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Pantesco EJ, Schanke MR. Pre-sleep arousal and poor sleep quality link experiential avoidance to depressive symptoms in young adults. J Health Psychol 2024:13591053241302136. [PMID: 39641458 DOI: 10.1177/13591053241302136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Abstract
Higher levels of experiential avoidance are associated with increased risk for depression. Here, we examined the mediating roles of pre-sleep arousal and sleep quality in the relationship between experiential avoidance and depressive symptoms. Undergraduate students (N = 173) completed self-reports of experiential avoidance, pre-sleep arousal, habitual sleep quality, and depressive symptoms. The indirect effect of experiential avoidance on depressive symptoms through pre-sleep arousal and sleep quality was examined in a set of serial mediation analyses. Effect estimates supported a pathway in which higher experiential avoidance was associated with heightened pre-sleep arousal, and heightened pre-sleep arousal was associated with poor sleep quality. Poor sleep quality, in turn, was associated with increased depressive symptoms. Follow-up analyses showed that the indirect path was driven by cognitive, rather than somatic, arousal. Future research assessing the role of pre-sleep cognitive arousal in the relationship between experiential avoidance and mood disruption using longitudinal design is warranted.
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Portilla-Tamarit I, Rubio-Aparicio M, Ruiz-Robledillo N, Ferrer-Cascales R, Albaladejo-Blázquez N, Portilla J. Impact of mental disorders on low adherence to antiretroviral therapy in people living with HIV in Spain. PSYCHOL HEALTH MED 2024:1-16. [PMID: 39342966 DOI: 10.1080/13548506.2024.2407438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 09/15/2024] [Indexed: 10/01/2024]
Abstract
The relationship between mental disorders other than depression or anxiety, and low adherence to both antiretroviral treatment (ART) and linkage to HIV care are unclear. The aim of our study was to compare the prevalence of mental disorders in people living with HIV (PLHIV) in Spain who present low versus high adherence to ART. We performed a cross-sectional study comparing two groups of PLHIV: 20 PLHIV with low adherence and 80 PLHIV with high adherence to ART. PLHIV who met at least one of the following criteria were included in the low-adherence group: virological failure (HIV-VL > 50 copies/mL in two consecutive blood samples); low attendance to scheduled clinical visits (≥2 missed visits in last year); irregular administration of ART (≥10 forgotten doses in the last month); and interruption of ART for more than 1 week. Inclusion criteria for high adherence were: PLHIV who had been on stable ART for more than 1 year with an HIV-VL below 50 copies/mL and without missed visits over the previous 12 months. The Millon Clinical Multiaxial Inventory was administered to participants. PLHIV with low adherence showed higher scores for all mental disorders compared with those with high adherence. And, in the multivariate binary logistic regression analysis, drug dependence and post-traumatic stress disorder were independently associated with low adherence (Nagelkerke R2 = 0.0686). In conclusion, PLHIV with poorly controlled HIV infection presented important psychological vulnerabilities. Mental health should be checked at the beginning of ART and during follow-up, especially in PLHIV with low adherence or low linkage to the health care system.
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Affiliation(s)
- Irene Portilla-Tamarit
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
| | - María Rubio-Aparicio
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Natalia Albaladejo-Blázquez
- Department of Health Psychology, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Joaquín Portilla
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Alicante University General Hospital, Alicante, Spain
- Spanish AIDS Research Network, Carlos III Health Institute, Madrid, Spain
- Department of Clinical Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Nutor JJ, Gyamerah AO, Alhassan RK, Duah HO, Thompson RGA, Wilson N, Harris O, Gutierrez J, Hoffmann TJ, Getahun M, Santos GM. Influence of depression and interpersonal support on adherence to antiretroviral therapy among people living with HIV. AIDS Res Ther 2023; 20:42. [PMID: 37386514 PMCID: PMC10308781 DOI: 10.1186/s12981-023-00538-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing and adhering to ART but are under-studied in low-income countries. The purpose of this study was to examine the association of interpersonal support and depression scores with adherence to ART among persons living with HIV (PLWH) in the Volta region of Ghana. METHODS We conducted a cross-sectional survey among 181 PLWH 18 years or older who receive care at an ART clinic between November 2021 and March 2022. The questionnaire included a 6-item simplified ART adherence scale, the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), and the 12-item Interpersonal Support Evaluation List-12 (ISEL-12). We first used a chi-squared or Fisher's exact test to assess the association between these and additional demographic variables with ART adherence status. We then built a stepwise multivariable logistic regression model to explain ART adherence. RESULTS ART adherence was 34%. The threshold for depression was met by 23% of participants, but it was not significantly associated with adherence in multivariate analysis(p = 0.25). High social support was reported by 48.1%, and associated with adherence (p = 0.033, aOR = 3.45, 95% CI = 1.09-5.88). Other factors associated with adherence included in the multivariable model included not disclosing HIV status (p = 0.044, aOR = 2.17, 95% CI = 1.03-4.54) and not living in an urban area (p = 0.00037, aOR = 0.24, 95% CI = 0.11-0.52). CONCLUSION Interpersonal support, rural residence, and not disclosing HIV status were independent predictors of adherence to ART in the study area.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Akua O Gyamerah
- Department of Community Health and Health Behavior, University of Buffalo, Buffalo, NY, USA
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Henry Ofori Duah
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Rachel G A Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Natalie Wilson
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jose Gutierrez
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
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Pollard R, Enugu A, Sriudomporn S, Bell J, Ghosh SC, Arumugam V, Mugundu P, Singh A, McFall AM, Mehta SH, Patenaude BN, Solomon SS. COVID-19 impact on index testing services and programmatic cost in 5 high HIV prevalence Indian districts. BMC Infect Dis 2022; 22:918. [PMID: 36482363 PMCID: PMC9733361 DOI: 10.1186/s12879-022-07912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Restrictions to curb the first wave of COVID-19 in India resulted in a decline in facility-based HIV testing rates, likely contributing to increased HIV transmission and disease progression. The programmatic and economic impact of COVID-19 on index testing, a standardized contact tracing strategy, remains unknown. METHODS Retrospective programmatic and costing data were analyzed under a US government-supported program to assess the pandemic's impact on the programmatic outcomes and cost of index testing implemented in two Indian states (Maharashtra and Andhra Pradesh). We compared index testing continuum outcomes during lockdown (April-June 2020) and post-lockdown (July-Sept 2020) relative to pre-lockdown (January-March 2020) by estimating adjusted rate ratios (aRRs) using negative binomial regression. Startup and recurrent programmatic costs were estimated across geographies using a micro-costing approach. Per unit costs were calculated for each index testing continuum outcome. RESULTS Pre-lockdown, 2431 index clients were offered services, 3858 contacts were elicited, 3191 contacts completed HIV testing, 858 contacts tested positive, and 695 contacts initiated ART. Compared to pre-lockdown, the number of contacts elicited decreased during lockdown (aRR = 0.13; 95% CI: 0.11-0.16) and post-lockdown (aRR = 0.49; 95% CI: 0.43-0.56); and the total contacts newly diagnosed with HIV also decreased during lockdown (aRR = 0.22; 95% CI: 0.18-0.26) and post-lockdown (aRR = 0.52; 95% CI: 0.45-0.59). HIV positivity increased from 27% pre-lockdown to 40% during lockdown and decreased to 26% post-lockdown. Further, ART initiation improved from 81% pre-lockdown to 88% during lockdown and post-lockdown. The overall cost to operate index testing was $193,457 pre-lockdown and decreased during lockdown to $132,177 (32%) and $126,155 (35%) post-lockdown. Post-lockdown unit cost of case identification rose in facility sites ($372) compared to pre-lockdown ($205), however it decreased in community-based sites from pre-lockdown ($277) to post-lockdown ($166). CONCLUSIONS There was a dramatic decline in the number of index testing clients in the wake of COVID-19 restrictions that resulted in higher unit costs to deliver services; yet, improved linkage to ART suggests that decongesting centres could improve efficiency. Training index testing staff to provide support across services including non-facility-based HIV testing mechanisms (i.e., telemedicine, HIV self-testing, community-based approaches) may help optimize resources during public health emergencies.
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Affiliation(s)
- Rose Pollard
- grid.21107.350000 0001 2171 9311Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Ajay Enugu
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Salin Sriudomporn
- grid.21107.350000 0001 2171 9311International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 N Washington St, Baltimore, MD 21231 USA
| | - Jade Bell
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Subash Chandra Ghosh
- grid.433847.f0000 0000 9555 1294Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), 58 Harrington Road, Chetput, Chennai, 600031 India
| | - Visvanathan Arumugam
- grid.433847.f0000 0000 9555 1294Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), 58 Harrington Road, Chetput, Chennai, 600031 India
| | - Parthasarathy Mugundu
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Aditya Singh
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
| | - Allison M. McFall
- grid.21107.350000 0001 2171 9311Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Shruti H. Mehta
- grid.21107.350000 0001 2171 9311Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Bryan N. Patenaude
- grid.21107.350000 0001 2171 9311Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Sunil S. Solomon
- grid.21107.350000 0001 2171 9311Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 1830 E. Monument St, Baltimore, MD 21205 USA
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Adherence to Antiretroviral Therapy and Its Predictive Factors Among People Living with HIV in China: A Behavioral Theory-Based Prospective Cohort Study. Int J Behav Med 2022:10.1007/s12529-022-10120-7. [DOI: 10.1007/s12529-022-10120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/05/2022]
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Sikkema KJ, Rabie S, King A, Watt MH, Mulawa MI, Andersen LS, Wilson PA, Marais A, Ndwandwa E, Majokweni S, Orrell C, Joska JA. ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial. Trials 2022; 23:680. [PMID: 35982485 PMCID: PMC9386207 DOI: 10.1186/s13063-022-06655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. Methods This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). Discussion This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.
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Affiliation(s)
- K J Sikkema
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - S Rabie
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A King
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M I Mulawa
- Duke University School of Nursing and Duke Global Health Institute, Durham, NC, USA
| | - L S Andersen
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Present Address, University of Copenhagen, Copenhagen, Denmark
| | - P A Wilson
- Department of Psychology, University of California, Los Angeles, USA
| | - A Marais
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - E Ndwandwa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - S Majokweni
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - C Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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7
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Davis A, Pala AN, Nguyen N, Robbins RN, Joska J, Gouse H, Mellins CA, Myer L, Henry M, Leu CS, Remien RH. Sociodemographic and psychosocial predictors of longitudinal antiretroviral therapy (ART) adherence among first-time ART initiators in Cape Town, South Africa. AIDS Care 2020; 33:1394-1403. [PMID: 32698680 DOI: 10.1080/09540121.2020.1798336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
First-time antiretroviral therapy (ART) initiators may be more vulnerable to poor ART adherence because they may be coping with a new HIV diagnosis, facing logistical challenges to accessing and adhering to ART for the first time, and have not yet developed support networks or the skills to support long-term adherence. We recruited 324 participants in two HIV clinics near Cape Town, South Africa. Sociodemographic/psychosocial factors were measured at baseline and self-reported adherence at the 6 month follow-up. We conducted multivariable regression to determine which baseline factors were associated with 6-month adherence. A better patient-clinic relationship score (OR: 1.08 [95% CI: 1.05-1.11]) was associated with higher adherence. A drug use problem (0.51 [0.29-0.87]), higher social isolation (0.93 [0.87-0.99]), and greater number of years living with HIV before initiating ART (0.92 [0.86-1.00]) were associated with adherence levels below 90%. Patient-clinic relationships and social support are key psycho-social factors in early adherence behavior. Reducing drug use problems through targeted screening and early intervention may improve ART adherence.
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Affiliation(s)
- Alissa Davis
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - John Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Landon Myer
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michelle Henry
- Numeracy Centre, Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - Cheng Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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8
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Harrison A, Scott W, Timmins L, Graham CD, Harrison AM. Investigating the potentially important role of psychological flexibility in adherence to antiretroviral therapy in people living with HIV. AIDS Care 2020; 33:337-346. [PMID: 32468841 DOI: 10.1080/09540121.2020.1771263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Antiretroviral therapy (ART) has significantly improved immune health and survival rates in HIV, but these outcomes rely on near perfect adherence. While many psychosocial factors are related to sub-optimal adherence, effectiveness of associated interventions are modest or inconsistent. The Psychological Flexibility (PF) model underlying Acceptance and Commitment Therapy (ACT) identifies a core set of broadly applicable transdiagnostic processes that may be useful to explain and improve non-adherence. However, PF has not previously been examined in relation to ART adherence. Therefore, this cross-sectional study (n = 275) explored relationships between PF and intentional/unintentional ART non-adherence in people with HIV. Adults with HIV prescribed ART were recruited online. Participants completed online questionnaires assessing self-reported PF, adherence and emotional and general functioning. Logistic regressions examined whether PF processes were associated with intentional/unintentional non-adherence. Fifty-eight percent of participants were classified as nonadherent according to the Medication Adherence Rating Scale, of which 41.0% reported intentional and 94.0% unintentional non-adherence. Correlations between PF and adherence were small. PF did not significantly explain intentional/unintentional non-adherence after controlling for demographic and disease factors. Further clarification of the utility of PF in understanding ART non-adherence is warranted using prospective or experimental designs in conjunction with more objective adherence measures.
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Affiliation(s)
- Anja Harrison
- School of Psychology, University of Central Lancashire, Preston, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Liadh Timmins
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | - Anthony M Harrison
- Leeds and York Partnership National Health Service Foundation Trust, Leeds, UK
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9
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McMahon JM, Braksmajer A, Zhang C, Leblanc N, Chen M, Aidala A, Simmons J. Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men. AIDS Res Ther 2019; 16:32. [PMID: 31706357 PMCID: PMC6842154 DOI: 10.1186/s12981-019-0248-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suboptimal adherence to HIV antiretroviral therapy (ART) and concomitant lack of viral control can have severe consequences for health and onward transmission among persons living with HIV. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men. METHODS Structural equation modeling (SEM) was performed to test a theory-derived model of ART adherence using data from a cross-sectional sample of 317 HIV-positive self-identified heterosexual men residing in New York City. We assessed a conceptual model in which mental health (depression, anxiety) and substance use dependence mediated the effects of socio-structural factors (HIV-related stigma, social support) on ART adherence, and subsequently, undetectable viral load. RESULTS Structural equation modeling analyses indicated that men who reported higher levels of HIV-related stigma tended to experience higher levels of general anxiety, which in turn was associated with reduced probability of optimal ART adherence. Moreover, men who reported higher levels of social support tended to exhibit less dependence on illicit substance use, which in turn was associated with increased probability of optimal ART adherence. African-American men reported lower ART adherence compared to other racial/ethnic groups. CONCLUSIONS Our findings support the hypothesis that substance use dependence and mental health problems, particularly anxiety, may be primary drivers of suboptimal ART adherence among heterosexual men, and that socio-structural factors such as HIV-related stigma and social support are potential modifiable antecedents of these drivers.
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10
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López CM, Hahn CK, Gilmore AK, Danielson CK. Tailoring Cognitive Behavioral Therapy for Trauma-Exposed Persons Living With HIV. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 27:70-83. [PMID: 32742160 DOI: 10.1016/j.cbpra.2019.02.006] [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: 01/18/2023]
Abstract
This Treatment Development Report describes the need for evidence-based psychosocial trauma-focused treatment for people living with comorbid posttraumatic stress disorder (PTSD) and HIV. Individuals with HIV have higher rates of exposure to traumatic events and PTSD than the general public, and they also experience additional consequences of PTSD on the management of their chronic disease (e.g., established link between PTSD symptoms and lack of adherence to antiretroviral therapy [ART]). We used the empirically-supported ADAPT-ITT approach to consider the initial steps in adapting evidence-based Cognitive Processing Therapy (CPT) for individuals with PTSD and HIV. This paper reviews a case example that involved various clinical issues that may arise when providing trauma-focused treatment for people living with HIV including HIV-stigma, disease management, and the need for making multicultural adaptations to psychotherapy. This case example illustrates how trauma-focused treatment may benefit from enhancement to address additional barriers that may arise over the course of PTSD treatment in this population. Feasibility of engaging and delivering a "full dose" of evidence-based PTSD treatment among individuals living with HIV is discussed. While evidence-based treatments can reduce PTSD symptom severity, issues related to chronic disease coping and HIV-related stigma management could be integrated to augment the efficacy of treatment for individuals with HIV. Adaptive intervention research targeting PTSD in persons living with HIV warrants further attention, especially given the association between PTSD and adherence to ART.
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Affiliation(s)
- Cristina M López
- College of Nursing, Medical University of South Carolina; 99 Jonathan Lucas MSC 160, Charleston, SC 29425.,National Crime Victims Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; 67 President Street, MSC 861, Charleston, SC 29425
| | - Christine K Hahn
- National Crime Victims Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; 67 President Street, MSC 861, Charleston, SC 29425
| | - Amanda K Gilmore
- College of Nursing, Medical University of South Carolina; 99 Jonathan Lucas MSC 160, Charleston, SC 29425
| | - Carla Kmett Danielson
- National Crime Victims Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina; 67 President Street, MSC 861, Charleston, SC 29425
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11
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Topp SM, Mwamba C, Sharma A, Mukamba N, Beres LK, Geng E, Holmes CB, Sikazwe I. Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care. PLoS One 2018. [PMID: 29538443 PMCID: PMC5851576 DOI: 10.1371/journal.pone.0193641] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Failure to keep people living with HIV engaged in life-long care and treatment has serious implications for individual and population-level health. Nested within a four-province study of HIV care and treatment outcomes, we explored the dynamic role of social and service-related factors influencing retention in HIV care in Zambia. METHODS From a stratified random sample of 31 facilities, eight clinics were selected, one urban and one rural from each province. Across these sites we conducted a total of 69 in-depth interviews, including with patients (including pregnant women) engaged in-care (n = 28), disengaged from care (n = 15), engaged facility transferee (n = 12), and friends/family of deceased patients (n = 14). At the same sites we conducted 24 focus group discussions with a total of 192 lay and professional healthcare workers (HCWs). Two-day observations in each of the eight facilities helped triangulate data on operational context, provider relations and patient-provider interactions. We ordered and analysed data using an adapted version of Ewart's Social Action Theory. RESULTS Three overarching findings emerged. First, the experience of living with HIV and engaging in HIV care in Zambia is a social, not individual experience, influenced by social and gendered norms and life goals including financial stability, raising family and living stigma-free. Second, patients and their networks act collectively to negotiate and navigate HIV care. Anticipated responses from social network influenced patients' willingness to engage in care, while emotional and material support from those networks influenced individuals' capacity to remain in HIV care. Lastly, health system factors were most influential where they facilitated or undermined peoples' collective approach to health service use. Participants living with HIV reported facilitation of both their initial and continued engagement in care where services involved social networks, such as during couples testing and community outreach. Conversely, service features that were poorly aligned with respondents' social reality (e.g. workplace obligations) hindered long-term engagement. CONCLUSIONS This study moves beyond listing barriers or socio-ecological groupings, to explain how social and health systems interact to produce HIV care outcomes. Our findings challenge the implicit assumption of individual agency underpinning many retention studies to highlight the social nature of illness and healthcare utilization for HIV in Zambia. This understanding of collective action for accessing and remaining in HIV care should underpin future efforts to revise and reform HIV and potentially other chronic service models and systems.
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Affiliation(s)
- Stephanie M. Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- * E-mail:
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Beres
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elvin Geng
- School of Medicine, University of San Francisco, San Francisco, California, United States of America
| | - Charles B. Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Topp SM, Mwamba C, Sharma A, Mukamba N, Beres LK, Geng E, Holmes CB, Sikazwe I. Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care. PLoS One 2018; 13:e0193641. [PMID: 29538443 PMCID: PMC5851576 DOI: 10.1371/journal.pone.0193641&type=printable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/13/2018] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Failure to keep people living with HIV engaged in life-long care and treatment has serious implications for individual and population-level health. Nested within a four-province study of HIV care and treatment outcomes, we explored the dynamic role of social and service-related factors influencing retention in HIV care in Zambia. METHODS From a stratified random sample of 31 facilities, eight clinics were selected, one urban and one rural from each province. Across these sites we conducted a total of 69 in-depth interviews, including with patients (including pregnant women) engaged in-care (n = 28), disengaged from care (n = 15), engaged facility transferee (n = 12), and friends/family of deceased patients (n = 14). At the same sites we conducted 24 focus group discussions with a total of 192 lay and professional healthcare workers (HCWs). Two-day observations in each of the eight facilities helped triangulate data on operational context, provider relations and patient-provider interactions. We ordered and analysed data using an adapted version of Ewart's Social Action Theory. RESULTS Three overarching findings emerged. First, the experience of living with HIV and engaging in HIV care in Zambia is a social, not individual experience, influenced by social and gendered norms and life goals including financial stability, raising family and living stigma-free. Second, patients and their networks act collectively to negotiate and navigate HIV care. Anticipated responses from social network influenced patients' willingness to engage in care, while emotional and material support from those networks influenced individuals' capacity to remain in HIV care. Lastly, health system factors were most influential where they facilitated or undermined peoples' collective approach to health service use. Participants living with HIV reported facilitation of both their initial and continued engagement in care where services involved social networks, such as during couples testing and community outreach. Conversely, service features that were poorly aligned with respondents' social reality (e.g. workplace obligations) hindered long-term engagement. CONCLUSIONS This study moves beyond listing barriers or socio-ecological groupings, to explain how social and health systems interact to produce HIV care outcomes. Our findings challenge the implicit assumption of individual agency underpinning many retention studies to highlight the social nature of illness and healthcare utilization for HIV in Zambia. This understanding of collective action for accessing and remaining in HIV care should underpin future efforts to revise and reform HIV and potentially other chronic service models and systems.
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Affiliation(s)
- Stephanie M. Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- * E-mail:
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Beres
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elvin Geng
- School of Medicine, University of San Francisco, San Francisco, California, United States of America
| | - Charles B. Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| |
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