHA completed self-report measures. Simple mediation and moderated mediation analyses were performed. FoP was directly and negatively associated with ART adherence, and the mediating role of depression in this relationship was significant. Indirect effect of FoP mediated by anxiety on ART adherence was not significant. The moderating effect of social support was significant in the FoP-depression pathway, while the indirect effect of FoP on ART adherence mediated by depression was greatest at a higher level of social support and lower level of FoP. The results suggest the relevance of high FoP and depression-mediated FoP in ART adherence and social support may attenuate the negative impact of FoP.
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Affiliation(s)
- Chan-Woo Yeom
- Uijeongbu Eulji Medical Center, Republic of Korea
- Eulji University School of Medicine, Republic of Korea
| | - Hyeju Ha
- Pusan National University, Republic of Korea
| | - Bong-Jin Hahm
- Seoul National University College of Medicine, Republic of Korea
- Seoul National University Hospital, Republic of Korea
| | - Sun Hee Lee
- Pusan National University School of Medicine and Medical Research Institute, Republic of Korea
- Pusan National University Hospital, Republic of Korea
| | - Nam Joong Kim
- Seoul National University College of Medicine, Republic of Korea
- Seoul National University Hospital, Republic of Korea
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Mergenova G, Davis A, Gilbert L, El‐Bassel N, Terlikbayeva A, Primbetova S, Nugmanova Z, Pala AN, Gustafson D, Rosenthal SL, Denebayeva AY, DeHovitz J. Mental health and cognition in relation to adherence to antiretroviral therapy among people living with HIV in Kazakhstan: a cross-sectional study. J Int AIDS Soc 2024; 27 Suppl 3:e26320. [PMID: 39030875 PMCID: PMC11258456 DOI: 10.1002/jia2.26320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024] Open
Abstract
INTRODUCTION There is a research gap in how mental health and cognition are associated with antiretroviral treatment (ART) adherence among people living with HIV (PLWH) in Kazakhstan. METHODS We randomly selected and enrolled 230 PLWH from the Almaty City AIDS Center registry (June-November 2019) into a cross-sectional study. We examined associations between self-reported ART adherence for the last 1 and 2 weeks; the Adherence Self-Efficacy Scale (ASES) and symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder tool [GAD-7]), post-traumatic stress disorder (PTSD Checklist [PTSD]); cognitive function (PROMIS v2.0 Adult Cognitive Function 8a short form) and forgetfulness (Forgetfulness Assessment Inventory). We used cut points of ≥5 for at least mild and ≥10 for at least moderate symptom severity for PHQ-9 and GAD-7 and of ≥44 for PTSD. Logistic and linear regression analyses were used. RESULTS Participants' median age was 40.0 (IQR: 34-47) with 40.9% (n = 94) of females in the sample. Those who missed at least one pill for the last 2 weeks had higher odds of reporting at least mild depression (aOR = 3.34, 95% CI: 1.22-9.11, p < 0.05); mild anxiety (aOR = 3.27, 95% CI: 1.20-8.92, p < 0.05); and PTSD (aOR = 4.04, 95% CI: 1.15-14.21, p < 0.05) symptoms. Participants who missed at least one pill for the last week had higher odds of at least mild depression (aOR = 7.74, 95% CI: 1.31-45.7, p < 0.05), moderate anxiety (aOR = 21.33, 95% CI: 3.24-140.33, p < 0.005) and PTSD (aOR = 13.81, 95% CI: 2.36-80.84, p < 0.005) symptoms. Participants with better cognitive function had lower odds of non-adherence over the last week (aOR = 0.88, 95% CI: 0.81-0.96, p < 0.005) and higher ASES scores (β = 0.26, 95% CI: 0.13-0.40, p < 0.005). Poor memory was associated with higher odds of non-adherence over the last week (aOR = 4.64, 95% CI: 1.76-12.24, p < 0.005) and lower ASES score (β = -0.31, 95% CI: -0.45 to 0.16, p < 0.005). Those who had at least mild depression (β = -0.21, 95% CI: -0.35 to -0.07, p < 0.005); moderate anxiety (β = -0.21, 95% CI: -0.34 to -0.07, p < 0.005) and PTSD (β = -0.19, 95% CI: -0.33 to -0.05, p < 0.005) symptoms had lower ASES scores. CONCLUSIONS Depression, anxiety and PTSD symptoms, poorer cognition, and forgetfulness were associated with poorer ART adherence and worse adherence self-efficacy. It is crucial to assess and treat mental illness and provide support for PLWH with worsened cognition to enhance ART adherence.
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Affiliation(s)
- Gaukhar Mergenova
- Global Health Research Center of Central AsiaAlmatyKazakhstan
- Asfendiyarov Kazakh National Medical UniversityAlmatyKazakhstan
| | - Alissa Davis
- Columbia University School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Louisa Gilbert
- Columbia University School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Nabila El‐Bassel
- Columbia University School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | | | | | | | - Andrea Norcini Pala
- Columbia University School of Social WorkColumbia UniversityNew York CityNew YorkUSA
| | - Deborah Gustafson
- State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Susan L. Rosenthal
- Department of Pediatrics and PsychiatryVagelos College of Physicians and SurgeonsColumbia University Irving Medical CenterNew York CityNew YorkUSA
| | | | - Jack DeHovitz
- State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
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Liu J, Yan Y, Li Y, Lin K, Xie Y, Tan Z, Liu Q, Li J, Wang L, Zhou Y, Yao G, Huang S, Ye C, Cen M, Liao X, Xu L, Zhang C, Yan Y, Huang L, Yang F, Yang Y, Fu X, Jiang H. Factors associated with antiretroviral treatment adherence among people living with HIV in Guangdong Province, China: a cross sectional analysis. BMC Public Health 2024; 24:1358. [PMID: 38769474 PMCID: PMC11106959 DOI: 10.1186/s12889-024-18774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Understanding factors associated with antiretroviral treatment (ART) adherence is crucial for ART success among people living with HIV (PLHIV) in the "test and treat" era. Multiple psychosocial factors tend to coexist and have a syndemic effect on ART adherence. We aimed to explore factors associated with ART adherence and the syndemic effect of multiple psychosocial factors on ART adherence among PLHIV newly starting ART in Guangdong Province, China. METHODS Newly diagnosed PLHIV from six cities in Guangdong Province were recruited between May 2018 and June 2019, and then followed up from May 2019 to August 2020. Baseline and follow-up data were collected from a questionnaire and the national HIV surveillance system, the follow-up data of which were analyzed in this study. A Center for Adherence Support Evaluation (CASE) index > 10 points was defined as optimal ART adherence, which was measured via participants' self-reported adherence during follow-up survey. Multivariable logistic regression was used to identify factors associated with ART adherence. Exploratory factor analysis (EFA) and multi-order latent variable structural equation modeling (SEM) were performed to explore the syndemic effect of multiple psychosocial factors on ART adherence. RESULTS A total of 734 (68.53%) follow-up participants were finally included in this study among the 1071 baseline participants, of whom 91.28% (670/734) had self-reported optimal ART adherence. Unemployment (aOR = 1.75, 95%CI: 1.01-3.02), no medication reminder (aOR = 2.28, 95%CI: 1.09-4.74), low medication self-efficacy (aOR = 2.28, 95%CI: 1.27-4.10), low social cohesion (aOR = 1.82, 95%CI: 1.03-3.19), no social participation (aOR = 5.65, 95%CI: 1.71-18.63), and ART side effects (aOR = 0.46, 95%CI: 0.26-0.81) were barriers to optimal ART adherence. The EFA and second-order latent variable SEM showed a linear relationship (standardized coefficient = 0.43, P < 0.001) between ART adherence and the latent psychosocial (syndemic) factor, which consisted of the three latent factors of medication beliefs and self-efficacy (standardized coefficient = 0.65, P < 0.001), supportive environment (standardized coefficient = 0.50, P < 0.001), and negative emotions (standardized coefficient=-0.38, P < 0.01). The latent factors of medication beliefs and self-efficacy, supportive environment, and negative emotions explained 42.3%, 25.3%, and 14.1% of the variance in the latent psychosocial factor, respectively. CONCLUSIONS About nine out of ten PLHIV on ART in Guangdong Province self-reported optimal ART adherence. However, more efforts should be made to address barriers to optimal ART adherence.
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Affiliation(s)
- Jun Liu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Yao Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yan Li
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Kaihao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
| | - Yingqian Xie
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
| | - Qicai Liu
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junbin Li
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lihua Wang
- Jiangmen Center for Disease Control and Prevention, Jiangmen, China
| | - Yi Zhou
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Gang Yao
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Shanzi Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Chenglong Ye
- Yangjiang Center for Disease Control and Prevention, Yangjiang, China
| | - Meixi Cen
- Yunfu Center for Disease Control and Prevention, Yunfu, China
| | - Xiaowen Liao
- Yunfu Center for Disease Control and Prevention, Yunfu, China
| | - Lu Xu
- Shantou Center for Disease Control and Prevention, Shantou, China
| | - Chi Zhang
- Shantou Center for Disease Control and Prevention, Shantou, China
| | - Yubin Yan
- Huizhou Center for Disease Control and Prevention, Huizhou, China
| | - Lin Huang
- Huizhou Center for Disease Control and Prevention, Huizhou, China
| | - Fang Yang
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China
| | - Xiaobing Fu
- Department of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, No. 160 Qunxian Road, Panyu District Guangzhou, Guangzhou, China.
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China.
- Institute for Global Health, University College London, London, NW3 2PF, United Kingdom.
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Weinstein ER, Mendez NA, Jones MA, Safren SA. The impact of syndemic burden, age, and sexual minority status on internalized HIV stigma among people living with HIV in South Florida. J Health Psychol 2024:13591053241249633. [PMID: 38738485 DOI: 10.1177/13591053241249633] [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: 05/14/2024] Open
Abstract
Internalized HIV stigma has been associated with several poor mental and physical health outcomes among people living with HIV (PLWH); yet, little research has explored how internalized HIV stigma may be affected by syndemic burden. This study sought to examine the relationship between syndemic conditions and HIV stigma over and above the potential effects of two social determinants of health, age and sexual minority status, using a linear regression approach (N = 1343). Syndemic burden was significantly positively associated with internalized HIV stigma above and beyond the effects of age and sexual minority status (b = 0.23). Additionally, age (b = -0.02) and being a sexually minority (b = -0.31) were significantly negatively associated with internalized HIV stigma. Findings should inform future treatment targets for this population by specifically working to reduce internalized HIV stigma for people with a greater syndemic burden and, potentially, among young adults and heterosexual PLWH.
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Affiliation(s)
| | | | - Megan A Jones
- Milken Institute School of Public Health, George Washington University, USA
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Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
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Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
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Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Pitpitan EV, Horvath KJ, Aldous J, Stockman JK, Patterson TL, Liang M, Barrozo C, Moore V, Penninga K, Smith LR. Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV. Trials 2024; 25:212. [PMID: 38520030 PMCID: PMC10958824 DOI: 10.1186/s13063-024-08042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, San Diego, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA.
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Megan Liang
- San Diego State University Research Foundation, San Diego, USA
| | | | | | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
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11
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Harkness A, Morales V, Atuluru P, Jaramillo J, Safren SA, Balise R, Turner D. PrEP and Behavioral Health Treatment Referral Among HIV Test Counselors in Miami-Dade County: A Rapid Qualitative Study Using the Consolidated Framework for Implementation Research. AIDS Behav 2024; 28:820-836. [PMID: 37792227 PMCID: PMC11110539 DOI: 10.1007/s10461-023-04184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
HIV test counselors are well positioned to refer individuals to pre-exposure prophylaxis (PrEP) and behavioral health treatments. HIV test counselors in Miami-Dade County (N = 20), a priority jurisdiction for Ending the HIV Epidemic, completed interviews to assess determinants of PrEP and behavioral health treatment referrals. To identify determinants, we used a rapid deductive qualitative analysis approach and the Consolidated Framework for Implementation Research (CFIR). Identified determinants sometimes served as facilitators (e.g., relative priority, leadership importance) and sometimes as barriers (e.g., lack of access to knowledge and information, available resources for referrals) to making referrals. We also observed differences in determinants between PrEP and behavioral health referrals. For example, complexity (perceived difficulty of the referral) was a barrier to behavioral health more often than PrEP referral. Our findings suggest that determinants across many CFIR domains affect referral implementation, and the corresponding need for multiple implementation strategies to improve implementation of PrEP and behavioral health referrals in the context of HIV testing.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr Coral Gables, Coral Gables, FL, 33146, USA.
| | - Vanessa Morales
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | | | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - DeAnne Turner
- College of Nursing, University of South Florida, Tampa, FL, USA
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12
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Kohli M, Ham L, Saloner R, Dung D, Iudicello J, Ellis RJ, Moore DJ. Latent Profile Analysis of Cognitive Performance and Depressive Symptoms Among People with HIV. AIDS Patient Care STDS 2024; 38:93-106. [PMID: 38381950 PMCID: PMC10890962 DOI: 10.1089/apc.2023.0224] [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: 02/23/2024] Open
Abstract
Depression and cognitive impairment are prevalent conditions among people with HIV (PWH), likely attributable to shared causes and common risk factors. Identifying subtypes of PWH with similar patterns of neurocognitive impairment (NCI) and depressive symptoms may inform development of patient-centered interventions that target-specific profiles. This study aimed to (1) classify PWH based on patterns of domain-specific NCI and depression; and (2) determine the relationship between latent class membership and pertinent clinical characteristics. PWH (N = 580, 86.2% male, 57.1% non-Hispanic White, 69.2% unemployed) completed a comprehensive neuropsychological test battery assessing global and domain-specific cognition. Domain-specific NCI was classified as deficit score >0.5. Participants completed the Beck Depression Inventory-II (BDI-II), and domain-specific BDI-II scores reflecting cognitive, affective, and somatic symptoms were computed. Latent profile analysis (LPA) was used to determine latent subgroups of NCI and depression. The optimal LPA solution consisted of five classes: minimal NCI and minimal depression (Class 1), amnestic and minimal depression (Class 2), severe multi-domain NCI and moderate depression (somatic and affective; Class 3), mild NCI and mild depression (Class 4), and moderate multi-domain NCI and severe depression (Class 5). Despite similar levels of functional impairment, Class 5 had a significant psychiatric profile, whereas Class 3 had a complex medical profile (i.e., higher frailty index, higher medications, greater proportion of AIDS diagnosis). In contrast, Class 1 had the lowest medication use and frailty index, with similar HIV disease characteristics to Classes 3 and 5. Our results suggest there are multiple pathways to cognitive and functional impairment among PWH with co-occurring depression and cognitive impairment, and these groups may respond differently to interventions. Of note, our sample was majority non-Hispanic White and male, which is nonrepresentative of the US population of PWH. Future interventions should consider a more integrated, person-centered approach that addresses cognitive and emotional health to optimize health outcomes in PWH.
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Affiliation(s)
- Maulika Kohli
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Lillian Ham
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Rowan Saloner
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Devin Dung
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Jennifer Iudicello
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry and University of California, San Diego, La Jolla, California, USA
| | - Ronald J. Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry and University of California, San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry and University of California, San Diego, La Jolla, California, USA
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13
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Smith WP. Negative Lifestyle Factors Specific to Aging Persons Living with HIV and Multimorbidity. J Int Assoc Provid AIDS Care 2024; 23:23259582241245228. [PMID: 39051608 PMCID: PMC11273731 DOI: 10.1177/23259582241245228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 07/27/2024] Open
Abstract
The primary goal of medical care during the pre-antiretroviral therapy (ART) era was to keep persons living with human immunodeficiency virus (HIV) alive, whereas since the advent of ART, the treatment objective has shifted to decreasing viral loads and infectiousness while increasing CD4+ T-cell counts and longevity. The health crisis, however, is in preventing and managing multimorbidity (ie, type 2 diabetes), which develops at a more accelerated or accentuated pace among aging persons living with HIV. Relative to the general population and age-matched uninfected adults, it may be more difficult for aging HIV-positive persons who also suffer from multimorbidity to improve negative lifestyle factors to the extent that their behaviors could support the prevention and management of diseases. With recommendations and a viable solution, this article explores the impact of negative lifestyle factors (ie, poor mental health, suboptimal nutrition, physical inactivity, alcohol use) on the health of aging individuals living with HIV.
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14
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SantaBarbara NJ, Swendeman D, Arnold EM, Nosrat S, Comulada WS. Exercise preferences for young people at-risk for and living with HIV: a short report. AIDS Care 2023; 35:1830-1835. [PMID: 36200381 PMCID: PMC10076448 DOI: 10.1080/09540121.2022.2128161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/14/2022] [Indexed: 10/10/2022]
Abstract
Exercise can improve physical and mental health for young people at risk for and with HIV, but prevalence rates remain low. This study explored exercise preferences and barriers among young people at risk for and with HIV, and potential gender differences. A total of 129 participants (66.7% male, mean age = 23.8 [SD = 2.1; range: 19-28], 35.7% Black/African American) at-risk for or with HIV were recruited from a larger study and completed an online survey of exercise preferences and barriers. Overall, participants preferred an exercise program that takes place at a fitness center, occurs alone, has a coach/instructor present, is between 30 and 60 minutes, lasts longer than 8 weeks, and includes aerobic and resistance exercises. The fatiguing nature of exercise and cost were common barriers among all genders. Few gender differences emerged. These results should be used to design exercise programs for young adults at risk for and with HIV.
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Affiliation(s)
- Nicholas J. SantaBarbara
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024
- School of Health Sciences, Merrimack College, 315 Turnpike Street, North Andover, MA, 01845
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd #303, Dallas, TX, 75390
| | - Sanaz Nosrat
- Department of Health Sciences, Lehman College/CUNY, 250 Bedford Park Boulevard Bronx, NY, 10468
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024
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15
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Diaz JE, Preciado E, Chiasson MA, Hirshfield S. Association Between Age of Anal Sex Debut and Adult Health Behaviors Among Sexual Minoritized Men Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3565-3575. [PMID: 37378702 PMCID: PMC11034742 DOI: 10.1007/s10508-023-02642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Earlier age of anal sex debut (ASD) has been linked with contemporary and long-term health outcomes, including vulnerability to HIV acquisition. The goal of this study was to utilize a life course approach to examine associations between earlier ASD and recent health behaviors among sexual minoritized men (SMM) living with HIV. A total of 1156 U.S. SMM living with HIV recruited from social and sexual networking apps and websites completed online surveys as part of a longitudinal eHealth intervention. Data from baseline surveys were analyzed to determine associations between age of ASD and adult health outcomes, including mental health, HIV viral load, and substance use. The median age of ASD among these participants was 17 years old, consistent with other work. Earlier ASD was significantly associated with a greater likelihood of past 2-week anxiety (AOR = 1.45, 95% CI 1.07-1.97) and past 3-month opioid use (AOR = 1.60, 95% CI 1.13-2.26); no significant associations were found for recent depression, HIV viral load, or stimulant use. Earlier ASD may function as an important proxy measure for deleterious health outcomes in adulthood, particularly recent anxiety and opioid use. Expansion of comprehensive and affirming sexual health education is critical to early engagement of individuals with a higher risk of HIV acquisition, with plausible downstream health benefits lasting into adulthood among SMM living with HIV.
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Affiliation(s)
- José E Diaz
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | | | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
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16
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Graff NR, Hong C, Guthrie B, Micheni M, Chirro O, Wahome E, van der Elst E, Sanders EJ, Simoni JM, Graham SM. The Effect of the Shikamana Peer-and-Provider Intervention on Depressive Symptoms, Alcohol Use, and Other Drug Use Among Gay, Bisexual, and Other Men Who Have Sex with Men in Kenya. AIDS Behav 2023; 27:3053-3063. [PMID: 36929320 PMCID: PMC10504414 DOI: 10.1007/s10461-023-04027-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] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
Kenyan gay, bisexual, and other men who have sex with men (GBMSM) face stigma and discrimination, which may adversely impact mental health and limit antiretroviral therapy (ART) adherence among GBMSM living with HIV. We evaluated whether the Shikamana peer-and-provider intervention, which improved ART adherence among participants in a small randomized trial, was associated with changes in mental health or substance use. The intervention was associated with a significant decrease in PHQ-9 score between baseline and month 6 (estimated change - 2.7, 95% CI - 5.2 to - 0.2, p = 0.037) compared to standard care. In an exploratory analysis, each one-point increment in baseline HIV stigma score was associated with a - 0.7 point (95% CI - 1.3 to - 0.04, p = 0.037) greater decrease in PHQ-9 score over the study period in the intervention group. Additional research is required to understand factors that influence this intervention's effects on mental health outcomes.
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Affiliation(s)
- Nicholas R Graff
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
| | - Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Brandon Guthrie
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
| | | | - Oscar Chirro
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Elise van der Elst
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
- Global Health Department, University of Amsterdam, Amsterdam, The Netherlands
| | - Eduard J Sanders
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
- University of Oxford, Headington, England, UK
| | - Jane M Simoni
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, WA, USA
| | - Susan M Graham
- Department of Epidemiology, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
- Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA, 98104, USA.
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17
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Stockman JK, Anderson KM, Fernandez DeSoto A, Campbell DM, Tsuyuki K, Horvath KJ. A Trauma-Informed HIV Intervention (LinkPositively) to Improve HIV Care Among Black Women Affected by Interpersonal Violence: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46325. [PMID: 37405824 DOI: 10.2196/46325] [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: 03/05/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Black women bear a disproportionate burden of HIV, accounting for nearly 60% of new diagnoses among US women. Black women living with HIV often experience mutually reinforcing epidemics, known as syndemics, including interpersonal violence and substance use. Syndemics are associated with decreased HIV care engagement and treatment adherence and worsening HIV outcomes. Few HIV services and resources are tailored to be culturally and gender-responsive and trauma informed for Black women living with HIV. Technology-based, psychoeducational, and peer navigation programs offer promising pathways to tailored HIV support and improved HIV care outcomes. Therefore, the web-based, trauma-informed intervention LinkPositively was developed in collaboration with Black women living with HIV to promote uptake of HIV care and ancillary support services. OBJECTIVE This study primarily determines the feasibility and acceptability of the LinkPositively intervention among Black women living with HIV affected by interpersonal violence. The secondary aim is to examine the preliminary impact of the LinkPositively intervention on retention in HIV care, antiretroviral therapy adherence, and viral suppression while evaluating the role of mechanism of change variables (eg, social support) in the associations. METHODS The LinkPositively trial is a pilot randomized controlled trial conducted in California, United States, among 80 adult Black women living with HIV who have experienced interpersonal violence. Core components of LinkPositively include one-on-one peer navigation with phone and SMS text message check-ins; 5 weekly one-on-one video sessions to build coping and care navigation skills; and a mobile app that contains a peer support social networking platform, an educational database with healthy living and self-care tips, a GPS-enabled HIV and ancillary care resource locator, and a medication self-monitoring and reminder system. Participants are randomly assigned to the intervention (n=40) or control (Ryan White standard of care; n=40) arm, with follow-up at 3 and 6 months. At each assessment, participants complete an interviewer-administered survey and submit hair samples for the assessment of HIV medication adherence. All research staff and investigators adhere to ethical principles and guidelines for conducting research activities. Data will be analyzed using generalized estimating equations. RESULTS Final development and testing of the LinkPositively app were completed in July 2021. As of May 2023, we have screened 97 women for eligibility. Of the 97 women screened, 27 (28%) were eligible and have been enrolled in the study. The dissemination of preliminary results will occur in 2024. CONCLUSIONS This trial will advance HIV prevention science by harnessing technology to promote engagement in HIV care while improving social support through peers and social networking-all while being trauma informed for Black women living with HIV with experiences of interpersonal violence. If shown to be feasible and acceptable, LinkPositively has the potential to improve HIV care outcomes among Black women, a marginalized key population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46325.
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Affiliation(s)
- Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Katherine M Anderson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Alexandra Fernandez DeSoto
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Danielle M Campbell
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Kiyomi Tsuyuki
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
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18
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Lee JS, Bainter SA, Tsai AC, Andersen LS, Stanton AM, Magidson JF, Kagee A, Joska JA, O'Cleirigh C, Safren SA. Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems. AIDS Behav 2023; 27:1741-1756. [PMID: 36309936 PMCID: PMC10148921 DOI: 10.1007/s10461-022-03906-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/27/2022]
Abstract
In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.
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Affiliation(s)
- Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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19
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Traynor SM, Schmidt RD, Gooden LK, Matheson T, Haynes L, Rodriguez A, Mugavero M, Jacobs P, Mandler R, Del Rio C, Carrico AW, Horigian VE, Metsch LR, Feaster DJ. Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions. J Clin Med 2022; 12:114. [PMID: 36614917 PMCID: PMC9820894 DOI: 10.3390/jcm12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network's CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals' experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.
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Affiliation(s)
- Sharleen M. Traynor
- Clinical Trials Research Associate Program, Durham Technical Community College, Durham, NC 27703, USA
| | - Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lauren K. Gooden
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd # 229, Birmingham, AL 35233, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, MD 20892, USA
| | - Raul Mandler
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, GA 30322, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lisa R. Metsch
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
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20
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Kagee A, Saal W, Bantjes J, Sterley A. Correlates of viral non-suppression among South African antiretroviral therapy users: comorbidity of major depression, posttraumatic stress, and alcohol use disorders. AIDS Care 2022; 34:1540-1546. [PMID: 34927489 DOI: 10.1080/09540121.2021.2016577] [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: 01/26/2023]
Abstract
Antiretroviral therapy (ART) users at two public health facilities in South Africa were assessed for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), using the Structured Clinical Interview for the DSM5 (n = 688). Multivariate regression analysis was used to identify associations between mental disorders and unsuppressed viral load (VL), controlling for sociodemographic factors. All main effects and two-way interaction effects between mental disorders were explored. Prevalence estimates for MDD, PTSD and AUD were 24.9%, 14.7% and 22.1%, respectively, and 22.0% had unsuppressed VL. In multivariate regression models, unsuppressed VL was associated with being unemployed (aOR = 2.23) and AUD (aOR = 1.78). MDD, PTSD and comorbid mental disorders did not increase risk of unsuppressed VL. Population Attributable Risk analysis indicated that treating AUD could yield a 2% absolute reduction in prevalence of unsuppressed VL (equivalent to 9.3% proportional reduction), highlighting the importance of screening and treating AUD among persons receiving ART.
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Affiliation(s)
- Ashraf Kagee
- Psychology, University of Stellenbosch, Cape Town, South Africa
| | - Wylene Saal
- Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jason Bantjes
- Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Adelle Sterley
- Psychology, University of Stellenbosch, Cape Town, South Africa.,Infectious Diseases Clinic, Helderberg Hospital, Matieland, South Africa
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21
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Nguyen MX, Reyes HL, Pence BW, Muessig KE, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Tran HV, Go VF. Effects of Two Alcohol Reduction Interventions on Depression and Anxiety Symptoms of ART Clients in Vietnam. AIDS Behav 2022; 26:1829-1840. [PMID: 34807321 PMCID: PMC10144180 DOI: 10.1007/s10461-021-03532-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use.
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Affiliation(s)
- M X Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA.
| | - H L Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - B W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - H E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Chander
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - K E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - C Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - H V Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - V F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
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22
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Tolley EE, Hamilton EL, Eley N, Maragh-Bass AC, Okumu E, Balán IC, Gamble T, Beyrer C, Remien R. "The role of case management in HIV treatment adherence: HPTN 078". AIDS Behav 2022; 26:3119-3130. [PMID: 35362913 PMCID: PMC9371990 DOI: 10.1007/s10461-022-03644-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Adherence to care and antiretroviral therapy is challenging, especially for people living with HIV (PLWH) with additional co-occurring risk factors. Case management interventions, including motivational interviewing (MI), show promise to improve HIV treatment adherence, but few studies have examined how such interventions are delivered to or experienced by PLWH who have been reengaged in care. We conducted qualitative interviews with six case managers and 110 PLWH exiting from a randomized study (HPTN 078) who received a MI-based case management intervention in addition to standard patient-navigation services, or standard services only. Our study provided greater insight into the main findings from HPTN 078, including an in-depth description of the multiple barriers to adherence faced by this largely "out-of-care" population, as well as a more nuanced understanding of the benefits and challenges of implementing MI. A blend of MI plus more intensive interventions may be needed for PLWH facing multiple structural barriers.
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Affiliation(s)
- Elizabeth E. Tolley
- grid.245835.d0000 0001 0300 5112Behavioral, Epidemiological & Clinical Sciences, FHI 360, 359 Blackwell Street, 27701 Durham, North Carolina United States
| | - Erica L. Hamilton
- grid.245835.d0000 0001 0300 5112Science Facilitation, FHI 360, Durham, NC United States
| | - Natalie Eley
- grid.245835.d0000 0001 0300 5112Behavioral, Epidemiological & Clinical Sciences, FHI 360, 359 Blackwell Street, 27701 Durham, North Carolina United States
| | - Allysha C. Maragh-Bass
- grid.245835.d0000 0001 0300 5112Behavioral, Epidemiological & Clinical Sciences, FHI 360, 359 Blackwell Street, 27701 Durham, North Carolina United States
| | - Eunice Okumu
- grid.410711.20000 0001 1034 1720UNC Center for AIDS Research, University of North Carolina, Chapel Hill, NC United States
| | - Iván C. Balán
- grid.255986.50000 0004 0472 0419Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL United States
| | - Theresa Gamble
- grid.245835.d0000 0001 0300 5112Science Facilitation, FHI 360, Durham, NC United States
| | - Chris Beyrer
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD United States
| | - Robert Remien
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, New York, NY United States
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23
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Holloway IW, Beltran R, Shah SV, Cordero L, Garth G, Smith T, Wilson BDM, Ochoa AM. Structural Syndemics and Antiretroviral Medication Adherence Among Black Sexual Minority Men Living With HIV. J Acquir Immune Defic Syndr 2021; 88:S12-S19. [PMID: 34757988 PMCID: PMC8579986 DOI: 10.1097/qai.0000000000002806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although HIV antiretroviral treatment (ART) access and uptake have increased among racial/ethnic minority individuals, lower rates of ART adherence and viral suppression persist, especially among Black men who have sex with men (BMSM) compared with their White counterparts. SETTING Black men who have sex with men living with HIV (BMSM+) residing in Los Angeles County (N = 124) were recruited in-person (eg, clinic) and online (eg, social networking apps). METHODS Participants completed a cross-sectional survey measuring demographic characteristics, structural syndemics (poverty, criminal justice involvement, and housing instability), and psychosocial syndemics (mental health and substance use). A text message survey assessed missed doses of ART over the past week. Zero-inflated Poisson regression models were used to evaluate variables associated with the number of missed doses of ART. RESULTS On average, participants missed 1.30 doses of ART (SD = 2.09) and reported structural syndemics: poverty (56.1%), criminal justice involvement (36.6%), housing instability (26.3%), and psychosocial syndemics: childhood sexual abuse (51.8%), intimate partner violence (16.9%), depression (39%), and problem alcohol use (15.5%). After controlling for employment, age, education, and psychosocial syndemics, participants with a one-point increase in structural syndemic indicators were found to be 1.63 times more likely to have missed a dose of ART. CONCLUSIONS Structural syndemic were associated with ART nonadherence among BMSM+ after adjusting for demographic and psychosocial factors. HIV treatment interventions that incorporate financial incentives, legal support, and housing may help improve ART adherence among BMSM+. Findings suggest that key priorities to ending the HIV epidemic must include structural interventions that alleviate poverty, eliminate disproportionate policing and criminalization, and end homelessness.
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Affiliation(s)
- Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Raiza Beltran
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Saanchi V. Shah
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Luisita Cordero
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Gerald Garth
- Arming Minorities Against Addiction and Disease (AMAAD) Institute, Los Angeles, CA
| | | | - Bianca D. M. Wilson
- The Williams Institute, UCLA School of Law, University of California, Los Angeles, CA
| | - Ayako M. Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, CA
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24
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Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review. AIDS Behav 2021; 25:3574-3604. [PMID: 33866444 PMCID: PMC8053369 DOI: 10.1007/s10461-021-03262-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.
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25
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Hershow RB, Reyes HLMN, Ha TV, Chander G, Mai NVT, Sripaipan T, Dowdy DW, Latkin C, Hutton HE, Pettifor A, Maman S, Frangakis C, Go VF. Evaluating the effects of two alcohol reduction counseling interventions on intimate partner violence perpetration: secondary analysis of a three-arm randomized controlled trial among Vietnamese men with HIV. Addiction 2021; 116:2712-2723. [PMID: 33788329 DOI: 10.1111/add.15496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/06/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Evidence suggests that alcohol reduction interventions decrease intimate partner violence (IPV) perpetration, although this remains untested in low- and middle-income countries and among men with human immunodeficiency virus (HIV). This study evaluates the effectiveness of alcohol reduction counseling interventions on IPV perpetration among men on anti-retroviral therapy (ART) and tests whether alcohol use explains the intervention effects. DESIGN Secondary analysis of data from a three-arm randomized controlled trial among ART patients with hazardous alcohol use. Participants were recruited from March 2016 to May 2017. SETTING Thai Nguyen, Vietnam. PARTICIPANTS, INTERVENTIONS AND COMPARATORS Male participants (n = 426). Participants received a two-session brief intervention (BI), a six-session combined intervention (CoI) or the standard of care (SOC), comprising alcohol treatment referrals. Alcohol reduction counseling interventions were guided by cognitive-behavioral therapy and motivational enhancement therapy delivered by psychosocial counselors over 3 months. MEASUREMENTS IPV perpetration was measured using the shortened Conflict Tactics Scale 2 and alcohol use was measured using timeline followback. FINDINGS BI and CoI participants reported reduced IPV perpetration at 3 months compared with SOC participants [BI: adjusted odds ratio (aOR) = 0.27, 95% confidence interval (CI) = 0.11, 0.65; CoI: aOR = 0.50, 95% CI = 0.22, 1.13]; the association was only significant for the BI group. Intervention effects were not sustained at 6 and 12 months. There was little evidence that alcohol use acted as a mediator (indirect effect, BI: aOR = 0.84, 95% CI = 0.63, 1.04; indirect effect, CoI: aOR = 0.86, 95% CI = 0.66, 1.03). CONCLUSIONS Among Vietnamese men receiving anti-retroviral therapy, alcohol reduction counseling interventions appeared to reduce intimate partner violence perpetration immediately post-intervention, but reductions were not sustained at 6 and 12 months and were not explained by alcohol reduction.
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Affiliation(s)
- Rebecca B Hershow
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - H Luz Mc Naughton Reyes
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Tran Viet Ha
- UNC Project Vietnam, Yen Hoa Health Clinic, Hanoi, Vietnam
| | - Geetanjali Chander
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Teerada Sripaipan
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David W Dowdy
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Audrey Pettifor
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Constantine Frangakis
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vivian F Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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26
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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27
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Satyanarayana S, Rogers BG, Bainter SA, Christopoulos KA, Fredericksen RJ, Mathews WC, Moore RD, Mugavero MJ, Napravnik S, Carrico AW, Mimiaga MJ, Mayer KH, Crane HM, Safren SA. Longitudinal Associations of Syndemic Conditions with Antiretroviral Therapy Adherence and HIV Viral Suppression Among HIV-Infected Patients in Primary Care. AIDS Patient Care STDS 2021; 35:220-230. [PMID: 34097465 PMCID: PMC8336208 DOI: 10.1089/apc.2021.0004] [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] [Indexed: 01/14/2023] Open
Abstract
Psychosocial syndemic conditions have received more attention regarding their deleterious effects on HIV acquisition risk than for their potential impact on HIV treatment and viral suppression. To examine syndemic conditions' impact on the HIV care continuum, we analyzed data collected from people living with HIV (N = 14,261) receiving care through The Centers for AIDS Research Network of Integrated Clinical Systems at seven sites from 2007 to 2017 who provided patient-reported outcomes ∼4-6 months apart. Syndemic condition count (depression, anxiety, substance use, and hazardous drinking), sexual risk group, and time in care were modeled to predict antiretroviral therapy (ART) adherence and viral suppression (HIV RNA <400 copies/mL) using multilevel logistic regression. Comparing patients with each other, odds of ART adherence were 61.6% lower per between-patient syndemic condition [adjusted odds ratio (AOR) = 0.384; 95% confidence interval (CI), 0.362-0.408]; comparing patients with themselves, odds of ART adherence were 36.4% lower per within-patient syndemic condition (AOR = 0.636 95% CI, 0.606-0.667). Odds of viral suppression were 29.3% lower per between-patient syndemic condition (AOR = 0.707; 95% CI, 0.644-0.778) and 27.7% lower per within-patient syndemic condition (AOR = 0.723; 95% CI, 0.671-0.780). Controlling for the effects of adherence (AOR = 5.522; 95% CI, 4.67-6.53), each additional clinic visit was associated with 1.296 times higher odds of viral suppression (AOR = 1.296; 95% CI, 1.22-1.38), but syndemic conditions were not significant. Deploying effective interventions within clinics to identify and treat syndemic conditions and bolster ART adherence and continued engagement in care can help control the HIV epidemic, even within academic medical settings in the era of increasingly potent ART.
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Affiliation(s)
- Satyanand Satyanarayana
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,Address correspondence to: Satyanand Satyanarayana, JD, MS, Department of Psychology, University of Miami, Coral Gables, FL 33124, USA
| | - Brooke G. Rogers
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sierra A. Bainter
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Rob J. Fredericksen
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - William C. Mathews
- Department of Medicine, UCSD School of Medicine, San Diego, California, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J. Mugavero
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Medicine, UAB School of Medicine, Birmingham, Alabama, USA
| | - Sonia Napravnik
- Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthew J. Mimiaga
- UCLA Center for LGBTQ Advocacy, Research, and Health (C-LARAH), Los Angeles, California, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California, USA.,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Kenneth H. Mayer
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA.,Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Heidi M. Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
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Nguyen MX, McNaughton Reyes HL, Pence BW, Muessig K, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Ha Tran V, Go VF. The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam. J Int AIDS Soc 2021; 24 Suppl 2:e25746. [PMID: 34165258 PMCID: PMC8222856 DOI: 10.1002/jia2.25746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Mental health disorders may negatively impact HIV outcomes, such as viral suppression (VS) and antiretroviral (ART) adherence among people with HIV (PWH) with hazardous alcohol use. This study evaluates the longitudinal association between depression, anxiety symptoms, VS and complete ART adherence among ART clients with hazardous alcohol use in Vietnam; and examines alcohol dependence as a modifier in this association. METHODS This was a secondary data analysis of a trial for hazardous drinking ART clients in Thai Nguyen, Vietnam. From March 2016 to May 2018, 440 ART clients with an Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score ≥4 for men and ≥3 for women were enrolled. Individuals were randomized to either a combined intervention, a brief intervention or a standard of care. Data on sociodemographics, depression, anxiety symptoms, alcohol use, VS and ART adherence were collected at baseline, three, six, and twelve months. Generalized estimating equation models controlling for intervention exposure were used to estimate time-lagged associations. Risk ratios were estimated using Poisson regression with robust variance estimation. RESULTS The mean age of participants was 40.2. The majority was male (96.8%), had at least some secondary school education (85.0%) and had a history of injection drug use (80.9%). No overall effect of depression and anxiety symptoms on VS was observed. When stratified by time, increased anxiety symptoms at six months were associated with VS at 12 months (adjusted risk ratio (aRR) = 1.09; 95% CI 1.02 to 1.17). An increase in depression or anxiety symptoms was associated with a decreased probability of complete ART adherence (depression symptoms: aRR = 0.95; 95% CI: 0.91 to 0.99; anxiety symptoms: aRR = 0.93; 85% CI: 0.88 to 0.99). The negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without. CONCLUSIONS Depression and anxiety symptoms had no overall effect on VS, although they were associated with a lower probability of complete ART adherence. Interventions focusing on mental healthcare for PWH with hazardous alcohol use are needed, and integration of mental healthcare and alcohol reduction should be implemented in HIV primary care settings.
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Affiliation(s)
- Minh X Nguyen
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - H. Luz McNaughton Reyes
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Brian W Pence
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kate Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Carl A Latkin
- Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - David Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Kathryn E Lancaster
- Department of EpidemiologyCollege of Public HealthOhio State UniversityColumbusOHUSA
| | - Constantine Frangakis
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Teerada Sripaipan
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Viet Ha Tran
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Vivian F Go
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Sued O, Cecchini D, Abbamonte JM, Rodriguez VJ, Mandell LN, Cristofari NV, Figueroa MI, Cassetti I, Cahn P, Weiss SM, Alcaide ML, Cahn F, Calanni L, Crinejo A, David D, Lupo S, Pérez C, Pérez R, Rodriguez C, Rolón MJ, Sisto A, Trapé L, Jones DL. Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina. Int J Behav Med 2021; 28:318-327. [PMID: 32725586 DOI: 10.1007/s12529-020-09921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. METHOD Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. RESULTS Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). CONCLUSION This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care.
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Affiliation(s)
- Omar Sued
- Fundacion Huesped, Buenos Aires, Argentina.
| | - Diego Cecchini
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
- Helios Salud, Buenos Aires, Argentina
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicholas V Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Ana Crinejo
- Hospital Guillermo Rawson, Córdoba, Argentina
| | | | - Sergio Lupo
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | | | | | - Claudia Rodriguez
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | - María José Rolón
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Alicia Sisto
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Liliana Trapé
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Examining stigma, social support, and gender differences in unsuppressed HIV viral load among participants in HPTN 065. J Behav Med 2021; 44:159-171. [PMID: 33161564 PMCID: PMC11068030 DOI: 10.1007/s10865-020-00186-7] [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] [Received: 03/09/2020] [Accepted: 09/17/2020] [Indexed: 01/13/2023]
Abstract
Successful navigation of the HIV care continuum is necessary to maintain viral suppression. We explored gender-stratified correlates of being virally unsuppressed in the Prevention for Positives (P4P) component of HPTN 065. The outcome of interest was unsuppressed viral load (> 40 copies/mL) among individuals already living with HIV. Correlates included medication adherence factors, social support and stigma. Logistic regression models were stratified by gender (N = 673). Men-specific correlates of being virally unsuppressed included opposite-sex partners, older age and HIV disclosure stigma. Women-specific correlates included time since diagnosis, and personal-level barriers to medication adherence. When more individuals knew about their HIV status, women had over twice the likelihood of being virally unsuppressed; no such association was seen among men. Additionally, higher levels of social support were not associated with viral suppression among women. Interventions should consider gender-specific approaches to engaging social support in de-stigmatization of HIV and promotion of medication adherence and subsequent viral suppression.
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Affiliation(s)
| | | | - Wafaa M El-Sadr
- International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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Rogers BG, Glynn TR, Bainter SA, McCauley T, Antoni MH, Safren SA. Syndemics and salivary inflammation in people living with HIV/AIDS. Psychol Health 2021; 36:496-510. [PMID: 32400209 PMCID: PMC7665986 DOI: 10.1080/08870446.2020.1763995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE People living with HIV/AIDS (PLWHA) are disproportionally exposed to a host of structural, community, and individual-level physical and psychosocial stressors also termed 'syndemic conditions.' The current study aimed to examine the association between experiencing syndemic conditions and physiological stress response and be associated with bodily inflammation, including Interlekin-6 (IL-6) and C-reactive protein (CRP) in PLWHA. DESIGN Participants (N = 103) were recruited from a public HIV clinic. They provided saliva samples of IL-6 and CRP and completed psychosocial measures. MAIN OUTCOME MEASURES Levels of circulating salivary IL-6 and CRP. RESULTS When predictors (birth country, recent housing instability, and incarceration history) were simultaneously entered into a regression model, only incarceration history was negatively associated with IL-6 [b = -.27, t(98) = -3.11, p = .002]. For CRP, the resulting regression model was not significant, [F(3, 98) = 2.23, p = .090]. CONCLUSION Although we had expected higher levels of syndemics to be associated with higher levels of circulating inflammation, in our sample, length of incarceration was associated with lower levels of circulating IL-6. Findings are therefore suggestive of a stress response disruption resulting in a negative feedback loop as the long-term impact of chronic stress on inflammation.
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Affiliation(s)
- Brooke G. Rogers
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Tiffany R. Glynn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sierra A. Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Thomas McCauley
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Mimiaga MJ, Hughto JM, Klasko-Foster L, Jin H, Mayer KH, Safren SA, Biello KB. Substance Use, Mental Health Problems, and Physical and Sexual Violence Additively Increase HIV Risk Between Male Sex Workers and Their Male Clients in Northeastern United States. J Acquir Immune Defic Syndr 2021; 86:305-312. [PMID: 33148992 PMCID: PMC8343953 DOI: 10.1097/qai.0000000000002563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Male sex workers (MSW) are disproportionately affected by HIV/AIDS, with an estimated HIV prevalence in the United States of 19.3%. Existing research suggests that MSW are also at risk of adverse psychosocial problems. Cross-sectional studies of MSW have suggested that co-occurring epidemics or a "syndemic" of psychosocial problems may increase vulnerability to HIV acquisition/transmission by elevated sexual risk. To the best of our knowledge, there are no published studies examining this relationship longitudinally among MSW. This study examined how a syndemic of 6 psychosocial problems result in additive risk for condomless anal sex (CAS) with male clients among a multicity, longitudinal cohort of MSW. SETTING Community-based organization and health center in 2 Northeastern US cities. METHODS Between 2015 and 2017, 100 MSW from Boston, MA and Providence, RI completed behavioral/psychosocial surveys at baseline, 6 months, and 12months. Generalized estimating equation modeling was used to examine the prospective relationship of additive psychosocial problems and subsequent CAS with male clients, adjusting for age, site, race/ethnicity, MSW-type, and HIV serostatus. RESULTS Mean age = 34.7 (SD = 11.8); 62% racial/ethnic minority; and 20% HIV+. The prevalence of 6 psychosocial syndemic problems was substantial at baseline and remained high at each time point (all within the past 6 months): 74% problematic depressive symptoms, 27% polydrug use (3+ drugs, not including stimulants), 57% stimulant (methamphetamine/cocaine/crack) use, 44% hazardous drinking, 15% experienced client-specific physical/sexual violence, and 57% childhood sexual abuse. Looking at the number of psychosocial problems experienced, 7% had zero, 27% had 1, 24% had 2, 27% had 3, and 15% had 4 or more. We identified a statistically significant positive "dose-response" relationship between the number of psychosocial problems and CAS with male clients over time, with the greatest odds of engaging in CAS with a male client over follow-up among those with 4 or more psychosocial problems (adjusted odds ratio = 5.18, 95% CI: 1.61 to 16.62). CONCLUSIONS Internet escorts and street-based MSW are likely to experience psychosocial problems and engaging in HIV sexual risk with male clients. The accumulation of psychosocial problems additively predicted CAS with male clients in a prospective cohort of MSW. The specification of psychosocial problems presents distinct treatment targets for HIV prevention among MSW in the United States.
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Affiliation(s)
- Matthew J. Mimiaga
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jaclyn M.W. Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Harry Jin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical, Center, Boston, MA, USA
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Katie B. Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Satyanarayana S, Safren SA, Rogers BG, Bainter SA, Christopoulos KA, Fredericksen RJ, Mathews WC, Moore RD, Mugavero MJ, Napravnik S, Carrico AW, Mimiaga MJ, Mayer KH, Crane HM. Estimating HIV transmissions in a large U.S. clinic-based sample: effects of time and syndemic conditions. J Int AIDS Soc 2021; 24:e25679. [PMID: 33724718 PMCID: PMC7962793 DOI: 10.1002/jia2.25679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Little is known about onward HIV transmissions from people living with HIV (PLWH) in care. Antiretroviral therapy (ART) has increased in potency, and treatment as prevention (TasP) is an important component of ending the epidemic. Syndemic theory has informed modelling of HIV risk but has yet to inform modelling of HIV transmissions. METHODS Data were from 61,198 primary HIV care visits for 14,261 PLWH receiving care through the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) at seven United States (U.S.) sites from 2007 to 2017. Patient-reported outcomes and measures (PROs) of syndemic conditions - depressive symptoms, anxiety symptoms, drug use (opiates, amphetamines, crack/cocaine) and alcohol use - were collected approximately four to six months apart along with sexual behaviours (mean = 4.3 observations). Counts of syndemic conditions, HIV sexual risk group and time in care were modelled to predict estimated HIV transmissions resulting from sexual behaviour and viral suppression status (HIV RNA < 400/mL) using hierarchical linear modelling. RESULTS Patients averaged 0.38 estimated HIV transmissions/100 patients/year for all visits with syndemic conditions measured (down from 0.83, first visit). The final multivariate model showed that per 100 patients, each care visit predicted 0.05 fewer estimated transmissions annually (95% confidence interval (CI): 0.03 to 0.06; p < 0.0005). Cisgender women, cisgender heterosexual men and cisgender men of undisclosed sexual orientation had, respectively, 0.47 (95% CI: 0.35 to 0.59; p < 0.0005), 0.34 (95% CI: 0.20 to 0.49; p < 0.0005) and 0.22 (95% CI: 0.09 to 0.35; p < 0.005) fewer estimated HIV transmissions/100 patients/year than cisgender men who have sex with men (MSM). Each within-patient syndemic condition predicted 0.18 estimated transmissions/100 patients/year (95% CI: 0.12 to 0.24; p < 0.0005). Each between-syndemic condition predicted 0.23 estimated HIV transmissions/100 patients/year (95% CI: 0.17 to 0.28; p < 0.0005). CONCLUSIONS Estimated HIV transmissions among PLWH receiving care in well-resourced U.S. clinical settings varied by HIV sexual risk group and decreased with time in care, highlighting the importance of TasP efforts. Syndemic conditions remained a significant predictor of estimated HIV transmissions notwithstanding the effects of HIV sexual risk group and time in care.
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Affiliation(s)
| | - Steven A Safren
- Department of PsychologyUniversity of MiamiCoral GablesFLUSA
- The Fenway Institute at Fenway HealthBostonMAUSA
| | - Brooke G Rogers
- Department of PsychologyUniversity of MiamiCoral GablesFLUSA
- Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | | | | | - Rob J Fredericksen
- Department of MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | | | | | | | | | - Adam W Carrico
- Department of Public Health SciencesUniversity of Miami School of MedicineMiamiFLUSA
| | - Matthew J Mimiaga
- The Fenway Institute at Fenway HealthBostonMAUSA
- UCLA Center for LGBTQ Advocacy, Research, and Health (C‐LARAH)Los AngelesCAUSA
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCAUSA
- Department of Psychiatry and Biobehavioral SciencesUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Kenneth H Mayer
- The Fenway Institute at Fenway HealthBostonMAUSA
- Massachusetts General Hospital Center for Global HealthBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Heidi M Crane
- Department of MedicineUniversity of Washington School of MedicineSeattleWAUSA
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Shenderovich Y, Boyes M, Esposti MD, Casale M, Toska E, Roberts KJ, Cluver L. Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa. BMC Public Health 2021; 21:172. [PMID: 33472607 PMCID: PMC7816135 DOI: 10.1186/s12889-020-10147-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. METHODS The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. RESULTS Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97-0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98-1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92-0.97, p<.0001) and anxiety (0.91, 95% CI 0.89-0.94, p<.0001) symptoms reported by adolescents. CONCLUSIONS Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.
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Affiliation(s)
- Yulia Shenderovich
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Mark Boyes
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Michelle Degli Esposti
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Marisa Casale
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Elona Toska
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | | | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Byrd KK, Hardnett F, Hou JG, Clay PG, Suzuki S, Camp NM, Shankle MD, Weidle PJ, Taitel MS. Improvements in Retention in Care and HIV Viral Suppression Among Persons with HIV and Comorbid Mental Health Conditions: Patient-Centered HIV Care Model. AIDS Behav 2020; 24:3522-3532. [PMID: 32415615 DOI: 10.1007/s10461-020-02913-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Patient-centered HIV Care Model (PCHCM) integrated community-based pharmacists with medical providers and required sharing of patient clinical information and collaborative therapy-related action planning. We determined the proportions of participants with HIV and mental health conditions who were retained in care and the proportion virally suppressed, pre- and post-implementation. Overall, we found a relative 13% improvement in both retention [60% to 68% (p = 0.009)] and viral suppression [79% to 90% (p < 0.001)]. Notable improvements were seen among persons triply diagnosed with HIV, mental illness and substance use [+ 36% (50% to 68%, p = 0.036) and + 32% (66% to 86%, p = 0.001) in retention and viral suppression, respectively]. There were no differences in the proportions of persons adherent to psychiatric medications, pre- to post-implementation, nor were there differences in the proportions of persons retained in care or virally suppressed by psychiatric medication adherence, post-implementation. PCHCM demonstrated that collaborations between community-based pharmacists and medical providers can improve HIV care continuum outcomes among persons with mental health conditions.
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Affiliation(s)
- Kathy K Byrd
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA.
| | - Felicia Hardnett
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA
| | - John G Hou
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA
| | - Patrick G Clay
- Department of Pharmacotherapy, University of North Texas Health Science Center System College of Pharmacy, Fort Worth, TX, USA
| | - Sumihiro Suzuki
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Nasima M Camp
- Department of Health, Research, Informatics, and Technology, ICF, Atlanta, GA, USA
| | | | - Paul J Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA
| | - Michael S Taitel
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA
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36
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Quinn KG, Voisin DR. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 2020; 17:290-300. [PMID: 32557117 DOI: 10.1007/s11904-020-00510-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- Factor-Intwentash School of Social Work, University of Toronto, Toronto, Canada
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37
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Safren SA, Harkness A, Lee JS, Rogers BG, Mendez NA, Magidson JF, Blashill AJ, Bainter S, Rodriguez A, Ironson G. Addressing Syndemics and Self-care in Individuals with Uncontrolled HIV: An Open Trial of a Transdiagnostic Treatment. AIDS Behav 2020; 24:3264-3278. [PMID: 32410049 PMCID: PMC7546114 DOI: 10.1007/s10461-020-02900-7] [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: 12/22/2022]
Abstract
Interventions addressing syndemics and ART adherence are needed for individuals with uncontrolled HIV and psychosocial problems. Twenty-seven participants with detectable HIV plasma viral load (PVL) or recent STI participated in an open trial of transdiagnostic adherence counseling and cognitive behavioral therapy. Outcomes were collected at baseline, 4-, and 8-months. Log PVL improved from baseline to 4-month (γ = - 1.13, 95% CI - 1.72, - 0.55, p < 0.001) and 8-month (γ = - 0.93, 95% CI - 1.57, - 0.30, p = 0.006), with more participants suppressed at 4- (χ2(1) = 9.09, p = 0.001) and 8-month (χ2(1) = 5.14, p = 0.016). Self-reported adherence improved across major assessments (γ = 0.87, 95% CI 0.28, 1.46, p = .005); Wisepill adherence did not. Negative affect declined during treatment (γ = - 0.28, 95% CI - 0.40, - 0.16, p < 0.001), with improvement at 4- (γ = - 4.34, 95% CI - 6.99, - 1.69, p = 0.002) but not 8-month. Positive affect trended positively during treatment and from baseline to 4-month, with significant 8-month improvement (γ = 3.84, 95% CI 0.33, 7.44, p = 0.04). Depressive symptoms did not change. In a complicated sample of participants selected for uncontrolled HIV, the intervention yielded improved PVL and self-reported adherence. Efforts to end HIV should improve upon strategies such as these, addressing syndemics. Registration: clinicaltrial.gov: NCT02696681.
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Affiliation(s)
- S A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA.
| | - A Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - J S Lee
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - B G Rogers
- Department of Medicine, Brown University, Providence, RI, USA
| | - N A Mendez
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - J F Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - A J Blashill
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - S Bainter
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - A Rodriguez
- Department of Medicine, University of Miami, Miami, FL, USA
| | - G Ironson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
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38
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Hershow RB, Reyes HLM, Ha TV, Chander G, Mai NVT, Sripaipan T, Frangakis C, Dowdy DW, Latkin C, Hutton HE, Pettifor A, Maman S, Go VF. Alcohol use, depressive symptoms, and intimate partner violence perpetration: A longitudinal analysis among men with HIV in northern Vietnam. PLoS One 2020; 15:e0240674. [PMID: 33064780 PMCID: PMC7567346 DOI: 10.1371/journal.pone.0240674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background While the link between alcohol use and male-perpetrated intimate partner violence (IPV) has been well-established, research is needed to test whether psychosocial factors interact with alcohol use to exacerbate IPV perpetration. We tested whether depressive symptoms influenced the strength and/or direction of the alcohol-IPV relationship among men with HIV in Vietnam. Methods This study is a secondary analysis using data from a randomized controlled trial conducted in Thai Nguyen, Vietnam. Participants were clinic patients with HIV and hazardous alcohol use. Questionnaires were administered at baseline, three, six, and 12 months. Alcohol use was assessed as proportion of days alcohol abstinent. Analyses were restricted to males who reported being married/cohabitating at baseline (N = 313). Multilevel growth models were used to test whether time-varying depressive symptoms modified the time-varying effect of alcohol use on IPV perpetration. Results Time-varying depressive symptoms modified the effect of proportion of days alcohol abstinent on IPV perpetration. However, the pattern of effect modification was not as expected, as reporting depressive symptoms weakened the alcohol-IPV relationship. At times when participants screened negative for depressive symptoms, those who reported higher proportion of days alcohol abstinent than usual had significantly lower odds of IPV perpetration (Odds Ratio [OR] = 0.17, 95% Confidence Interval 0.06, 0.45, p = 0.0004). At times when participants screened positive for depressive symptoms, there was no observed effect of alcohol use on IPV perpetration (OR = 4.28, 95% CI 0.80, 22.78, p = 0.09). Conclusion The findings highlight the complex nature of the alcohol-IPV relationship and the need to investigate the intersection between hazardous drinking, mental health, and IPV. Men who concurrently report depressive symptoms and heightened alcohol use may be socially isolated from an intimate partner or experiencing fatigue, leading to less alcohol-related IPV perpetration. Mental health interventions addressing depression and alcohol misuse integrated into HIV services may reduce IPV perpetration.
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Affiliation(s)
- Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - H. Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tran Viet Ha
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Yen Hoa Health Clinic, University of North Carolina Vietnam, Hanoi, Vietnam
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Constantine Frangakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David W. Dowdy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Carl Latkin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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39
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Maragh-Bass AC, Gamble T, El-Sadr WM, Hanscom B, Tolley EE. Exploring individual-level barriers to HIV medication adherence among men who have sex with men in the HIV Prevention Trials Network (HPTN 065) study. AIDS Care 2020; 33:1404-1413. [PMID: 33025791 DOI: 10.1080/09540121.2020.1828799] [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: 10/23/2022]
Abstract
African-American men who have sex with men (MSM) with HIV are more likely to have unsuppressed viral load than other racial/ethnic groups. HPTN 065 Study, completed in 2015, consisted of five interconnected study components conducted at clinics in Bronx, New York and Washington, D.C. Participants completed surveys with questions related to socio-demographic factors and individual-level HIV medication adherence barriers, such as forgetting doses or fear of taking medications in front of others. Descriptive analyses and ordinal logistic regression with robust standard errors were conducted. Fifty-seven per cent of participants (N = 359) were African-American (57.1%) and roughly 40% had no more than a high school education. Mean age was 48 years. Overall, MSM with viral load suppression identified fewer individual-level barriers to adherence (p < .01) and individuals with depressive symptoms identified a greater number of barriers to adherence (p < .01). Compared to African-Americans, white MSM had a lower likelihood of identifying barriers to adherence (p < .05). Findings suggest that individual-level barriers to HIV medication adherence are common among MSM, irrespective of time since diagnosis and viral suppression. Race-specific interventions which address intersectional stigma are needed to improve health outcomes among African-American MSM, who bear much of the burden of poor HIV outcomes in the United States.
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Affiliation(s)
| | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Brett Hanscom
- HIV Prevention Trials Network Statistical Center for HIV AIDS Research and Prevention, University of Washington Seattle, Seattle, WA, USA
| | - Elizabeth E Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences, Durham, NC, USA
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40
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Walters SM, Braksmajer A, Coston B, Yoon I, Grov C, Downing MJ, Teran R, Hirshfield S. A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1965-1978. [PMID: 31965453 PMCID: PMC7321855 DOI: 10.1007/s10508-020-01628-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 05/18/2023]
Abstract
Exchange sex is a behavior associated with HIV transmission risk among men who have sex with men (MSM). Few studies have examined exchange sex among HIV-positive MSM. We utilize a syndemic framework to account for co-occurring psychosocial problems that suggest the presence of intertwining epidemics (i.e., syndemics), which have not been examined within the context of exchange sex among HIV-positive MSM. In 2015, MSM were recruited via online sexual networking Web site and app advertisements for Sex Positive![+], a video-based online intervention that aimed to improve health outcomes for men living with HIV. Participants completed surveys every three months for a year. Surveys covered demographics, drug use, exchange sex, intimate partner violence (IPV), and past 2-week depressive symptoms. We conducted three logistic regression models to assess syndemic factors associated with exchange sex in the past 3 months. Of the 722 HIV-positive MSM included in the sample, 59 (8%) reported exchange sex in the past 3 months at 12-month follow-up. HIV-positive MSM who had more syndemic factors had greater odds of exchange sex. Exchange sex was associated with being African-American/Black, age 18-29 years, past and present experiences with IPV, stimulant use, polysubstance use, and depressive symptoms. Exchange sex was associated with multiple psychosocial factors, indicating exchange sex may be part of a syndemic involving substance use, depression, HIV, and IPV. Interventions should address the social and behavioral circumstances that perpetuate environments that can foster multiple negative health outcomes.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, 380 2nd Ave., Suite 306, NY 10010, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | | | - Bethany Coston
- Department of Gender, Sexuality, and Women's Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Irene Yoon
- Research and Advisory, Gartner L2, New York, NY, USA
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy and the CUNY Institute for Implementation Science in Population Health, New York, NY, USA
| | | | - Richard Teran
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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41
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Rendina HJ, Weaver L, Millar BM, López-Matos J, Parsons JT. Psychosocial Well-Being and HIV-Related Immune Health Outcomes among HIV-Positive Older Adults: Support for a Biopsychosocial Model of HIV Stigma and Health. J Int Assoc Provid AIDS Care 2020; 18:2325958219888462. [PMID: 31795813 PMCID: PMC6893929 DOI: 10.1177/2325958219888462] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Evidence suggests that psychosocial stress negatively impacts immunological health in HIV-positive individuals. However, few studies have explored this association in substance-using older adults living with HIV (OALWH). We evaluated the effect of depression, loneliness, substance use problems, and HIV stigma on primary markers of immune function in a sample of 120 OALWH with substance-related issues. HIV stigma correlated with the greatest number of factors, including depression, loneliness, and substance use problems. Older age and antiretroviral adherence were associated with viral suppression, which was in turn associated with higher percentage of CD4 count. Multivariate path analyses demonstrated that lower HIV stigma and viral suppression were the only factors independently associated with higher percentage of CD4 count, with a significant indirect effect of adherence on CD4 through viral suppression. HIV stigma emerged as the most salient factor associated with both psychosocial well-being and immune health in the current study, suggesting that it is a critical factor to consider in future interventions for the rapidly growing population of OALWH.
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Affiliation(s)
- H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Laurel Weaver
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Brett M Millar
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Jonathan López-Matos
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
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42
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Hershow RB, Reyes HLM, Ha TV, Chander G, Mai NVT, Sripaipan T, Frangakis C, Dowdy DW, Latkin C, Hutton HE, Pettifor A, Maman S, Go VF. Longitudinal analysis of alcohol use and intimate partner violence perpetration among men with HIV in northern Vietnam. Drug Alcohol Depend 2020; 213:108098. [PMID: 32563847 PMCID: PMC7372834 DOI: 10.1016/j.drugalcdep.2020.108098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol use is a known risk factor for male-perpetrated intimate partner violence (IPV), although few studies have been conducted globally and among men with HIV (MWH). We estimated the longitudinal effects of alcohol use on IPV perpetration among MWH. METHODS This study is a secondary analysis of randomized controlled trial data among male and female antiretroviral treatment patients with hazardous alcohol use in Thai Nguyen, Vietnam. Analyses were restricted to male participants who were married/cohabitating (N = 313). Alcohol use was assessed as proportion days alcohol abstinent, heavy drinking, and alcohol use disorder (AUD) using the Timeline Followback and Mini International Neuropsychiatric Interview questionnaire. Multilevel modeling was used to estimate the effects of higher versus lower average alcohol use on IPV perpetration (between-person effects) and the effects of time-specific deviations in alcohol use on IPV perpetration (within-person effects). RESULTS Participants with higher average proportion days alcohol abstinent had decreased odds of IPV perpetration (adjusted Odds Ratio [aOR] = 0.43, p = 0.03) and those with higher average heavy drinking and AUD had increased odds of IPV perpetration (Heavy drinking: aOR = 1.05, p = 0.002; AUD: aOR = 4.74, p < 0.0001). Time-specific increases in proportion days alcohol abstinent were associated with decreased odds of IPV perpetration (aOR = 0.39, p = 0.02) and time-specific increases in AUD were associated with increased odds of IPV perpetration (aOR = 2.95, p = 0.001). Within-person effects for heavy drinking were non-significant. CONCLUSIONS Alcohol use is associated with IPV perpetration among Vietnamese men with HIV. In this context, AUD and frequent drinking are stronger correlates of IPV perpetration as compared to heavy drinking.
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Affiliation(s)
- Rebecca B Hershow
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - H Luz McNaughton Reyes
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Tran Viet Ha
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Hanoi, Viet Nam
| | - Geetanjali Chander
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Nguyen Vu Tuyet Mai
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Hanoi, Viet Nam
| | - Teerada Sripaipan
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Constantine Frangakis
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - David W Dowdy
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Audrey Pettifor
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Suzanne Maman
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
| | - Vivian F Go
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 302 Rosenau Hall, Chapel Hill, NC, 27599, USA
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43
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Rowell-Cunsolo TL, Hu G. Barriers to optimal antiretroviral therapy adherence among HIV-infected formerly incarcerated individuals in New York City. PLoS One 2020; 15:e0233842. [PMID: 32479552 PMCID: PMC7263611 DOI: 10.1371/journal.pone.0233842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/13/2020] [Indexed: 01/26/2023] Open
Abstract
In the United States (U.S.), the HIV infection rate is disproportionately high among incarcerated individuals. HIV-infected individuals typically receive antiretroviral therapy (ART) to suppress HIV and reduce the threat of transmission. Although HIV-infected individuals are generally ART-adherent while incarcerated, the public health benefits experienced during incarceration are often lost as HIV-infected individuals struggle to maintain optimal adherence post-incarceration. While the importance of maintaining adherence in the post-incarceration period has been acknowledged, research on barriers to ART adherence during this period is limited. To better understand post-release barriers to ART adherence, we conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City; we also followed up with 18 (90%) participants after three months to explore whether their adherence challenges changed over time. Viral load testing results from their most recent physician visit were also recorded at each interview. Interviews were transcribed using transcription software and reviewed for accuracy by a researcher. Thematic coding based on discussion guide prompts were then used to identify commonly mentioned barriers to adherence. The results identified four overarching themes that affected study participants’ efforts to adhere to their ART regimen: medication burden, forgetfulness, mental health and emotional difficulties, and perceived conflict between substance use and medication adherence. These barriers were the most commonly cited and largely persisted at three-month follow-up. The results suggest that interventions addressing these challenges are essential for promoting ART adherence among HIV-infected formerly incarcerated individuals. Effective interventions may include mobile-based text messaging reminders and those that facilitate patient-provider communication. Additionally, interventions or programs that integrate substance use and mental health treatment into HIV-related care, along with other types of behavioral health support, may also be beneficial for this population. Such interventions should be a routine part of discharge planning and support for incarcerated individuals returning to the community.
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Affiliation(s)
- Tawandra L. Rowell-Cunsolo
- Assistant Professor of Social Welfare Science, School of Nursing, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Gloria Hu
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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44
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Zepf R, Greene M, Hessol NA, Johnson MO, Santos GM, John MD, Dawson-Rose C. Syndemic conditions and medication adherence in older men living with HIV who have sex with men. AIDS Care 2020; 32:1610-1616. [PMID: 32468831 PMCID: PMC7784841 DOI: 10.1080/09540121.2020.1772954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For people living with HIV, lack of adherence to antiretroviral therapy (ART) is a serious problem and frequently results in HIV disease progression. Reasons for non-adherence include concomitant psychosocial health conditions – also known as syndemic conditions – such symptoms of depression or posttraumatic stress disorder (PTSD), past physical or sexual abuse, intimate partner violence (IPV), stimulant use, and binge drinking. The aim of this study was to investigate the association between syndemic conditions and medication adherence. The sample included 281 older men living with HIV who have sex with men (MSM). The study period was December 2012–July 2016. We observed the following syndemic conditions significantly decreased medication adherence: symptoms of depression (p = .008), PTSD (p = .002), and stimulant use (p < .0001). Past physical or sexual abuse, IPV, and binge drinking were not significantly associated with decreased medication adherence. The findings suggest that syndemic conditions may impact medication adherence in older MSM living with HIV.
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Affiliation(s)
- R Zepf
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - M Greene
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - N A Hessol
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA.,Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - M O Johnson
- Department of Medicine, Division of Epidemiology, University of California, San Francisco, CA, USA
| | - G M Santos
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,HIV Prevention, San Francisco Department of Public Health, San Francisco, CA, USA
| | - M D John
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - C Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
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45
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Willie TC, Kershaw TS, Blackstock O, Galvao RW, Safon CB, Tekeste M, Ogburn DF, Wilbourn B, Modrakovic D, Taggart T, Kaplan C, Caldwell A, Calabrese SK. Racial and ethnic differences in women's HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic. AIDS Care 2020; 33:219-228. [PMID: 32408837 DOI: 10.1080/09540121.2020.1762067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women with syndemic conditions, i.e., two or more co-occurring epidemics, are at elevated risk for HIV acquisition and are therefore prime candidates for pre-exposure prophylaxis (PrEP). However, PrEP uptake remains low among women, especially among Black and Hispanic women. This study examined associations of syndemic conditions with PrEP attitudes and HIV risk among women, and the moderating effect of race and ethnicity. In 2017, 271 non-Hispanic Black, non-Hispanic White, and Hispanic, PrEP-eligible women engaged in care at Planned Parenthood in the northeastern region of the U.S. completed an online survey. Participants reported syndemic conditions (i.e., intimate partner violence, depression, substance use), PrEP attitudes (e.g., PrEP interest), HIV sexual risk (e.g., multiple male sexual partners), and sociodemographics. Structural equation modeling was used to examine the effects of syndemic conditions on PrEP attitudes and HIV risk, and the moderating effect of race and ethnicity. Women with more syndemic conditions had a higher odds of reporting multiple male sexual partners. Syndemic conditions were positively associated with PrEP attitudes for Hispanic women than non-Hispanic Black and White women. Women with syndemic conditions, particularly Hispanic women, may be receptive to interventions promoting PrEP.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Oni Blackstock
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Rachel W Galvao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cara B Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Health Law, Policy, and Management, Boston University, Boston, MA, USA
| | - Mehrit Tekeste
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brittany Wilbourn
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Tamara Taggart
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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46
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Penrose K, Robertson M, Nash D, Harriman G, Irvine M. Social Vulnerabilities and Reported Discrimination in Health Care Among HIV-Positive Medical Case Management Clients in New York City. STIGMA AND HEALTH 2020; 5:179-187. [PMID: 32432165 PMCID: PMC7236577 DOI: 10.1037/sah0000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2024]
Abstract
We aimed to investigate the extent to which social vulnerabilities correlated with lifetime experience of discrimination in healthcare among people with HIV (PWH) receiving services to improve treatment adherence and viral suppression. Individuals (N=687) enrolled in a Ryan White Part A medical case management program were surveyed about discrimination experienced in healthcare settings, reasons for any discrimination faced, and self-reported health. We merged data from the survey with data from the New York City HIV Surveillance Registry and a programmatic database to obtain client sociodemographic and clinical characteristics and reported history of social vulnerabilities. Thirty-nine percent of participants reported lifetime experience of discrimination in healthcare settings; individuals with a history of at least three social vulnerabilities (mental health diagnosis, incarceration, substance use, and/or housing instability) had more than twice the odds of reporting discrimination than individuals who did not report any of these social vulnerabilities (aOR, 2.33 [95% CI, 1.43 - 3.83]). Among individuals who reported discrimination in healthcare, those who cited HIV status or substance use as reasons for discrimination were significantly more likely to report a higher number of social vulnerabilities (p=0.04 and p=0.009, respectively), with discrimination due to HIV status most strongly associated with a mental health diagnosis. These findings underscore the importance of acknowledging life experience and psychosocial barriers in provider interactions with PWH. They also highlight a need for monitoring provider attitudes and behaviors regarding intersectional stigmas related not only to factors such as race and sexual orientation, but also to social vulnerabilities.
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Affiliation(s)
- Katherine Penrose
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Graham Harriman
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
| | - Mary Irvine
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
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47
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Blashill AJ, Brady JP, Rooney BM, Rodriguez-Diaz CE, Horvath KJ, Blumenthal J, Morris S, Moore DJ, Safren SA. Syndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:125-135. [PMID: 31591666 PMCID: PMC7262779 DOI: 10.1007/s10508-019-01470-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 04/27/2019] [Accepted: 05/15/2019] [Indexed: 05/09/2023]
Abstract
Young Latino men who have sex with men (MSM) are a highly vulnerable population for HIV infection. Pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention tool that may aid in reducing the disparity in HIV incidence among Latino MSM. However, PrEP use is disproportionally low among Latino MSM and, therefore, identifying barriers along the PrEP continuum of care (the "PrEP cascade") would provide insight into how to best deploy PrEP interventions. Syndemics theory is a prominent framework employed in HIV prevention; however, to date, no known studies have applied this theory to PrEP. Thus, the aim of the current study was to explore the association between syndemics and the PrEP cascade, including the degree to which psychosocial and structural syndemic constructs are related to the PrEP cascade. Participants were 151 young Latino MSM (M age = 24 years; SD = 3) residing in San Diego, California, who completed a battery of online self-report measures. Results indicated high levels of syndemic indicators and varying levels of engagement across the PrEP cascade. As syndemic indicators increased, the odds of engagement across the PrEP cascade were significantly lowered. Psychosocial and structural syndemic factors accounted for unique variance in the PrEP cascade. Results highlight the need for combination interventions that address both psychosocial and structural barriers to PrEP use and persistence among young Latino MSM.
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Affiliation(s)
- Aaron J Blashill
- Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA, 92120, USA.
- Department of Psychology, San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - John P Brady
- Department of Psychology, San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Benjamin M Rooney
- Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA, 92120, USA
| | - Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, The George Washington University-Milken Institute School of Public Health, Washington, DC, USA
| | - Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jill Blumenthal
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Sheldon Morris
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - David J Moore
- Department of Psychology, San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Steven A Safren
- College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
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48
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Harkness A, Rogers BG, Puccinelli M, Ivardic I, Ironson G, Safren SA. Engaging, retaining, and providing transdiagnostic integrated cognitive-behavioral therapy and motivational interviewing for underserved people with HIV. ACTA ACUST UNITED AC 2019; 57:15-22. [PMID: 31855041 DOI: 10.1037/pst0000270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
People with HIV experience elevated levels of co-occurring psychosocial concerns, which can interfere with HIV-related self-care behaviors, such as medication adherence. We recently developed transdiagnostic, integrated cognitive-behavioral therapy and motivational interviewing psychotherapy to address interrelated psychosocial problems (syndemics) that can interfere with medication adherence and self-care among people with uncontrolled HIV (i.e., a detectable viral load). Through completion of a field trial that included development, clinical supervision, treatment, and administrative coordination of this project, we identified recommendations for engaging, retaining, and delivering transdiagnostic cognitive-behavioral therapy/motivational interviewing to individuals with HIV and experiencing psychosocial and structural barriers to mental and physical health. We describe these recommendations, which include (a) building the relationship; (b) addressing HIV in the context of syndemics; (c) attending to the impact of stigma on health; (d) being flexible in delivering the treatment; (e) managing emergent crises with relevant skill material; (f) tailoring the treatment to education, language, and sociocultural context; (g) implementing problem-solving skills for structural barriers; (h) scheduling flexibly and following up; (i) colocating mental health services and coordinating among providers; and (j) providing a comfortable and affirming physical space. In addition to describing these recommendations, we provide clinical examples and highlight empirical research to illustrate and support using these recommendations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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49
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Ramsey S, Ames E, Uber J, Habib S, Clark S. A Mobile Health App to Improve HIV Medication Adherence: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e15356. [PMID: 31719030 PMCID: PMC6881780 DOI: 10.2196/15356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/31/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence. OBJECTIVE The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes. METHODS This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations. RESULTS Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020. CONCLUSIONS This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus. TRIAL REGISTRATION ClinicalTrials.gov NCT02676128; https://clinicaltrials.gov/ct2/show/NCT02676128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15356.
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Affiliation(s)
- Susan Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | - Evan Ames
- Rhode Island Hospital, Providence, RI, United States
| | - Julia Uber
- Rhode Island Hospital, Providence, RI, United States
| | - Samia Habib
- Rhode Island Hospital, Providence, RI, United States
| | - Seth Clark
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
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50
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Glynn TR, Safren SA, Carrico AW, Mendez NA, Duthely LM, Dale SK, Jones DL, Feaster DJ, Rodriguez AE. High Levels of Syndemics and Their Association with Adherence, Viral Non-suppression, and Biobehavioral Transmission Risk in Miami, a U.S. City with an HIV/AIDS Epidemic. AIDS Behav 2019; 23:2956-2965. [PMID: 31392443 DOI: 10.1007/s10461-019-02619-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Miami is a Southeastern United States (U.S.) city with high health, mental health, and economic disparities, high ethnic/racial diversity, low resources, and the highest HIV incidence and prevalence in the country. Syndemic theory proposes that multiple, psychosocial comorbidities synergistically fuel the HIV/AIDS epidemic. People living with HIV/AIDS in Miami may be particularly affected by this due to the unique socioeconomic context. From April 2017 to October 2018, 800 persons living with HIV/AIDS in a public HIV clinic in Miami completed an interviewer-administered behavioral and chart-review cross-sectional assessment to examine the prevalence and association of number of syndemics (unstable housing, low education, depression, anxiety, binge drinking, drug use, violence, HIV-related stigma) with poor ART adherence, unsuppressed HIV viral load (≥ 200 copies/mL), and biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load). Overall, the sample had high prevalence of syndemics (M = 3.8), with almost everyone (99%) endorsing at least one. Each syndemic endorsed was associated with greater odds of: less than 80% ART adherence (aOR 1.64, 95% CI 1.38, 1.98); having unsuppressed viral load (aOR 1.16, 95% CI 1.01, 1.33); and engaging in condomless sex in the context of unsuppressed viral load (1.78, 95% CI 1.30, 2.46). The complex syndemic of HIV threatens to undermine the benefits of HIV care and are important to consider in comprehensive efforts to address the disproportionate burden of HIV/AIDS in the Southern U.S. Achieving the 90-90-90 UNAIDS and the recent U.S. "ending the epidemic" targets will require efforts addressing the structural, social, and other syndemic determinants of HIV treatment and prevention.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Lunthita M Duthely
- Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
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