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Smith JD, Li DH, Merle JL, Keiser B, Mustanski B, Benbow ND. Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations. Implement Sci 2024; 19:10. [PMID: 38331832 PMCID: PMC10854146 DOI: 10.1186/s13012-024-01345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient's health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term-adjunctive interventions-to classify change methods that are distinct from the common intervention/strategy taxonomy. MAIN TEXT Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients' motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention ("the thing"), as an adjunctive intervention, or an implementation strategy in different studies-further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients' attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients' utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided. CONCLUSION Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Third Coast Center for AIDS Research, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nanette D Benbow
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wiewel EW, Zhong Y, Xia Q, Beattie CM, Brown PA, Farquhar PX, Rojas JF. Homelessness and housing assistance among persons with HIV, and associations with HIV care and viral suppression, New York City 2018. PLoS One 2023; 18:e0285765. [PMID: 37172065 PMCID: PMC10180639 DOI: 10.1371/journal.pone.0285765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/01/2023] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVES To measure housing assistance and homelessness among persons living with HIV (PLWH) and their association with health. METHODS Exposure categories were: experiencing homelessness (per emergency shelter use or self-report), receiving housing assistance (per housing subsidy) without homelessness, or neither homelessness nor receiving housing assistance. Outcomes were: engagement (≥1 visit) and retention (≥2 visits ≥90 days apart) in HIV-related medical care and one-time (latest viral load) and durable (≥1 viral load test, all suppressed) HIV viral suppression (<200 copies/mL). Among PLWH in New York City (NYC), we calculated and conducted modified Poisson regressions of the four outcomes according to exposure category. RESULTS During 2018, 45% of NYC's 84,053 PLWH received housing assistance, and 8% experienced homelessness. Relative to homelessness, receipt of assistance without homelessness was associated with 3-7% higher adjusted relative risk (ARR) of engagement and retention in care and 31-64% higher ARR of one-time and durable viral suppression. Relative to not receiving assistance, receipt of assistance without homelessness was associated with 6-18% higher ARR of care and 2-5% lower ARR of viral suppression. CONCLUSIONS Programs promoting housing stability may support HIV care and viral suppression, particularly if preventing homelessness. These may help improve HIV care and suppression rates.
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Affiliation(s)
- Ellen Weiss Wiewel
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Yaoyu Zhong
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Qiang Xia
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Christopher M Beattie
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Paul A Brown
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Pam X Farquhar
- New York City Department of Social Services, New York, NY, United States of America
| | - John F Rojas
- New York City Department of Social Services, New York, NY, United States of America
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Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
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Molecular Epidemiology of Individuals Experiencing Unstable Housing or Living Homeless at HIV Diagnosis: Analysis of HIV Surveillance Data in King County, Washington. AIDS Behav 2022; 26:3459-3468. [PMID: 35445995 DOI: 10.1007/s10461-022-03689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/01/2022]
Abstract
We examined patterns of genetic clustering among individuals diagnosed with HIV between 2010 and 2018 using data from King County, Washington's National HIV Surveillance System. Among 2,371 individuals newly diagnosed with HIV, 231 (10%) experienced unstable housing or were living homeless at the time of diagnosis. Among the 1,658 (70%) people with an available HIV-1 pol gene sequence, 1,071 (65%) were identified to be part of 296 genetic clusters. In our analysis, housing status was not associated with genetic clustering (OR 1.02; 95%CI:0.75,1.39). After adjusting for demographic and behavioral factors, people who were living homeless at HIV diagnosis had 35% lower odds of being identified as part of a genetic cluster (AOR 0.65; 95%CI:0.44,0.95) compared to people with stable housing. Our findings highlight that people experiencing unstable housing are disproportionately burdened by HIV, and that within this population in King County, being in a genetic cluster is predominantly associated with substance use.
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Wu K, Tie Y, Dasgupta S, Beer L, Marcus R. Injection and Non-Injection Drug Use Among Adults with Diagnosed HIV in the United States, 2015-2018. AIDS Behav 2022; 26:1026-1038. [PMID: 34536178 DOI: 10.1007/s10461-021-03457-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
Understanding behavioral characteristics and health outcomes of people with HIV (PWH) who inject drugs and PWH who use drugs, but do not inject, can help inform public health interventions and improve HIV clinical outcomes. However, recent, nationally representative estimates are lacking. We used 2015-2018 Medical Monitoring Project data to examine health outcome differences among adults with diagnosed HIV who injected drugs or who only used non-injection drugs in the past year. Data were obtained from participant interviews and medical record abstraction. We reported weighted percentages and prevalence ratios with predicted marginal means to assess differences between groups (P < 0.05). PWH who injected drugs were more likely to engage in high-risk sex; experience depression and anxiety symptoms, homelessness, and incarceration; and have lower levels of care retention, antiretroviral therapy adherence, and viral suppression. Tailored, comprehensive interventions are critical for improving outcomes among PWH who use drugs, particularly among those who inject drugs.
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Aquino G, Byrne M, Dorsey K, Siegel M, Mitchell O, Grant S, Fox A, Lum G, Allston A, Monroe A, Doshi R. Examining Retention in HIV Care and HIV Suppression on Housing Services Intake at a Washington, DC Community Based Organization. J Community Health 2021; 46:861-868. [PMID: 33507489 DOI: 10.1007/s10900-020-00959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
In Washington, DC, 2% of residents are living with HIV, with 15.3% of them experiencing homelessness. Additionally, over half of DC-area renters are paying over 30% of their income for housing. The primary objective of this study was to describe HIV outcomes at initial intake at Housing Counseling Services (HCS). This retrospective study included adults with HIV completing HCS intake between 2015 and 2018 and linked HCS data with DC Department of Health (DOH) HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) surveillance data. Proportions of individuals with retention in care (RIC) and viral suppression (VS) were compared across client subgroups using chi-square or rank sum tests. The sample of 734 participants was mostly male (67%), Non-Hispanic Black (89%), had MSM as the HIV transmission risk factor (44%) and had rental housing (60%). Most participants (634/734, 86%) were RIC at HCS intake. A majority of participants (477/621 or 77%) had VS at intake. Older age was associated with VS (p = 0.0007). Homeless individuals (with intake from the street) were less likely to be VS (4.8% vs. 11.1%, p < 0.0045). Our results suggest that PWH who have unstable housing or who are homeless may need additional support services for maintaining RIC and VS, as the proportion meeting those benchmarks was not at goal when they sought services at HCS.
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Affiliation(s)
- Gabrielle Aquino
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA
| | - Kerri Dorsey
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
| | | | | | - Sherita Grant
- District of Columbia Department of Health, Washington, DC, USA
| | - Anthony Fox
- District of Columbia Department of Health, Washington, DC, USA
| | - Garrett Lum
- District of Columbia Department of Health, Washington, DC, USA
| | - Adam Allston
- District of Columbia Department of Health, Washington, DC, USA
| | - Anne Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.
| | - Rupali Doshi
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
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7
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Truman BI, Moonesinghe R, Brown YT, Chang MH, Mermin JH, Dean HD. Differential Association of HIV Funding With HIV Mortality by Race/Ethnicity, United States, 1999-2017. Public Health Rep 2020; 135:149S-157S. [PMID: 32735185 DOI: 10.1177/0033354920912716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017. METHODS We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant (P < .05) changes at joinpoints, and 2-sided t tests indicated significant APCs in AADRs. RESULTS Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was -9.4% (95% CI, -10.9% to -7.8%) for Hispanic residents, -7.8% (95% CI, -9.0% to -6.6%) for non-Hispanic black residents, -6.7% (95% CI, -9.3% to -4.0%) for non-Hispanic white residents, and -5.2% (95% CI, -7.8% to -2.5%) for non-Hispanic API+AI/AN residents. CONCLUSIONS Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.
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Affiliation(s)
- Benedict I Truman
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ramal Moonesinghe
- 1242 Office of Minority Health and Health Equity, Office of the Deputy Director for Public Health Service and Implementation Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yolanda T Brown
- 1242 Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Man-Huei Chang
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan H Mermin
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hazel D Dean
- 1242 Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wainwright JJ, Beer L, Tie Y, Fagan JL, Dean HD. Socioeconomic, Behavioral, and Clinical Characteristics of Persons Living with HIV Who Experience Homelessness in the United States, 2015-2016. AIDS Behav 2020; 24:1701-1708. [PMID: 31628555 PMCID: PMC7165020 DOI: 10.1007/s10461-019-02704-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homelessness is a substantial barrier to consistent, recommended HIV care, access and adherence to antiretroviral therapy (ART), and sustained viral suppression, thus increasing the risk for morbidity and transmission. We used data from the Medical Monitoring Project for June 1, 2015-May 31, 2017 to estimate the weighted prevalence of homelessness among persons with diagnosed HIV (PWH) (N = 7665) overall and by selected sociodemographic, behavioral, and clinical characteristics. Prevalence of homelessness was 8.5%. PWH experiencing homelessness were > 3 times as likely to have needed and not received shelter or housing services (32% vs. 10%), > 4 times as likely to inject drugs (9% vs. 2%), and > 7 times as likely to engage in exchange sex (10% vs. 1%), respectively, compared with PWH who did not experience homelessness. Homelessness was associated with lower HIV care retention, ART dose adherence, and sustained viral suppression. This analysis demonstrates substantial need for enhanced treatment, care, and service delivery for PWH experiencing homelessness. Research has demonstrated that housing assistance programs improve HIV-related outcomes and diminish HIV risk behaviors; therefore, housing assistance for PWH should be prioritized in public health policies and practice.
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Affiliation(s)
- Jacob J Wainwright
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA.
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA
| | - Jennifer L Fagan
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, 30329, USA
| | - Hazel D Dean
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zhong Y, Beattie CM, Rojas J, Farquhar XP, Brown PA, Wiewel EW. Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014-2017. Am J Public Health 2020; 110:1068-1075. [PMID: 32437285 DOI: 10.2105/ajph.2020.305660] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017.Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]).Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length.Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.
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Affiliation(s)
- Yaoyu Zhong
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Christopher M Beattie
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - John Rojas
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - X Pamela Farquhar
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Paul A Brown
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Ellen W Wiewel
- At the time of the analysis, all authors were with the New York City Department of Health and Mental Hygiene, Long Island City, NY
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Masters MC, Krueger KM, Williams JL, Morrison L, Cohn SE. Beyond one pill, once daily: current challenges of antiretroviral therapy management in the United States. Expert Rev Clin Pharmacol 2019; 12:1129-1143. [PMID: 31774001 DOI: 10.1080/17512433.2019.1698946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Modern antiretroviral therapy (ART) has revolutionized HIV treatment. ART regimens are now highly efficacious, well-tolerated, safe, often with one multi-drug pill, once-daily regimens available. However, clinical challenges persist in managing ART in persons with HIV (PWH), such as drug-drug interactions, side effects, pregnancy, co-morbidities, and adherence.Areas Covered: In this review, we discuss the ongoing challenges of ART for adults in the United States. We review the difficulties of initiating ART and maintaining therapy throughout adulthood and discuss new agents and strategies under investigation to address these issues. A PubMed search was utilized to identify relevant publications and guidelines through July 2019.Expert Opinion: Challenges persist in initiation and maintenance of ART. An individual's coexisting medical, social and personal factors must be considered in selecting and continuing ART to ensure safety, tolerability, and efficacy throughout adulthood. Continued development of new therapeutics and novel approaches to ART, such as long acting drugs or dual therapy, are needed to respond to many of these challenges. In addition, future research must address therapeutic disparities for populations historically underrepresented in clinical trials, including women, people aging with HIV, and those with complex comorbidities.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Krueger
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janna L Williams
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsay Morrison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Padilla M, Frazier EL, Carree T, Luke Shouse R, Fagan J. Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States - Medical Monitoring Project, 2009-2015. AIDS Care 2019; 32:594-599. [PMID: 31650855 DOI: 10.1080/09540121.2019.1683808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homelessness is a challenge to retention in HIV care and adherence to antiretroviral therapy. We describe the sociodemographic and behavioral characteristics of HIV-positive adults who reported recent homelessness. The Medical Monitoring Project is a complex sample survey of HIV-positive adults receiving medical care in the United States. We used weighted interview and medical record data collected from June 2009 to May 2015 to estimate the prevalence of depression, substance use, and HIV risk behaviors among adults experiencing recent homelessness. From 2009 to 2015, 8.3% of HIV-positive adults experienced recent homelessness. Homeless adults were more likely than housed adults to have major depression, to binge drink, use non-injection drugs, use injection drugs, and smoke. Over 60% of homeless adults were sexually active during the past year, with homeless adults reporting more condomless sex with an HIV-negative or unknown status sex partner than housed adults. Programs attempting to improve the health outcomes of HIV-positive homeless persons and reduce ongoing HIV transmission can focus on providing basic needs, such as housing, and ancillary services, such as mental health counseling or substance abuse treatment and counseling.
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Affiliation(s)
- Mabel Padilla
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma L Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamara Carree
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,ICF International, Atlanta, GA, USA
| | - R Luke Shouse
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fagan
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Towe VL, Wiewel EW, Zhong Y, Linnemayr S, Johnson R, Rojas J. A Randomized Controlled Trial of a Rapid Re-housing Intervention for Homeless Persons Living with HIV/AIDS: Impact on Housing and HIV Medical Outcomes. AIDS Behav 2019; 23:2315-2325. [PMID: 30879212 DOI: 10.1007/s10461-019-02461-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a randomized controlled trial to determine whether, for homeless persons living with HIV/AIDS (PLWHA), rapid re-housing can improve housing and HIV viral suppression more than standard housing assistance. We recruited 236 PLWHA from HIV emergency housing in New York City (NYC) and randomized them to: (1) Enhanced Housing Placement Assistance (EHPA), i.e., immediate assignment to a case manager to rapidly re-house the client and provide 12 months of case management or (2) usual services, i.e., referral to an NYC housing placement program for which all HIV emergency housing residents were eligible. We compared time to stable housing placement and percentage virally suppressed from baseline to 12 months. EHPA clients were placed faster than usual services clients (p = 0.02; 25% placed by 150 days vs. 243 days, respectively), more likely to be placed [adjusted hazards ratio = 1.8; 95% confidence interval(CI) 1.1-2.8], and twice as likely to achieve or maintain suppression (adjusted odds ratio 2.1; 95% CI 1.1-4.0).
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Affiliation(s)
| | - Ellen Weiss Wiewel
- Division of Disease Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN-44, Long Island City, NY, 11101, USA.
| | - Yaoyu Zhong
- Division of Disease Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN-44, Long Island City, NY, 11101, USA
| | | | - Rachel Johnson
- International Clinical Research Center (ICRC), University of Washington, Seattle, WA, USA
| | - John Rojas
- New York City Department of Social Services, New York, NY, USA
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13
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Cox J, Gutner C, Kronfli N, Lawson A, Robbins M, Nientker L, Ostawal A, Barber T, Croce D, Hardy D, Jessen H, Katlama C, Mallolas J, Rizzardini G, Alcorn K, Wohlfeiler M, Le Fevre E. A need for implementation science to optimise the use of evidence-based interventions in HIV care: A systematic literature review. PLoS One 2019; 14:e0220060. [PMID: 31425524 PMCID: PMC6699703 DOI: 10.1371/journal.pone.0220060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022] Open
Abstract
To improve health outcomes in people living with HIV, adoption of evidence-based interventions (EBIs) using effective and transferable implementation strategies to optimise the delivery of healthcare is needed. ViiV Healthcare's Positive Pathways initiative was established to support the UNAIDS 90-90-90 goals. A compendium of EBIs was developed to address gaps within the HIV care continuum, yet it was unknown whether efforts existed to adapt and implement these EBIs across diverse clinical contexts. Therefore, this review sought to report on the use of implementation science in adapting HIV continuum of care EBIs. A systematic literature review was undertaken to summarise the evaluation of implementation and effectiveness outcomes, and report on the use of implementation science in HIV care. Ten databases were reviewed to identify studies (time-period: 2013-2018; geographic scope: United States, United Kingdom, France, Germany, Italy, Spain, Canada, Australia and Europe; English only publications). Studies were included if they reported on people living with HIV or those at risk of acquiring HIV and used interventions consistent with the EBIs. A broad range of study designs and methods were searched, including hybrid designs. Overall, 118 publications covering 225 interventions consistent with the EBIs were identified. These interventions were evaluated on implementation (N = 183), effectiveness (N = 81), or both outcomes (N = 39). High variability in the methodological approaches was observed. Implementation outcomes were frequently evaluated but use of theoretical frameworks was limited (N = 13). Evaluations undertaken to assess effectiveness were inconsistent, resulting in a range of measures. This review revealed extensive reporting on implementation science as defined using evaluation outcomes. However, high variability was observed in how implementation outcomes and effectiveness were defined, quantified, and reported. A more specific and consistent approach to conducting and reporting on implementation science in HIV could facilitate achievement of UNAIDS 90-90-90 targets.
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Affiliation(s)
- Joseph Cox
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | | | - Nadine Kronfli
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Anna Lawson
- ViiV Healthcare, London, England, United Kingdom
| | | | | | | | - Tristan Barber
- Chelsea and Westminster Hospital, London, England, United Kingdom
| | | | - David Hardy
- Whitman-Walker Centre, Washington, DC, United States of America
| | | | | | | | | | - Keith Alcorn
- NAM publications, London, England, United Kingdom
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14
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Wiewel EW, Borrell LN, Jones HE, Maroko AR, Torian LV. Healthcare facility characteristics associated with achievement and maintenance of HIV viral suppression among persons newly diagnosed with HIV in New York City. AIDS Care 2019; 31:1484-1493. [PMID: 30909714 DOI: 10.1080/09540121.2019.1595517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Health care facility characteristics have been shown to influence intermediary health outcomes among persons with HIV, but few longitudinal studies of suppression have included these characteristics. We studied the association of these characteristics with the achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older newly diagnosed with HIV between 2006 and 2012. The NYC HIV surveillance registry provided individual and facility data (N = 12,547 persons). Multivariable proportional hazards models estimated the likelihood of individual achievement and maintenance of suppression by type of facility, patient volume, and distance from residence, accounting for facility clustering and for individual-level confounders. Viral suppression was achieved within 12 months by 44% and at a later point by another 29%. Viral suppression occurred at a lower rate in facilities with low HIV patient volume (e.g., 10-24 diagnoses per year vs. ≥75, adjusted hazard ratio [AHR] = 0.87, 95% confidence interval [CI] 0.79-0.95) and in screening/diagnosis sites (vs. hospitals, AHR = 0.86, 95% CI 0.80-0.92). Among persons achieving viral suppression, 18% experienced virologic failure within 12 months and 24% later. Those receiving care at large outpatient facilities or large private practices had a lower rate of virologic failure (e.g., large outpatient facilities vs. large hospitals, AHR = 0.63, 95% CI 0.53-0.75). Achievement and maintenance of viral suppression were associated with facilities with higher HIV-positive caseloads. Some facilities with small caseloads and screening/diagnosis sites may need stronger care or referral systems to help persons with HIV achieve and maintain viral suppression.
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Affiliation(s)
- Ellen W Wiewel
- Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| | - Luisa N Borrell
- Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Heidi E Jones
- Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Andrew R Maroko
- Environmental, Occupational, and Geospatial Health Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Lucia V Torian
- Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
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15
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Multilevel Factors Associated with a Lack of Viral Suppression Among Persons Living with HIV in a Federally Funded Housing Program. AIDS Behav 2019; 23:784-791. [PMID: 30680539 DOI: 10.1007/s10461-019-02399-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Persons with HIV who are receiving housing services often have high rates of engagement in care, yet many are not virally suppressed. We linked data from the New York City Housing Opportunities for Persons with AIDS (HOPWA) program to electronically reported laboratory tests from the HIV surveillance registry to examine factors associated with a lack of viral suppression. Of 1491 HOPWA consumers, 523 (35.1%) were not durably suppressed, and 253 (17.0%) were unsuppressed at their last viral load test. Substance use, age < 27 years, and emergency housing all independently predicted lack of durable viral suppression and lack of viral suppression at last viral load test.
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16
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Hawk M, Maulsby C, Enobun B, Kinsky S. HIV Treatment Cascade by Housing Status at Enrollment: Results from a Retention in Care Cohort. AIDS Behav 2019; 23:765-775. [PMID: 30334234 DOI: 10.1007/s10461-018-2295-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Though housing instability is linked to poor HIV health outcomes, studies that assess the HIV treatment cascade by housing status are limited. Using data from a multi-site Retention in Care initiative we constructed HIV treatment cascades for participants (n = 463) of five grantee sites. We found no significant differences in viral suppression at follow-up among participants who were unstably housed at enrollment (49%) as compared to those who were stably housed at enrollment (54%). Among participants with available data at 6- or 12-month follow-up, 94% were engaged in care, 90% were retained in, 94% were on ART, and 71% had suppressed viral load. Some site-level differences were noted; at two of the sites participants who were stably housed were more likely to be retained in care and on ART. Overall, findings demonstrated that participants moved successfully through the HIV treatment cascade regardless of housing status at enrollment, suggesting that evidence-based support and services to help people living with HIV/AIDS can help mitigate barriers to engagement in care associated with lack of stable housing.
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17
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Monroe AK, Lesko CR, Chander G, Lau B, Keruly J, Crane HM, Amico KR, Napravnik S, Quinlivan EB, Mugavero MJ. Ancillary service needs among persons new to HIV care and the relationship between needs and late presentation to care. AIDS Care 2019; 31:1131-1139. [PMID: 30776911 DOI: 10.1080/09540121.2019.1576840] [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] [Indexed: 10/27/2022]
Abstract
Ancillary service needs likely influence time to diagnosis and presentation for HIV care. The effect of both met and unmet needs on late presentation to HIV care is not well understood. We used baseline data from 348 people with HIV (PWH) with no prior HIV care who enrolled in iENGAGE (a randomized controlled trial (RCT) of an intervention to support retention in care) at one of four HIV clinics in the US. A standardized baseline questionnaire collected information on ancillary service needs, and whether each need was presently unmet. We examined covariates known to be associated with disease stage at presentation to care and their association with needs. We subsequently assessed the relationship of needs with CD4 accounting for those other covariates by estimating prevalence ratios (PR) using inverse probability weights. Most patients enrolling in the RCT were male (79%) and the majority were Black (62%); median age was 34 years. Prevalence of any reported individual need was 69%. One-third of the sample had a baseline CD4 cell count <200, 42% between 200 and 499 and 27% ≥500. There was no statistically significant association between need or unmet need and baseline CD4. In general, psychiatric health and SU issues (depression, anxiety, and drug use) were consistently associated with higher prevalence of need (met and unmet). Additionally, the Black race was associated with higher basic resource needs (housing: PR 1.67, 95%CI 1.08-2.59; transportation: PR 1.65, 95% CI 1.12-2.45). Ancillary service needs (met and unmet) were common among patients new to HIV care and impacted vulnerable subgroups. However, we found no evidence that reporting a specific individual need, whether met or unmet, was associated with a timely presentation to HIV care. The impact of needs on subsequent steps of the HIV care continuum will be examined with longitudinal data.
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Affiliation(s)
- Anne K Monroe
- a Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Epidemiology and Biostatistics , Milken Institute School of Public Health, George Washington University , Washington , DC , USA
| | - Catherine R Lesko
- c Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Bryan Lau
- c Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jeanne Keruly
- d Adult Ryan White Services , Johns Hopkins University , Baltimore , MD , USA
| | - Heidi M Crane
- e Harborview Medical Center , University of Washington , Seattle , WA , USA
| | - K Rivet Amico
- f Department of Health Behavior and Health Education , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | | | - E Byrd Quinlivan
- h Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Michael J Mugavero
- i Division of Infectious Diseases , University of Alabama at Birmingham (UAB) , Birmingham , AL , USA
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18
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Marcus R, de Groot A, Bachman S, Chisolm N, Quadri Y, Cabral H, Rajabiun S. Longitudinal Determinants of Housing Stability Among People Living With HIV/AIDS Experiencing Homelessness. Am J Public Health 2018; 108:S552-S560. [PMID: 32941778 DOI: 10.2105/ajph.2018.304772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine patterns of and factors associated with housing stability over time among people living with HIV (PLWH) experiencing homelessness with co-occurring substance use and mental health disorders enrolled in a patient-centered medical home (PCMH) intervention.Methods. Between September 2013 and February 2017, we ascertained housing trajectories among PLWH in 9 sites in the United States by conducting interviews at baseline, 6, and 12 months after and dichotomized them as improved consistently versus did not improve consistently. We identified covariates affecting housing stability using the socioecological model.Results. Forty-three percent (n = 198) experienced consistent housing improvement. Participants with history of mental health diagnosis (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.02, 2.35; P = .04) or trauma (AOR = 1.72; 95% CI = 1.22, 2.41; P = .006) had improved housing status; those with recent injecting drug use (AOR = 0.41; 95% CI = 0.19, 0.90; P = .03) had less consistent housing improvement.Conclusions. Improved housing stability may possibly reflect the importance of PCMH interventions that integrate housing, health, and behavioral services with patient navigators to address complex needs of PLWH experiencing homelessness.
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Affiliation(s)
- Ruthanne Marcus
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Alexander de Groot
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Sara Bachman
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Nicole Chisolm
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Yasmeen Quadri
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Howard Cabral
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Serena Rajabiun
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
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19
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Xia Q, Seyoum S, Wiewel EW, Torian LV, Braunstein SL. Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007-2016. Am J Public Health 2018; 109:126-131. [PMID: 30495998 DOI: 10.2105/ajph.2018.304748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To compare trends in HIV outcomes for cisgender and transgender persons living with HIV (PLWH) in New York City.Methods. We used HIV surveillance data for the analysis. We based CD4 count on the last measurement in a calendar year and defined viral suppression as the last viral load being less than or equal to 200 copies per milliliter in the calendar year.Results. The estimated number of PLWH increased from 73 415 in 2007 to 83 299 in 2016, including 606 transgender persons (0.8%) in 2007 and 1054 transgender persons (1.3%) in 2016. The proportion with CD4 count of 500 cells per cubic millimeter or more increased from 38% in 2007 to 61% in 2016 among cisgender persons versus 32% to 60% among transgender persons. The proportion with a suppressed viral load increased from 52% in 2007 to 80% in 2016 among cisgender persons versus 42% to 73% among transgender persons.Conclusions. Among PLWH in New York City, CD4 count and viral suppression improved during 2007 to 2016, with larger improvements among transgender persons, leading to narrower gaps. However, continuing efforts to improve HIV outcomes among transgender PLWH are needed to further eliminate disparities, particularly in viral suppression.
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Affiliation(s)
- Qiang Xia
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Selam Seyoum
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Ellen W Wiewel
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Lucia V Torian
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Sarah L Braunstein
- All of the authors are with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY
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20
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Deming R, Ford MM, Moore MS, Lim S, Perumalswami P, Weiss J, Wyatt B, Shukla S, Litwin A, Reynoso S, Laraque F. Evaluation of a hepatitis C clinical care coordination programme's effect on treatment initiation and cure: A surveillance-based propensity score matching approach. J Viral Hepat 2018; 25:1236-1243. [PMID: 29757491 DOI: 10.1111/jvh.12929] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/25/2018] [Indexed: 12/13/2022]
Abstract
Hepatitis C (HCV) is a viral infection that if left untreated can severely damage the liver. Project INSPIRE was a 3 year HCV care coordination programme in New York City (NYC) that aimed to address barriers to treatment initiation and cure by providing patients with supportive services and health promotion. We examined whether enrolment in Project INSPIRE was associated with differences in HCV treatment and cure compared with a demographically similar group not enrolled in the programme. INSPIRE participants in 2015 were matched with a cohort of HCV-infected persons identified in the NYC surveillance registry, using full optimal matching on propensity scores and stratified by INSPIRE enrolment status. Conditional logistic regression was used to assess group differences in the two treatment outcomes. Two follow-up sensitivity analyses using individual pair-matched sets and the full unadjusted cohort were also conducted. Treatment was initiated by 72% (790/1130) of INSPIRE participants and 36% (11 960/32 819) of study-eligible controls. Among initiators, 65% (514/790) of INSPIRE participants compared with 47% (5641/11 960) of controls achieved cure. In the matched analysis, enrolment in INSPIRE increased the odds of treatment initiation (OR: 5.25, 95% CI: 4.47-6.17) and cure (OR: 2.52, 95% CI: 2.00-3.16). Results from the sensitivity analyses showed agreement with the results from the full optimal match. Participation in the HCV care coordination programme significantly increased the probability of treatment initiation and cure, demonstrating that care coordination for HCV-infected individuals improves treatment outcomes.
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Affiliation(s)
- R Deming
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - M M Ford
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - M S Moore
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - S Lim
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - P Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Weiss
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B Wyatt
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Shukla
- Montefiore Medical Center, Bronx, NY, USA
| | - A Litwin
- Montefiore Medical Center, Bronx, NY, USA
| | - S Reynoso
- Montefiore Medical Center, Bronx, NY, USA
| | - F Laraque
- New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
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21
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Galárraga O, Rana A, Rahman M, Cohen M, Adimora AA, Sosanya O, Holman S, Kassaye S, Milam J, Cohen J, Golub ET, Metsch LR, Kempf MC. The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach. Soc Sci Med 2018; 214:70-82. [PMID: 30153546 PMCID: PMC6171130 DOI: 10.1016/j.socscimed.2018.07.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/30/2018] [Indexed: 11/20/2022]
Abstract
Unstable housing, including homelessness, is a public policy concern for all populations, and more critically for people with a serious health condition such as HIV. We measure the effect of unstable housing on HIV treatment biomarkers: viral suppression (viral load < 200 HIV RNA copies per ml) and adequate CD4+ T-cell count (CD4>350 cells per μl). We use panel data (1995-2015) from 3082 participants of the Women's Interagency HIV Study (WIHS) sites in Bronx and Brooklyn (NY), Chicago (IL), Los Angeles and San Francisco (CA), and Washington (DC). The instrumental variable (IV) measures allocations for the Housing Opportunities for People with AIDS (HOPWA) per person newly infected with HIV, and it represents actual availability of housing assistance for HIV-positive persons at the metropolitan area level. Using an extended probit model with the IV, we find that unstable housing reduces the likelihood of viral suppression by 51 percentage points, and decreases the probability of having adequate CD4 cell count by 53 percentage points. The endogeneity-corrected results are larger than naïve probits, which show decreases of 8.1 and 7.8 percentage points, respectively. The hypothesized pathways for the effect are: decreased use of mental healthcare/counseling, any healthcare, and less continuity of care. Increasing efforts to improve housing assistance, including HOPWA, and other interventions to make housing more affordable for low-income populations, and HIV-positive populations in particular, may be warranted not only for the benefits of stable housing, but also to improve HIV-related biomarkers.
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Affiliation(s)
- Omar Galárraga
- Brown University, School of Public Health, 121 S. Main St., Providence, RI 02912, USA.
| | - Aadia Rana
- University of Alabama at Birmingham, School of Medicine, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - Momotazur Rahman
- Brown University, School of Public Health, 121 S. Main St., Providence, RI 02912, USA.
| | - Mardge Cohen
- Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118, USA.
| | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Institute for Global Health and Infectious Diseases, 130 Mason Farm Rd., Chapel Hill, NC 27599, USA.
| | - Oluwakemi Sosanya
- Montefiore Medical Center, 3311 Bainbridge Ave., Bronx, NY, 10467, USA.
| | - Susan Holman
- SUNY Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA.
| | - Seble Kassaye
- Georgetown University, Department of Medicine, 3800 Reservoir Rd., NW, Washington, DC 20007, USA.
| | - Joel Milam
- University of Southern California, Institute for Health Promotion & Disease Prevention Research, 2001 N. Soto St., Los Angeles, CA 90032, USA.
| | - Jennifer Cohen
- University of California at San Francisco, School of Pharmacy, 1515 Scott St., San Francisco, CA 94115, USA.
| | - Elizabeth T Golub
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Lisa R Metsch
- Columbia University, Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, USA.
| | - Mirjam-Colette Kempf
- University of Alabama at Birmingham, School of Nursing, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
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22
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Terzian AS, Younes N, Greenberg AE, Opoku J, Hubbard J, Happ LP, Kumar P, Jones RR, Castel AD. Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression. AIDS Behav 2018; 22:3009-3023. [PMID: 29603112 DOI: 10.1007/s10461-018-2103-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.
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Affiliation(s)
- A S Terzian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
| | - N Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - J Opoku
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - J Hubbard
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - L P Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - P Kumar
- School of Medicine, Georgetown University, Washington, DC, USA
| | - R R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
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Udeagu CCN, Shah S, Misra K, Sepkowitz KA, Braunstein SL. Where Are They Now? Assessing if Persons Returned to HIV Care Following Loss to Follow-Up by Public Health Case Workers Were Engaged in Care in Follow-Up Years. AIDS Patient Care STDS 2018; 32:181-190. [PMID: 29750551 DOI: 10.1089/apc.2018.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We examined care engagement and viral suppression (VS) over a 1- to 5-year period among persons re-engaged in HIV care using retrospective cohort study and longitudinal follow-up. The population comprised five cohorts of persons re-engaged in care from 2009 to 2013. We used surveillance data [CD4 T cell count or HIV viral load (VL) RNA] to measure four outcomes 1-5 years post-care engagement. Engagement-in-care indicated persons with laboratory reports in each follow-up year. Continuous engagement or sustained engagement, respectively, included persons with ≥1 or ≥2 (separated by 90 days) CD4 or VL reports in each follow-up year. VS indicated persons living with HIV (PLWH) re-engaged in care with VL ≤200 copies/mL in any follow-up year, and we measured re-engaged PLWH who subsequently became out of care (OOC) in each follow-up year. Overall, 84-86% PLWH were engaged in care in any follow-up year. The proportions of PLWH cohorts continuously engaged in care [86% (1 year), 77% (2 years), 72% (3 years), 67% (4 years), and 63% (5 years)] declined over time. Thirty-four percent of the PLWH who were re-engaged in care were subsequently OOC in the follow-up years. Most re-engaged PLWH became OOC in their first (40%) and second (30%) follow-up years. In follow-up years (1-5 years), fewer PLWH continuously engaged in care with ≥1 CD4 or VL reports in the registry had VS ≤200 copies/mL: 65%, 58%, 49%, 44%, and 42%, respectively. Encouragingly, higher proportions had VL ≤1500 copies/mL in follow-up years (1-5): (75%, 72%, 73%, 75%, and 70%), likely reflecting levels of HIV treatment. Our results support the use of surveillance data to identify and re-engage OOC PLWH in care. However, structures and programs are needed to support retention in care and reduce repeat OOC.
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Affiliation(s)
- Chi-Chi N. Udeagu
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Sharmila Shah
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Kavita Misra
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Kent A. Sepkowitz
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
- Memorial Sloan Kettering Center, New York, New York
| | - Sarah L. Braunstein
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
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24
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Castel AD, Terzian A, Opoku J, Happ LP, Younes N, Kharfen M, Greenberg A. Defining Care Patterns and Outcomes Among Persons Living with HIV in Washington, DC: Linkage of Clinical Cohort and Surveillance Data. JMIR Public Health Surveill 2018; 4:e23. [PMID: 29549065 PMCID: PMC5878363 DOI: 10.2196/publichealth.9221] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 12/25/2022] Open
Abstract
Background Triangulation of data from multiple sources such as clinical cohort and surveillance data can help improve our ability to describe care patterns, service utilization, comorbidities, and ultimately measure and monitor clinical outcomes among persons living with HIV infection. Objectives The objective of this study was to determine whether linkage of clinical cohort data and routinely collected HIV surveillance data would enhance the completeness and accuracy of each database and improve the understanding of care patterns and clinical outcomes. Methods We linked data from the District of Columbia (DC) Cohort, a large HIV observational clinical cohort, with Washington, DC, Department of Health (DOH) surveillance data between January 2011 and June 2015. We determined percent concordance between select variables in the pre- and postlinked databases using kappa test statistics. We compared retention in care (RIC), viral suppression (VS), sexually transmitted diseases (STDs), and non-HIV comorbid conditions (eg, hypertension) and compared HIV clinic visit patterns determined using the prelinked database (DC Cohort) versus the postlinked database (DC Cohort + DOH) using chi-square testing. Additionally, we compared sociodemographic characteristics, RIC, and VS among participants receiving HIV care at ≥3 sites versus <3 sites using chi-square testing. Results Of the 6054 DC Cohort participants, 5521 (91.19%) were included in the postlinked database and enrolled at a single DC Cohort site. The majority of the participants was male, black, and had men who have sex with men (MSM) as their HIV risk factor. In the postlinked database, 619 STD diagnoses previously unknown to the DC Cohort were identified. Additionally, the proportion of participants with RIC was higher compared with the prelinked database (59.83%, 2678/4476 vs 64.95%, 2907/4476; P<.001) and the proportion with VS was lower (87.85%, 2277/2592 vs 85.15%, 2391/2808; P<.001). Almost a quarter of participants (23.06%, 1279/5521) were identified as receiving HIV care at ≥2 sites (postlinked database). The participants using ≥3 care sites were more likely to achieve RIC (80.7%, 234/290 vs 62.61%, 2197/3509) but less likely to achieve VS (72.3%, 154/213 vs 89.51%, 1869/2088). The participants using ≥3 care sites were more likely to have unstable housing (15.1%, 64/424 vs 8.96%, 380/4242), public insurance (86.1%, 365/424 vs 57.57%, 2442/4242), comorbid conditions (eg, hypertension) (37.7%, 160/424 vs 22.98%, 975/4242), and have acquired immunodeficiency syndrome (77.8%, 330/424 vs 61.20%, 2596/4242) (all P<.001). Conclusions Linking surveillance and clinical data resulted in the improved completeness of each database and a larger volume of available data to evaluate HIV outcomes, allowing for refinement of HIV care continuum estimates. The postlinked database also highlighted important differences between participants who sought HIV care at multiple clinical sites. Our findings suggest that combined datasets can enhance evaluation of HIV-related outcomes across an entire metropolitan area. Future research will evaluate how to best utilize this information to improve outcomes in addition to monitoring them.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Arpi Terzian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Jenevieve Opoku
- HIV/AIDS, Hepatitis, STD, and TB Administration, The District of Columbia Department of Health, Washington, DC, United States
| | - Lindsey Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Naji Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Michael Kharfen
- HIV/AIDS, Hepatitis, STD, and TB Administration, The District of Columbia Department of Health, Washington, DC, United States
| | - Alan Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
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- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
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25
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Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, Shearer K, Dowdy D, Rosenberg E, Sullivan P, Shah M. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 2017; 21:2101-2123. [PMID: 28120257 PMCID: PMC5843766 DOI: 10.1007/s10461-017-1687-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
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Affiliation(s)
- Kathryn A Risher
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
| | - Sunaina Kapoor
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Moji Daramola
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Doyle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Shearer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - Eli Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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26
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Xia Q, Braunstein SL, Wiewel EW, Hadler JL, Torian LV. Persistent Racial Disparities in HIV Infection in the USA: HIV Prevalence Matters. J Racial Ethn Health Disparities 2016; 4:87-93. [PMID: 26746424 DOI: 10.1007/s40615-015-0205-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Despite increased funding and efforts to prevent and control HIV infections in the black and Hispanic communities, racial disparities persist in the USA. We used a mathematical model to explain the phenomena. METHODS A mathematical model was constructed to project HIV prevalence ratio (PR), incidence rate ratio (IRR), and HIV-specific mortality rate ratio (MRR) among blacks and Hispanics vs. whites in two scenarios: (1) an annual reduction in HIV incidence rate at the 2007-2010 level and (2) an annual reduction in HIV incidence rate at the 2007-2010 level among whites (4.2 %) and twice that of whites among blacks and Hispanics (8.4 %). RESULTS In scenario no. 1, the PR, IRR, and MRR among blacks would decrease from 7.6 to 5.8, 7.9 to 5.9, and 11.3 to 5.3 and among Hispanics from 2.8 to 1.8, 3.1 to 1.9, and 2.3 to 1.0, respectively. In scenario no. 2, the PR, IRR, and MRR among blacks would decrease from 7.6 to 5.1, 7.9 to 2.5, and 11.3 to 4.7 and among Hispanics from 2.8 to 1.6, 3.1 to 0.8, and 2.3 to 0.9, respectively. CONCLUSIONS Much of the persistent racial disparities in HIV infection in the USA, as measured by PR, IRR, and MRR, can be explained by higher HIV prevalence among blacks and Hispanics. The public health community should continue its efforts to reduce racial disparities, but also need to set realistic goals and measure progress with sensitive indicators.
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Affiliation(s)
- Qiang Xia
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA.
| | - Sarah L Braunstein
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA
| | - Ellen W Wiewel
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA
| | - James L Hadler
- Yale University School of Public Health, New Haven, CT, USA
| | - Lucia V Torian
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY, 11101, USA
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