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Gyamerah AO, Marr A, Maleke K, Manyuchi AE, Mirzazadeh A, Radebe O, Lane T, Puren A, Steward WT, Struthers H, Lippman SA. Correlates of viral suppression among sexual minority men and transgender women living with HIV in Mpumalanga, South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003271. [PMID: 39038019 PMCID: PMC11262663 DOI: 10.1371/journal.pgph.0003271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/07/2024] [Indexed: 07/24/2024]
Abstract
Sexual minority men (SMM) and transgender women in South Africa engage in HIV care at lower rates than other persons living with HIV and may experience population-specific barriers to HIV treatment and viral suppression (VS). As part of a pilot trial of an SMM-tailored peer navigation (PN) intervention in Ehlanzeni district, South Africa, we assessed factors associated with ART use and VS among SMM at trial enrolment. A total of 103 HIV-positive SMM and transgender women enrolled in the pilot trial. Data on clinical visits and ART adherence were self-reported. VS status was verified through laboratory analysis (<1000 copies/ml). We assessed correlates of VS at baseline using Poisson generalized linear model (GLM) with a log link function, including demographic, psychosocial, clinical, and behavioral indicators. Among participants, 52.4% reported ART use and only 42.2% of all participants had evidence of VS. Of the 49.5% who reported optimal engagement in HIV care (consistent clinic visits with pills never missed for ≥ 4 consecutive days) in the past 3-months, 56.0% were virally suppressed. In multivariable analysis, SMM were significantly more likely to be virally suppressed when they were ≥ 25 years of age (Adjusted prevalence ratio [APR] = 2.0, CI 95%:1.0-3.8); in a relationship but not living with partner, as compared to married, living together, or single (APR = 1.7, CI 95%:1.0-2.7), and optimally engaged in care (APR = 2.1, 95% CI:1.3-3.3). Findings indicate a need for targeted treatment and care support programming, especially for SMM and transgender women who are young and married/living with their partners to improve treatment outcomes among this population.
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Affiliation(s)
- Akua O. Gyamerah
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Alexander Marr
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | | | - Ali Mirzazadeh
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Oscar Radebe
- Anova Health Institute, Johannesburg, South Africa
| | - Tim Lane
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Adrian Puren
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Division of Virology School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Wayne T. Steward
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Pakhomova TE, Tam C, Wang L, Salters K, Moore DM, Barath J, Elterman S, Dawydiuk N, Wesseling T, Grieve S, Sereda P, Hogg R, Barrios R. Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada. AIDS Behav 2024; 28:43-58. [PMID: 37632606 DOI: 10.1007/s10461-023-04156-3] [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: 08/10/2023] [Indexed: 08/28/2023]
Abstract
Depressive symptoms among people living with HIV (PLWH) are associated with poorer overall health outcomes. We characterized depressive symptoms and improvements in symptomology among PLWH (≥ 19 years old) in British Columbia (BC), Canada. We also examined associations between depressive symptomology and antiretroviral therapy (ART) treatment interruptions. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), within a longitudinal cohort study with three surveys administered 18-months apart. We used multivariable logistic regression to model factors associated with improvements in depressive symptoms (CES-D-10 scores from ≥ 10 to < 10). Of the 566 participants eligible for analysis 273 (48.2%) had CES-D scores indicating significant depressive symptoms (score ≥ 10) at enrollment. Improvements in symptoms at first follow-up were associated with greater HIV self-care on the Continuity of Care Scale (adjusted odds ratio: 1.17; 95% CI 1.03-1.32), and not having a previously reported mental health disorder diagnosis (aOR 2.86; 95% CI 1.01-8.13). Those reporting current cocaine use (aOR 0.33; 95% CI 0.12-0.91) and having a high school education, vs. less than, (aOR 0.25; 95% CI 0.08-0.82) had lower odds of improvement in depressive symptomatology. CES-D scores ≥ 10 were not significantly associated with ART treatment interruptions during follow-up (aOR: 1.08; 95% CI:0.65-1.8). Supporting greater self-care and consideration of mental health management strategies in relation to HIV may be useful in promoting the wellbeing of PLWH who experience depressive symptoms.
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Affiliation(s)
- Tatiana E Pakhomova
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada.
| | - Clara Tam
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- University of British Columbia, Vancouver, Canada
| | - Justin Barath
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Simon Elterman
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Nicole Dawydiuk
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Tim Wesseling
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Sean Grieve
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- University of British Columbia, Vancouver, Canada
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Sauceda JA, Campbell CK, Ndukwe SO, Dubé K, Saberi P. Medical mistrust of health systems as a moderator of resilience and self-reported HIV care engagement in Black and Latinx young adults living with HIV. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2023:2023-99078-001. [PMID: 37589681 PMCID: PMC10873476 DOI: 10.1037/cdp0000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To study resilience and its association with HIV care engagement in a sample of young adult Black and Latinx people living with HIV (PLWH) in the United States and to test if a systems-level barrier, medical mistrust, would moderate the resilience-engagement association. METHOD Between April and August 2021, we recruited participants through social media and dating apps (N = 212) and verified age and HIV status through a review process of digital text-messaged and emailed photos. Participants completed a one-time online survey consisting of the Connor-Davidson Resilience Scale, The Index of Engagement in HIV Care, and the Medical Mistrust Index. We ran a regression-based moderation analysis using the Johnson-Neyman Technique to estimate regions of significance. RESULTS The sample (N = 212) was 80.5% Black and 19.5% Latinx with a mean age of 25.8 years (SD = 2.84). Higher resilience scores were associated with higher HIV care engagement scores (b = 0.72, p = .003), and medical mistrust moderated this relationship as evidenced by a mistrust by resilience interaction (b = -0.16, p = .01). Our regions of statistical significance showed that as mistrust increased, the size of the resilience-engagement association decreased. CONCLUSION Resilience may be a protective factor associated with greater participation and sense of connection to HIV care, but is diminished by mistrust of the medical system at large. This suggest that systems-level changes, in addition to individual-level interventions, are needed to address medical mistrust to fully harness the resilience of young PLWH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- John A. Sauceda
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
| | - Chadwick K. Campbell
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, San Diego, CA
| | - Samuel O. Ndukwe
- Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA
| | - Parya Saberi
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA
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Sauceda JA, Lechuga J, Ramos ME, Puentes J, Ludwig-Barron N, Salazar J, Christopoulos KA, Johnson MO, Gomez D, Covarrubias R, Hernandez J, Montelongo D, Ortiz A, Rojas J, Ramos L, Avila I, Gwadz MV, Neilands TB. A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol. BMC Public Health 2023; 23:307. [PMID: 36765309 PMCID: PMC9921633 DOI: 10.1186/s12889-023-15172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND People who inject drugs living with HIV (PWIDLH) suffer the lowest rates of HIV viral suppression due to episodic injection drug use and poor mental health coupled with poor retention in HIV care. Approximately 44% of PWIDLH along the US-Mexico border are retained in care and only 24% are virally suppressed. This underserved region faces a potential explosion of transmission of HIV due to highly prevalent injection drug use. This protocol describes an optimization trial to promote sustained viral suppression among Spanish-speaking Latinx PWIDLH. METHODS The multiphase optimization strategy (MOST) is an engineering-inspired framework for designing and building optimized interventions and guides this intervention. The primary aim is to conduct a 24 factorial experiment in which participants are randomized to one of 16 intervention conditions, with each condition comprising a different combination of four behavioral intervention components. The components are peer support for methadone uptake and persistence; behavioral activation therapy for depression; Life-Steps medication adherence counseling; and patient navigation for HIV care. Participants will complete a baseline survey, undergo intervention, and then return for 3-,6-,9-, and 12-month follow-up assessments. The primary outcome is sustained viral suppression, defined as viral loads of < 40 copies per mL at 6-,9-, and 12-month follow-up assessments. Results will yield effect sizes for each component and each additive and interactive combination of components. The research team and partners will make decisions about what constitutes the optimized multi-component intervention by judging the observed effect sizes, interactions, and statistical significance against real-world implementation constraints. The secondary aims are to test mediators and moderators of the component-to-outcome relationship at the 6-month follow-up assessment. DISCUSSION We are testing well-studied and available intervention components to support PWIDLH to reduce drug use and improve their mental health and engagement in HIV care. The intervention design will allow for a better understanding of how these components work in combination and can be optimized for the setting. TRIAL REGISTRATION This project was registered at clinicaltrials.gov (NCT05377463) on May 17th, 2022.
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Affiliation(s)
- John A Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA.
| | - Julia Lechuga
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Maria Elena Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Jorge Puentes
- College of Health Sciences, Department of Public Health Sciences, University of Texas at El Paso, 1851 Wiggins Rd., 79968, El Paso, TX, USA
| | - Natasha Ludwig-Barron
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - Jorge Salazar
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, 996 Potrero Avenue, Building 80, 6th Floor, 94110, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
| | - David Gomez
- Centro de Integración Juvenil (CIJ), Cuidad Juárez, Blvd Ing Bernardo Norzagaray, 32130, Cazatecas, Chihuahua, México
| | - Rogelio Covarrubias
- Centro Ambulatorio para la prevención y Atención de SIDA y de las Enfermedades de Transmisión Sexual (CAPASITS), Cuidad Juárez, Avenue Paseo Triunfo de la Republica 3530, 32330, Partido Escobedo, Chihuahua, México
| | - Joselyn Hernandez
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - David Montelongo
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Alejandro Ortiz
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Julian Rojas
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Luisa Ramos
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Itzia Avila
- Program Compañeros, Cuidad Juárez, Avenue de la Raza 2661, Silvias, Chihuahua, México
| | - Marya V Gwadz
- Silver School of Social Work, New York University, 1 Washington Square N, 10003, New York, NY, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA
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Saberi P, Eskaf S, Campbell CK, Neilands TB, Sauceda JA, Dubé K. Exploration of a Mobile Technology Vulnerability Scale's association with antiretroviral adherence among young adults living with HIV in the United States. Mhealth 2022; 8:23. [PMID: 35928514 PMCID: PMC9343971 DOI: 10.21037/mhealth-21-54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Young adults living with HIV (YLWH) have suboptimal adherence to antiretroviral therapy (ART) and HIV care outcomes. Mobile health technologies are increasingly used to deliver interventions to address HIV health outcomes. However, not all YLWH have equal and consistent access to mobile technologies. METHODS Using our novel Mobile Technology Vulnerability Scale (MTVS) to evaluate how vulnerable an individual feels with regard to their personal access to mobile technology in the past 6 months, we conducted a cross-sectional online survey with 271 YLWH (18-29 years) in the US to evaluate the relationships between MTVS and self-reported ART adherence. RESULTS Participants reported changes in phone numbers (25%), stolen (14%) or lost (22%) phones, and disconnections of phone service due to non-payment (39%) in the past 6 months. On a scale of 0 to 1 (0 having no mobile technology vulnerability and 1 having complete mobile technology vulnerability), participants had a mean MTVS of 0.33 (SD =0.26). Black and financially constrained participants had the highest MTVS, which was significantly higher that other racial/ethnic and financially non-constrained groups, respectively. Higher MTVS was significantly associated with ART non-adherence and non-persistence. CONCLUSIONS Findings suggest the need to measure MTVS to recognize pitfalls when using mobile health interventions and identify populations whose inconsistent mobile technology access may be related to worse health outcomes.
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Affiliation(s)
- Parya Saberi
- Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Shadi Eskaf
- School of Government, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chadwick K. Campbell
- Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Torsten B. Neilands
- Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - John A. Sauceda
- Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ramsey SE, Ames EG, Uber J, Habib S, Clark S, Waldrop D. A Preliminary Test of an mHealth Facilitated Health Coaching Intervention to Improve Medication Adherence among Persons Living with HIV. AIDS Behav 2021; 25:3782-3797. [PMID: 34117965 PMCID: PMC8563378 DOI: 10.1007/s10461-021-03342-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
This study examined feasibility, acceptability, and preliminary efficacy of an mHealth facilitated health coaching antiretroviral therapy (ART) adherence intervention. Persons living with HIV (n = 53) were randomized to an in-person adherence session and 12 months of app access and health coaching via the app (Fitbit Plus) versus single adherence session (SOC). At baseline and 1, 3, 6, and 12 months, we measured ART adherence, substance use, and depressive symptoms. We also conducted individual qualitative interviews. The intervention was found to be largely feasible and highly acceptable, with the health coach spending an average of 2.4 min per month with a participant and 76.5% of Fitbit Plus participants using the app regularly at 12 months. While most comparisons were not significant, the pattern of results was consistent with better adherence in the Fitbit Plus compared to SOC condition. Substance use was significantly associated with poorer ART adherence while depressive symptoms were not.ClinicalTrials.gov Identifier: NCT02676128; Registered: 2/8/2016.
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Affiliation(s)
- Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Evan G Ames
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Julia Uber
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Samia Habib
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Seth Clark
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Brief Report: Linking Depressive Symptoms to Viral Nonsuppression Among Women With HIV Through Adherence Self-Efficacy and ART Adherence. J Acquir Immune Defic Syndr 2020; 83:340-344. [PMID: 32097193 PMCID: PMC7266092 DOI: 10.1097/qai.0000000000002268] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Depression plays a key role in suboptimal HIV outcomes, possibly mediated by adherence self-efficacy beliefs and antiretroviral treatment (ART) adherence behavior. Applying social-cognitive theory, we examined a longitudinal sequential path model of the association between depressive symptoms and viral nonsuppression in women with HIV (WWH) through these mediating mechanisms. METHODS This was an observational longitudinal study using data from the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. WWH (N = 375) completed measures of depressive symptoms, adherence self-efficacy, and ART adherence. Viral load was measured through blood draw. We examined a longitudinal sequential path model spanning 3 time points at least 6 months apart between 2015 and 2017. Indirect effects were assessed of depressive symptoms at time 1 (T1) on viral nonsuppression at T3 through adherence self-efficacy at T2 and ART adherence at T3. Covariates included age, income, recreational drug use, race, and months on ART. RESULTS Depressive symptoms were associated with subsequent viral nonsuppression through its association with adherence self-efficacy and ART adherence [indirect effect: adjusted odds ratio = 1.004, 95% confidence interval: (1.001 to 1.008)]. Months on ART and recreational drug use were also significantly associated with viral nonsuppression at T3. CONCLUSIONS Our findings support depressive symptoms' association with adherence self-efficacy that in turn lead to suboptimal ART adherence and ultimately to viral nonsuppression for WWH. Tailoring of interventions aimed at addressing depressive symptoms, substance use, and adherence self-efficacy among WWH is needed to help close the gap between ART prescription and viral suppression on the HIV care continuum.
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Cognitive-affective depressive symptoms and substance use among Latino and non-Latino White patients in HIV care: an analysis of the CFAR network of integrated clinical systems cohort. J Behav Med 2018; 42:561-566. [PMID: 30377875 DOI: 10.1007/s10865-018-9986-8] [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: 05/15/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
Abstract
The disparity in viral suppression rates between Latino and non-Latino White patients in HIV care appears to be narrowing, but it is unclear if depression and substance use perpetuate this disparity. We analyzed electronic medical records from the CFAR network of integrated clinical systems cohort. First observations/enrollment data collected between 2007 and 2013 were analyzed, which included survey (race/ethnicity, depression, substance use, adherence) and clinical data (viral suppression). We estimated indirect effects with a regression-based bootstrapping method. In 3129 observations, Latinos and non-Latino Whites did not differ in depression or alcohol use (ORs 1.11, 0.99, ns), but did in drug use (OR 1.13, p < .001). For all patients, depression and substance use were indirectly associated with small increases (ORs 1.02-1.66) in the odds for a detectable viral load, via worse adherence. We conclude that variables not captured in EMR systems (e.g., health literacy, structural factors) may better explain viral suppression disparities that persist.
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Levison JH, Levinson JK, Alegría M. A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care. AIDS Behav 2018; 22:2500-2512. [PMID: 29948334 DOI: 10.1007/s10461-018-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
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Harris RA, Haberer JE, Musinguzi N, Chang KM, Schechter CB, Doubeni CA, Gross R. Predicting short-term interruptions of antiretroviral therapy from summary adherence data: Development and test of a probability model. PLoS One 2018; 13:e0194713. [PMID: 29566096 PMCID: PMC5864044 DOI: 10.1371/journal.pone.0194713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/08/2018] [Indexed: 11/18/2022] Open
Abstract
Antiretroviral therapy (ART) for HIV is vulnerable to unplanned treatment interruptions-consecutively missed doses over a series of days-which can result in virologic rebound. Yet clinicians lack a simple, valid method for estimating the risk of interruptions. If the likelihood of ART interruption could be derived from a convenient-to-gather summary measure of medication adherence, it might be a valuable tool for both clinical decision-making and research. We constructed an a priori probability model of ART interruption based on average adherence and tested its predictions using data collected on 185 HIV-infected, treatment-naïve individuals over the first 90 days of ART in a prospective cohort study in Mbarara, Uganda. The outcome of interest was the presence or absence of a treatment gap, defined as >72 hours without a dose. Using the pre-determined value of 0.50 probability as the cut point for predicting an interruption, the classification accuracy of the model was 73% (95% CI = 66%- 79%), the specificity was 87% (95% CI = 79%- 93%), and the sensitivity was 59% (95% CI = 48%- 69%). Overall model performance was satisfactory, with an area under the receiver operator characteristic curve (AUROC) of 0.85 (95% CI = 0.80-0.91) and Brier score of 0.20. The study serves as proof-of-concept that the probability model can accurately differentiate patients on the continuum of risk for short-term ART interruptions using a summary measure of adherence. The model may also aid in the design of targeted interventions.
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Affiliation(s)
- Rebecca Arden Harris
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessica E. Haberer
- Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | | | - Kyong-Mi Chang
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Clyde B. Schechter
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Chyke A. Doubeni
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Robert Gross
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
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Sauceda JA, Neilands TB, Johnson MO, Saberi P. An update on the Barriers to Adherence and a Definition of Self-Report Non-adherence Given Advancements in Antiretroviral Therapy (ART). AIDS Behav 2018; 22:939-947. [PMID: 28352983 DOI: 10.1007/s10461-017-1759-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Relying on the most frequently reported barriers to adherence and convenient definitions of non-adherence may lead to less valid results. We used a dominance analysis (a regression-based approach) to identify the most important barriers to adherence based on effect size using data collected through an online survey. The survey included the Adherence Barrier Questionnaire, self-reported non-adherence defined as a 4-day treatment interruption, and HIV clinical outcomes. The sample (N = 1217) was largely male, gay identified, and White. Nearly 1 in 3 participants reported "simply forgot" as a barrier; however, in a dominance analysis, it yielded a small effect size it its association with a 4-day treatment interruption. Further, dominance analyses stratified by race/ethnicity and age suggested that not all barriers impact all groups equally. The most frequently reported barriers to adherence were not the most important, and interventions should focus on barriers more strongly linked to clinical outcomes.
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Affiliation(s)
- John A Sauceda
- Center for AIDS Prevention Studies, Department of Medicine, University of California - San Francisco, San Francisco, CA, USA.
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California - San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California - San Francisco, San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies, Department of Medicine, University of California - San Francisco, San Francisco, CA, USA
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Technological methods to measure adherence to antiretroviral therapy and preexposure prophylaxis. Curr Opin HIV AIDS 2017; 12:467-474. [PMID: 28590335 DOI: 10.1097/coh.0000000000000393] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The WHO's Consolidated Guidelines (2016) call for research on improved methods to proactively monitor adherence and identify those individuals who have the greatest needs for adherence support. This review aims to elucidate the latest technologies available to measure adherence to HIV antiretroviral therapy and preexposure prophylaxis against HIV infection and present their utility in various settings and populations. RECENT FINDINGS Within the last few years, advances have been made in the features of existing technology to measure adherence (real-time electronic adherence measurements), additional approaches have been developed (digital medicine systems) and improved (short message service surveys), and point of care testing for pharmacokinetic measures are under development. SUMMARY Technology advances in adherence measurement are promising for improved accuracy and, in some cases, the ability to intervene with adherence challenges in real time. This progress will greatly further our understanding of adherence behavior, as well as the ability to effectively link interventions with individuals who need them, thus maximizing the clinical and public health benefits of both antiretroviral therapy and preexposure prophylaxis.
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13
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Development of a Conceptual Etiological Model of Treatment Regimen Fatigue Among Patients Engaged in HIV Care: A Qualitative Study. J Assoc Nurses AIDS Care 2017; 28:479-490. [PMID: 28318843 DOI: 10.1016/j.jana.2017.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/24/2017] [Indexed: 11/20/2022]
Abstract
Treatment regimen fatigue (TRF) is a decreased desire and motivation to maintain vigilance in adhering to treatment, and little is known about TRF in people living with HIV. We aimed to develop a conceptual framework of TRF. Five focus groups were conducted in 2014. Eligible participants were (a) HIV infected, (b) at least 18 years of age, (c) prescribed antiretroviral therapy, and (d) fluent in English. Data were analyzed using thematic analysis. Analyses revealed these themes: patient experiences of TRF; etiological factors at the systems, provider, and patient levels; strategies to manage TRF; consequences of TRF; and protective factors that prevent the occurrence of TRF. The results provided a conceptual framework for future investigations to build on in an effort to improve adherence and retention in HIV care. Study results indicate avenues for intervention at multiple levels (systems, provider, and patient) to reduce treatment burden and improve patient resources and capacity.
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