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Trepka MJ, Gong Z, Ward MK, Fennie KP, Sheehan DM, Jean-Gilles M, Devieux J, Ibañez GE, Gwanzura T, Nawfal ES, Gray A, Beach MC, Ladner R, Yoo C. Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression. AIDS Behav 2024; 28:2113-2130. [PMID: 38573473 PMCID: PMC11161314 DOI: 10.1007/s10461-024-04310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA.
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA.
| | - Zhenghua Gong
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, Miami, FL, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Jessie Devieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA
| | | | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, FL, USA
| | - Changwon Yoo
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Kimaru LJ, Habila MA, Mantina NM, Madhivanan P, Connick E, Ernst K, Ehiri J. Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002870. [PMID: 38349915 PMCID: PMC10863897 DOI: 10.1371/journal.pgph.0002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
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Affiliation(s)
- Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Magdiel A. Habila
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - Namoonga M. Mantina
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth Connick
- Department of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Kacey Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - John Ehiri
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
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Kerr J, Smith A, Nzama N, Bullock NAA, Chandler C, Osezua V, Johnson K, Rozema I, Metzger IW, Harris LM, Bond K, LaPreze D, Rice BM. Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States. J Urban Health 2024; 101:31-63. [PMID: 38093034 PMCID: PMC10897076 DOI: 10.1007/s11524-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/07/2024]
Abstract
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
| | - Adrienne Smith
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nqobile Nzama
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nana Ama Aya Bullock
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Cristian Chandler
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victory Osezua
- Public Health Program, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Isabel Rozema
- University of Louisville Health, Louisville, KY, USA
| | - Isha W Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lesley M Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Dani LaPreze
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Nguyen TQ, Roberts Lavigne LC, Brantner CL, Kirk GD, Mehta SH, Linton SL. Estimation of place-based vulnerability scores for HIV viral non-suppression: an application leveraging data from a cohort of people with histories of using drugs. BMC Med Res Methodol 2024; 24:21. [PMID: 38273277 PMCID: PMC10809603 DOI: 10.1186/s12874-023-02133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
The relationships between place (e.g., neighborhood) and HIV are commonly investigated. As measurements of place are multivariate, most studies apply some dimension reduction, resulting in one variable (or a small number of variables), which is then used to characterize place. Typical dimension reduction methods seek to capture the most variance of the raw items, resulting in a type of summary variable we call "disadvantage score". We propose to add a different type of summary variable, the "vulnerability score," to the toolbox of the researchers doing place and HIV research. The vulnerability score measures how place, as known through the raw measurements, is predictive of an outcome. It captures variation in place characteristics that matters most for the particular outcome. We demonstrate the estimation and utility of place-based vulnerability scores for HIV viral non-suppression, using data with complicated clustering from a cohort of people with histories of injecting drugs.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA.
| | | | | | | | | | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA
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Filippone P, Serrano S, Campos S, Freeman R, Cluesman SR, Israel K, Amos B, Cleland CM, Gwadz M. Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV. Int J Equity Health 2023; 22:168. [PMID: 37649049 PMCID: PMC10466874 DOI: 10.1186/s12939-023-01992-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects. METHODS Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis. RESULTS Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience. CONCLUSIONS To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.
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Affiliation(s)
- Prema Filippone
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Samantha Serrano
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Stephanie Campos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Robin Freeman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Sabrina R Cluesman
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Khadija Israel
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Brianna Amos
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA
| | - Charles M Cleland
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Marya Gwadz
- New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA.
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Liu Y, Rich SN, Siddiqi KA, Chen Z, Prosperi M, Spencer E, Cook RL. Longitudinal trajectories of HIV care engagement since diagnosis among persons with HIV in the Florida Ryan White program. AIDS Behav 2022; 26:3164-3173. [PMID: 35362911 PMCID: PMC10080894 DOI: 10.1007/s10461-022-03659-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
HIV care engagement is a dynamic process. We employed group-based trajectory modeling to examine longitudinal patterns in care engagement among people who were newly diagnosed with HIV and enrolled in the Ryan White program in Florida (n = 9,755) between 2010 and 2015. Five trajectories were identified (47.9% "in care" with 1-2 care visit(s) per 6 months, 18.0% "frequent care" with 3 or more care visits per 6 months, 11.0% "re-engage", 11.0% "gradual drop out", 12.6% "early dropout") based on the number of care attendances (including outpatient/case management visits, viral load or CD4 test) for each six-month during the first five years since diagnosis. Relative to "in care", people in the "frequent care" trajectory were more likely to be Hispanic/Latino and older at HIV diagnosis, whereas people in the three suboptimal care retention trajectories were more likely to be younger. Area deprivation index, rurality, and county health rankings were also strongly associated with care trajectories. Individual- and community-level factors associated to the three suboptimal care retention trajectories, if confirmed to be causative and actionable, could be prioritized to improve HIV care engagement.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, 32610-0231, Gainesville, FL, United States.
| | - Shannan N Rich
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, 32610-0231, Gainesville, FL, United States
| | - Khairul A Siddiqi
- Department of Health Outcome and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Zhaoyi Chen
- Department of Health Outcome and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, 32610-0231, Gainesville, FL, United States
| | - Emma Spencer
- Florida Department of Health, Bureau of Communicable Diseases, Tallahassee, FL, United States
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, 32610-0231, Gainesville, FL, United States
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Dulin AJ, Fava JL, Earnshaw VA, Dale SK, Carey MP, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Agil D, Howe CJ. Development of Long and Short Forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. AIDS Behav 2022; 26:2469-2484. [PMID: 35092536 PMCID: PMC10782857 DOI: 10.1007/s10461-022-03579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/15/2023]
Abstract
Understanding resilience in relation to HIV-related outcomes may help address racial/ethnic disparities, however, significant gaps in its measurement preclude in-depth study. Thus, this research aims to develop and evaluate the psychometric properties of long and short forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. To develop the items, we conducted a mixed methods study (N = 48) and reviewed published resilience measures. We completed content validity index analyses to ensure the items reflected the resilience construct. Next, we conducted 20 cognitive interviews and a field survey (N = 400). The long and short forms demonstrated acceptable to excellent psychometric properties based on factorial validity, internal consistency and convergent validity and on measurement invariance (conducted for the short form only). These measures provide a comprehensive framework to examine resilience and HIV-related outcomes and can inform resilience-building interventions to reduce racial and ethnic health disparities.
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Affiliation(s)
- Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Marta Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Hovhannisyan L, Coelho LE, Velasque L, De Boni RB, Clark J, Cardoso SW, Lake J, Veloso VG, Grinsztejn B, Luz PM. Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil. AIDS Behav 2022; 26:947-962. [PMID: 34564777 PMCID: PMC8898026 DOI: 10.1007/s10461-021-03450-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.
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Affiliation(s)
- Lyolya Hovhannisyan
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth) , Houston, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Durable Viral Suppression Among People with HIV and Problem Substance Use in the Era of Universal Antiretroviral Treatment. AIDS Behav 2022; 26:385-396. [PMID: 34331177 PMCID: PMC8800950 DOI: 10.1007/s10461-021-03392-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 02/03/2023]
Abstract
This study explored factors associated with durable viral suppression (DVS) among two groups of people living with HIV (PLWH) and problem substance use in the context of universal antiretroviral treatment initiation. Participants (N = 99) were recruited between 2014-2017 from public sexual health clinics [SHC] and a hospital detoxification unit [detox]). DVS (NYC HIV surveillance registry) was defined as two consecutive viral load tests ≤ 200 copies/mL, ≤ 90 days apart, with all other viral loads suppressed over 12 or 18 months. Detox participants were significantly older, with more unstable housing/employment, substance use severity, and longer-term HIV vs. SHC participants. Older age, opioid and stimulant use disorder were significantly associated with lower odds of DVS, while fulltime employment and stable housing were significantly associated with higher odds of DVS at 12-month follow-up. Patterns held at 18-month follow-up. Co-located substance use and HIV services, funding for supportive housing, and collaborative patient-provider relationships could improve DVS among populations with the syndemic of problem substance use, poverty, and long-term HIV.
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10
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Dawit R, Trepka MJ, Duncan DT, Li T, Pires SF, Brock P, Ladner RA, Sheehan DM. Neighborhood Factors Associated with Racial/Ethnic Disparities in Achieving Sustained HIV Viral Suppression Among Miami-Dade County Ryan White Program Clients. AIDS Patient Care STDS 2021; 35:401-410. [PMID: 34623889 PMCID: PMC8665786 DOI: 10.1089/apc.2021.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Racial/ethnic minorities are disproportionately affected by poor HIV care outcomes. Studies have also examined the effects of neighborhood-level factor on an individual's health outcomes. Thus, the objective of this study was to assess the effects of neighborhood factors on the association between race/ethnicity and sustained viral suppression (all viral load tests <200 copies/mL per year). Data for 6491 people with HIV in the 2017 Miami-Dade County Ryan White Program and neighborhood-level data by ZIP code tabulated areas from the American Community Survey were utilized. Multi-level logistic regression models were used to assess the role of neighborhood factors on the association between race/ethnicity and sustained viral suppression. Results show that non-Hispanic Blacks had lower odds of sustained viral suppression in low socioeconomic disadvantage [adjusted odds ratio (aOR): 0.39; 95% confidence interval (CI): 0.20-0.74], moderate residential instability (aOR: 0.31; 95% CI: 0.15-0.65), and low and high racial/language homogeneity neighborhoods (aOR: 0.38; 95% CI: 0.16-0.88) and (aOR: 0.38; 95% CI: 0.19-0.75), respectively, when compared to non-Hispanic Whites (NHWs). Haitians also exhibited poor outcomes in neighborhoods characterized by moderate residential instability (aOR: 0.42; 95% CI: 0.18-0.97) and high racial/language homogeneity (aOR: 0.49; 95% CI: 0.26-0.93), when compared to NHWs. In conclusion, disparities in rates of sustained viral suppression were observed for racial/ethnic minorities within various neighborhood-level factors. These findings indicate the importance of addressing neighborhood characteristics to achieve optimal care for minorities.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
| | - Dustin T. Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Stephen F. Pires
- Department of Criminology and Criminal Justice, Steven J. Green School of International and Public Affairs, Florida International University, Miami, Florida, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA.,Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA.,Address correspondence to: Diana M. Sheehan, PhD, MPH, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC 5, Room 479, Miami, FL 33199, USA
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11
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Lee Y, Walton R, Jackson L, Batey DS. Community-Level Factors and HIV Health Among Older People Living With HIV (PLWH) in Alabama, United States: A Qualitative Analysis. J Assoc Nurses AIDS Care 2021; 32:589-598. [PMID: 33009174 DOI: 10.1097/jnc.0000000000000214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT As the number of older people living with HIV (PLWH) is increasing, there is an urgent need for research on community-level factors to better understand the health care needs of this population. In-depth interview transcripts of 20 older PLWH who participated in a community-based participatory research study conducted in Alabama, in the United States, were analyzed through a phenomenological research approach. Results suggest that crime, lack of resources, and social isolation experienced at the community levels were found to be associated with the wellbeing of older PLWH. Moreover, community characteristics may confound older PLWH's comorbid conditions and resultant polypharmacy. An increased understanding of the impact of contextual factors on HIV health can inform more holistic individual- and community-level interventions aimed at addressing barriers to retention or re-engagement in HIV medical care and viral suppression among older PLWH.
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Affiliation(s)
- Yookyong Lee
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick Walton
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsey Jackson
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D Scott Batey
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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12
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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13
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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14
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Tying Structural Racism to Human Immunodeficiency Virus Viral Suppression. Clin Infect Dis 2020; 72:e646-e648. [DOI: 10.1093/cid/ciaa1252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 11/14/2022] Open
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15
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Cope AB, Edmonds A, Ludema C, Cole SR, Eron JJ, Anastos K, Cocohoba J, Cohen M, Ofotokun I, Golub ET, Kassaye S, Konkle-Parker D, Metsch LR, Wilson TE, Adimora AA. Neighborhood Poverty and Control of HIV, Hypertension, and Diabetes in the Women's Interagency HIV Study. AIDS Behav 2020; 24:2033-2044. [PMID: 31907676 PMCID: PMC7319872 DOI: 10.1007/s10461-019-02757-5] [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: 01/26/2023]
Abstract
Neighborhoods with high poverty rates have limited resources to support residents' health. Using census data, we calculated the proportion of each Women's Interagency HIV Study participant's census tract (neighborhood) living below the poverty line. We assessed associations between neighborhood poverty and (1) unsuppressed viral load [VL] in HIV-seropositive women, (2) uncontrolled blood pressure among HIV-seropositive and HIV-seronegative hypertensive women, and (3) uncontrolled diabetes among HIV-seropositive and HIV-seronegative diabetic women using modified Poisson regression models. Neighborhood poverty was associated with unsuppressed VL in HIV-seropositive women (> 40% versus ≤ 20% poverty adjusted prevalence ratio (PR), 1.42; 95% confidence interval (CI) 1.04-1.92). In HIV-seronegative diabetic women, moderate neighborhood poverty was associated with uncontrolled diabetes (20-40% versus ≤ 20% poverty adjusted PR, 1.75; 95% CI 1.02-2.98). Neighborhood poverty was associated with neither uncontrolled diabetes among HIV-seropositive diabetic women, nor uncontrolled hypertension in hypertensive women, regardless of HIV status. Women living in areas with concentrated poverty may need additional resources to control health conditions effectively.
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Affiliation(s)
- Anna B. Cope
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christina Ludema
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Epidemiology and Biostatistics, School of Public Health, Indiana University at Bloomington, Bloomington, IN
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joseph J. Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Mardge Cohen
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Seble Kassaye
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Adaora A. Adimora
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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16
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Dawit R, Sheehan DM, Gbadamosi SO, Fennie KP, Li T, Curatolo D, Maddox LM, Spencer EC, Trepka MJ. Identifying patterns of retention in care and viral suppression using latent class analysis among women living with HIV in Florida 2015-2017. AIDS Care 2020; 33:131-135. [PMID: 32460517 DOI: 10.1080/09540121.2020.1771264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The study objective was to classify women with newly diagnosed HIV into patterns of retention in care (≥2 HIV care visits ≥3 months apart) and viral suppression over time and identify factors associated with class membership. Florida HIV/AIDS surveillance data were used to conduct Latent Class Analysis to classify women into patterns, and multinomial regression was used to compare the prevalence of class membership by demographic and clinical factors. Four classes were selected based on model fit parameters: (Class 1) consistently retained and suppressed (>90% probability of being retained and suppressed), (Class 2) not consistently retained or suppressed (≤10% probability of being retained and suppressed), (Class 3) increasingly retained and suppressed, and (Class 4) decreasingly retained and suppressed. The proportion of women in each class was 48.6%, 24.9%, 14.3%, and 12.2%, respectively. Women aged 25-34 compared to 35-49 years old, injection drug use mode of exposure, US born, and not linked to care three months post-diagnosis had a lower prevalence of belonging to the consistently retained and suppressed class. Findings may be useful in tailoring and targeting interventions to increase the prevalence of women who are consistently retained in care and virally suppressed.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Danielle Curatolo
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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17
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Sheehan DM, Dawit R, Gbadamosi SO, Fennie KP, Li T, Gebrezgi M, Brock P, Ladner RA, Trepka MJ. Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors. BMC Public Health 2020; 20:326. [PMID: 32169065 PMCID: PMC7069036 DOI: 10.1186/s12889-020-8442-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/02/2020] [Indexed: 01/26/2023] Open
Abstract
Background HIV viral suppression is associated with health benefits for people living with HIV and a decreased risk of HIV transmission to others. The objective was to identify demographic, psychosocial, provider and neighborhood factors associated with sustained viral suppression among gay, bisexual, and other men who have sex with men. Methods Data from adult men who have sex with men (MSM) enrolled in the Miami-Dade County Ryan White Program (RWP) before 2017 were used. Sustained viral suppression was defined as having an HIV viral load < 200 copies/ml in all viral load tests in 2017. Three-level (individual, medical case management site, and neighborhood) cross-classified mixed-effect models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for sustained viral suppression. Results Of 3386 MSM, 90.8% were racial/ethnic minorities, and 84.4% achieved sustained viral suppression. The odds of achieving sustained viral suppression was lower for 18–24 and 25–34 year-old MSM compared with 35–49 year-old MSM, and for non-Latino Black MSM compared with White MSM. Those not enrolled in the Affordable Care Act, and those with current AIDS symptoms and a history of AIDS had lower odds of achieving sustained viral suppression. Psychosocial factors significantly associated with lower odds of sustained viral suppression included drug/alcohol use, mental health symptoms, homelessness, and transportation to appointment needs. Individuals with an HIV physician who serves a larger volume of RWP clients had greater odds of sustained viral suppression. Neighborhood factors were not associated with sustained viral suppression. Conclusion Despite access to treatment, age and racial disparities in sustained viral suppression exist among MSM living with HIV. Addressing substance use, mental health, and social services’ needs may improve the ability of MSM to sustain viral suppression long-term. Furthermore, physician characteristics may be associated with HIV outcomes and should be explored further.
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Affiliation(s)
- Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA. .,Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA. .,Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St, AHC 5, Room 479, Miami, FL, 33199, USA.
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bayshore Rd, Sarasota, FL, 34243, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Merhawi Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL, 33134, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Suite 240, Coral Gables, FL, 33134, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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18
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Jiang Y, Li X, Cho H, Brown MJ, Qiao S, Haider MR. Effects of individual and neighborhood socioeconomic status on antiretroviral therapy adherence: The role of adherence self-efficacy. J Health Psychol 2019; 26:1143-1153. [PMID: 31419916 DOI: 10.1177/1359105319869809] [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: 11/15/2022] Open
Abstract
This study aimed to examine the potential mediation effect of adherence self-efficacy on the associations between individual and neighborhood socioeconomic status and antiretroviral therapy adherence in a sample of 337 people living with HIV in South Carolina, United States. Results showed that there were no direct effects of individual or neighborhood socioeconomic status on antiretroviral therapy adherence, whereas both individual socioeconomic status and neighborhood socioeconomic status were associated with adherence self-efficacy, which in turn were related to antiretroviral therapy adherence. These findings suggest that interventions targeting adherence self-efficacy may improve antiretroviral therapy adherence among people living with HIV with low socioeconomic status or those living in socioeconomically disadvantaged neighborhoods.
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19
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Wiewel EW, Borrell LN, Maroko AR, Jones HE, Torian LV, Udeagu CC. Neighborhood social cohesion and viral suppression after HIV diagnosis. J Health Psychol 2018; 26:477-485. [PMID: 30518282 DOI: 10.1177/1359105318810088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Social cohesion has varying effects on health. We investigated the association of perceived neighborhood social cohesion with HIV viral suppression using individual-level data from the New York City HIV registry and surveillance-based interviews (n = 92). Suppression was achieved within 12 months of HIV diagnosis by 60 percent of persons perceiving low cohesion and 71 percent of those perceiving high (p = 0.31). Controlling for demographic and clinical characteristics and neighborhood poverty, per proportional hazards regression, cohesion was not associated with suppression (adjusted hazards ratio (95% confidence interval) for high versus low cohesion: 0.79 (0.49-1.28)). Cohesion may have heterogeneous effects on HIV medication adherence.
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Affiliation(s)
- Ellen W Wiewel
- New York City Department of Health and Mental Hygiene, USA
| | - Luisa N Borrell
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, USA
| | - Andrew R Maroko
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, USA
| | - Heidi E Jones
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, USA
| | - Lucia V Torian
- New York City Department of Health and Mental Hygiene, USA
| | - Chi-Chi Udeagu
- New York City Department of Health and Mental Hygiene, USA
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20
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Vourli G, Nikolopoulos G, Paparizos V, Skoutelis A, Metallidis S, Gargalianos P, Papadopoulos A, Chini M, Sipsas NV, Psychogiou M, Chrysos G, Sambatakou H, Gogos C, Katsarou O, Paraskeva D, Dedes N, Touloumi G. HIV cascade of care in Greece: Useful insights from additional stages. PLoS One 2018; 13:e0207355. [PMID: 30440000 PMCID: PMC6237384 DOI: 10.1371/journal.pone.0207355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022] Open
Abstract
Background Aiming to eliminate HIV infection, UNAIDS has set a global “90-90-90” target by 2020. We sought to construct a 6-stages HIV Cascade of Care (CoC) in Greece, overall and by risk group, to assess risk-group and stage-specific progress in achieving the UNAIDS target. Patients and methods Combining data from the HIV/AIDS surveillance system and a population-based HIV cohort study, the CoC included: i) number of people living with HIV (PLHIV) by end of 2013; ii) proportion of PLHIV ever diagnosed; iii) proportion of diagnosed linked-to-care iv) proportion of linked-to-care ever initiating antiretroviral therapy (ART); v) proportion of treated who retained-in-care vi) proportion of those retained-in-care who were virally suppressed (≤200 copies/mL) at their last visit (01/07/2012-31/12/2013). Results In 2013, 14147 PLHIV were in Greece. Overall, proportions of each stage in the cascade were: 78.4% diagnosed; 86% linked-to-care; 78.5% initiated ART; 86.4% retained-in-care, and 87.1% virally suppressed. Totally, 42.6% of all PLHIV were virally suppressed. The percentage diagnosed was lower among heterosexual men and women (heterosexuals) than in MSM (men who have sex with men) or PWID (people who inject drugs). Most MSM were linked to care (97.2% of diagnosed) while a substantial proportion of PWID were not (80.8% of diagnosed). Once treated, PWID remained in care in similar proportions to MSM. Unlike PWID, a high proportion of the retained in care MSM and heterosexuals achieved viral suppression. Conclusions At the end of 2013, we identified gaps in the HIV CoC in Greece, which differed across risk groups. Targeted interventions are critical in optimizing early diagnosis and timely linkage. A 6-stage CoC, stratified by risk group, can inform strategic public health planning in improving HIV treatment outcomes.
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Affiliation(s)
- Georgia Vourli
- Dept of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- * E-mail:
| | | | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Athens University, Medical School, Syngros Hospital, Athens, Greece
| | - Athanasios Skoutelis
- Infectious Diseases & HIV Division, Dept of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
| | - Symeon Metallidis
- Aristotle University HIV Unit, AHEPA University Hospital, Thessaloniki, Greece
| | - Panagiotis Gargalianos
- Infectious Diseases Unit, 1 Dept of Medicine, "G. Gennimatas" Athens General Hospital, Athens, Greece
| | - Antonios Papadopoulos
- 4th Dept of Internal Medicine, Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Maria Chini
- Infectious Diseases Unit, Red Cross General Hospital of Athens, Athens, Greece
| | - Nikolaos V. Sipsas
- Pathophysiology Department, “Laikon” General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psychogiou
- “Laikon” Athens General Hospital and Athens University, Medical School, Athens, Greece
| | - Georgios Chrysos
- Infectious Disease Unit, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece
| | - Helen Sambatakou
- Infectious Disease Unit, 2 Dpt. of Internal Medicine, Athens University, Medical School, Hippokration General Hospital, Athens, Greece
| | - Charalambos Gogos
- Infectious Diseases Section, 1 Dept of Internal Medicine, Patras University Hospital, Patras, Greece
| | - Olga Katsarou
- Blood Transfusion Unit, and National Reference Centre for Congenital Bleeding Disorders, Laikon General Hospital, Athens, Greece
| | - Dimitra Paraskeva
- HIV office, Hellenic Center of Disease Control and Prevention, Athens, Greece
| | - Nikos Dedes
- Positive voice, Non-Governmental Organization, Athens, Greece
| | - Giota Touloumi
- Dept of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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