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Soyer EM, McGinnis KA, Justice AC, Hsieh E, Rodriguez-Barradas MC, Williams EC, Park LS. COVID-19 Breakthrough Infection after Vaccination and Substance Use Disorders: A Longitudinal Cohort of People with and without HIV Receiving Care in the United States Veterans Health Administration. AIDS Behav 2024; 28:3605-3614. [PMID: 39046612 DOI: 10.1007/s10461-024-04449-1] [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: 07/09/2024] [Indexed: 07/25/2024]
Abstract
Research regarding HIV, substance use disorders (SUD), and SARS-CoV-2 infections after COVID-19 vaccination is limited. In the Veterans Aging Cohort Study (VACS)-HIV cohort, we followed vaccinated persons with HIV (PWH) and without HIV (PWoH) from 12/2020 to 3/2022 and linked SARS-CoV-2 test results for laboratory-confirmed breakthrough infection through 9/2022. We examined associations of substance use (alcohol use disorder [AUD], other SUD, smoking status) and HIV status and severity with breakthrough infections, using Cox proportional hazards regression hazard ratios (HR). To test for potential interactions between substance use and HIV, we fit survival models with a multiplicative interaction term. Among 24,253 PWH and 53,661 PWoH, 8.0% of PWH and 7.1% of PWoH experienced COVID-19 breakthrough. AUD (HR 1.42, 95% CI 1.32, 1.52) and other SUD (HR 1.49, 95% CI 1.39, 1.59) were associated with increased risk of breakthrough, and this was similar by HIV status (p-interaction > 0.09). Smoking was not associated with breakthrough. Compared to PWoH, PWH at all HIV severity levels had increased risk of breakthrough ranging from 9% for PWH with CD4 count ≥ 500 cells/µl (HR 1.09, 95% CI 1.02, 1.17) to 59% for PWH with CD4 count < 200 (HR 1.59, 95% CI 1.31, 1.92). Patients with AUD (HR 1.42, 95% CI 1.33, 1.52) and other SUD (HR 1.48, 95% CI 1.38, 1.59) had increased COVID-19 breakthrough risk, regardless of HIV status. HIV was associated with breakthrough; risk was greatest among PWH with lower CD4 count. In addition to inhibiting HIV treatment adherence and increasing HIV progression, AUD and other SUD may increase COVID-19 breakthrough risk.
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Affiliation(s)
- Elena M Soyer
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Washington State Health Care Authority, Olympia, WA, USA
| | | | - Amy C Justice
- Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Evelyn Hsieh
- Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Lesley S Park
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
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Kahler CW, Surace A, Liu T, Pantalone DW, Mastroleo NR, Yan Y, Wray TB, Mayer KH, Monti PM. Efficacy of Behavioral Intervention, Text Messaging, and Extended Intervention to Address Alcohol Misuse in Sexual Minority Men with HIV: A Factorial Randomized Clinical Trial. AIDS Behav 2024:10.1007/s10461-024-04493-x. [PMID: 39266891 DOI: 10.1007/s10461-024-04493-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 09/14/2024]
Abstract
This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements. Clinical Trials Number: NCT02709759.
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Affiliation(s)
- Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA.
| | - Anthony Surace
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Tao Liu
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - David W Pantalone
- The Fenway Institute, Fenway Health Boston, Boston, MA, USA
- University of Massachusetts Boston, Boston, MA, USA
| | - Nadine R Mastroleo
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, USA
| | - Yufei Yan
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Tyler B Wray
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health Boston, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA
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Palfai TP, Bernier LB, Kratzer MP, Magane KM, Fielman S, Otis JD, Heeren TC, Winter MR, Stein MD. Integrated telehealth intervention to reduce chronic pain and unhealthy drinking among people living with HIV: protocol for a randomized controlled trial. Addict Sci Clin Pract 2024; 19:64. [PMID: 39238059 PMCID: PMC11375999 DOI: 10.1186/s13722-024-00493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/08/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). METHODS Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. CONCLUSION This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. CLINICALTRIALS GOV IDENTIFIER NCT05503173.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA.
| | - Lauren B Bernier
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Maya Pl Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Sarah Fielman
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Timothy C Heeren
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Ferguson E, Busch AM, Anderson B, Abrantes AM, Pinkston MM, Baker JV, Stein MD, Uebelacker LA. Avoidance and Rumination as Predictors of Substance Use, Mental Health, and Pain Outcomes Among People Living With HIV. Behav Ther 2024; 55:1015-1025. [PMID: 39174262 PMCID: PMC11341950 DOI: 10.1016/j.beth.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 08/24/2024]
Abstract
Pain, substance use, and mental health conditions are common among people living with HIV (PLWH), and avoidance and rumination may influence the co-occurrence of these conditions. The present study examined longitudinal associations between avoidance/rumination and pain outcomes, anxiety, anger, and substance use among PLWH. Participants (N = 187) with chronic pain and depressive symptoms completed self-report assessments over a 1-year period. Greater avoidance/rumination was positively associated with mental health outcomes (anxiety, anger), pain interference, and alcohol use across participants after controlling for depression severity. At time points with greater avoidance/rumination than average, participants also reported increased pain severity and interference, anxiety and anger symptoms, and alcohol use. No associations were found between avoidance/rumination and cannabis use. Results suggest a mechanistic effect of avoidance/rumination, such that increases in avoidance/rumination correspond with poorer health outcomes among PLWH over time. Targeting avoidance/rumination through intervention approaches may be beneficial for addressing comorbid health conditions among PLWH. Additional research is necessary to investigate this possibility and further characterize the effects of avoidance/rumination on health outcomes for PLWH.
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Affiliation(s)
| | - Andrew M Busch
- Hennepin Healthcare and University of Minnesota Medical School
| | | | - Ana M Abrantes
- Alpert Medical School of Brown University and Butler Hospital
| | - Megan M Pinkston
- Alpert Medical School of Brown University and Lifespan Physicians Group, the Miriam Hospital
| | - Jason V Baker
- Hennepin Healthcare and University of Minnesota Medical School
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Briggs ES, Thomas RM, Frost MC, Fletcher OV, Crothers K, Chalal CK, Shahrir SF, McClure JB, Catz SL, Williams EC. "I Thought Cancer was a Tobacco Issue": Perspectives of Veterans with and without HIV on Cancer and Other Health Risks Associated with Alcohol and Tobacco/Nicotine Use. AIDS Behav 2024; 28:2607-2618. [PMID: 38869757 DOI: 10.1007/s10461-024-04363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
U.S. Veterans and people living with HIV (PWH) experience higher rates of unhealthy alcohol and tobacco/nicotine use than non-Veterans and people without HIV (PWoH). Both groups are susceptible to adverse health outcomes associated with alcohol and tobacco/nicotine use. We explored awareness of alcohol- and tobacco/nicotine-related cancer and immune health risks among Veterans Health Administration (VA) patients with and without HIV. Among a sample of 41 (46% PWH; 73% male; 39% Black) purposively-selected VA patients receiving care 2020-2021 we conducted semi-structured interviews via telephone; interviews were recorded, transcribed and analyzed using a Rapid Assessment Process. Purposive selection was based on HIV status, alcohol and/or tobacco/nicotine use, and demographics. Among participants, 66% reported current smoking, and most screened positive for unhealthy alcohol use. Participants had high awareness of cancer and other health risks related to smoking but low awareness of synergistic risks and cancer risks associated with alcohol use despite awareness of a range of other alcohol-related risks. Awareness of alcohol and/or tobacco/nicotine's impacts on the immune system was variable. Findings did not distinctly differ between PWH and PWoH. Low awareness of alcohol-related cancer risk, risks of co-occurring use, and varying awareness of the impacts of alcohol and tobacco/nicotine on the immune system suggest a need for improved messaging regarding substance use-related cancer and immune risk. This may be especially important among PWH, for whom the prevalence and adverse effects of alcohol and tobacco use, and immune dysfunction are higher.
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Affiliation(s)
- Elsa S Briggs
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA.
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
| | - Rachel M Thomas
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Madeline C Frost
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Olivia V Fletcher
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Kristina Crothers
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Clementine K Chalal
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Shahida F Shahrir
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
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Wynn A, Sileo KM, Schmarje Crockett K, Naigino R, Ediau M, Wanyenze RK, Kiwanuka N, Martin NK, Kiene SM. Prevalence of alcohol use by gender and HIV status in rural Uganda. PLoS One 2024; 19:e0303885. [PMID: 39012870 PMCID: PMC11251619 DOI: 10.1371/journal.pone.0303885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/03/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Alcohol use is a major contributor to mortality and morbidity worldwide. Uganda has a high level of alcohol use per capita. Compared to men, women are less likely to consume alcohol globally; however, women who drink have increased risks for co-occurring conditions, including depression, intimate partner violence, and HIV. This study assessed the prevalence of alcohol use and correlates of harmful alcohol use by gender and HIV status in rural Uganda. METHODS We used cross-sectional data from a study among women and men aged 15-59 residing in rural, central Uganda and accepting home-based HIV testing (Nov 2017 to Dec 2020). We estimated the prevalence of levels of alcohol use (categorized as no alcohol use (score 0), low (score 1-3 for men; 1-2 for women), medium (score 4-5 for men; 3-5 for women), high (score 6-7), and very-high (score 8-12) use with the AUDIT-C), stratified by gender and HIV status. We assessed correlates of harmful alcohol use using multivariable logistic regression models for women and men. RESULTS Among 18,460 participants, 67% (95% CI: 66-67%) reported no alcohol use, 16% (95% CI: 16-17%) reported low, 5% (95% CI: 4.8-5%) reported medium, 5% (95% CI: 4-5%) reported high, and 3% (95% CI: 2.8-3) reported very high alcohol use. Compared to women, men were more likely to report alcohol use (Chi-squared p-value<0.0001). People diagnosed with HIV (both newly diagnosed and previously aware of their status prior to home-based HIV testing) were more likely to report low, medium, high, and very high alcohol use compared to those who were HIV negative (Chi-squared p-value<0.0001). Among women, those who were newly diagnosed were more likely report alcohol use, compared to those who were HIV negative. In multivariable models, being newly diagnosed with HIV (compared to HIV negative) increased the odds of harmful alcohol use among women, but not men. CONCLUSION While alcohol use was higher among men and people living with HIV, being newly diagnosed with HIV had a stronger relationship with harmful alcohol use among women than men. More research is needed to understand how alcohol use may increase the risks of HIV acquisition among women and to identify gender-responsive services to address harmful alcohol use and increase access to HIV testing and linkage to care for women who use harmful levels of alcohol.
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Affiliation(s)
- Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Katelyn M. Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, United States of America
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Rose Naigino
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, United States of America
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, United States of America
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Noah Kiwanuka
- Epidemiology and Biostatistics Department, at Makerere University School of Public Health, Kampala, Uganda
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, United States of America
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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7
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Wynn A, Sileo KM, Schmarje Crockett K, Naigino R, Ediau M, Menzies NA, Kalichman SC, Wanyenze RK, Martin NK, Kiene SM. Associations Between Alcohol Use, Antiretroviral Therapy Use, and Viral Load Suppression Among People Living with HIV in Rural Central Uganda. AIDS Behav 2024; 28:2205-2215. [PMID: 38775856 PMCID: PMC11199259 DOI: 10.1007/s10461-024-04299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 06/15/2024]
Abstract
Alcohol use among people living with HIV (PWH) is common and may negatively affect engagement in HIV care. We evaluated the relationships between alcohol use, ART use, and viral suppression among PWH in Uganda. PATH/Ekkubo was a trial evaluating a linkage to HIV care intervention in four Ugandan districts, Nov 2015-Sept 2021. Our analytical sample included: (1) baseline data from individuals not enrolled in the intervention trial (previously diagnosed HIV+); and 12-month follow-up data from the control group (newly diagnosed or previously diagnosed, but not in care). Level of alcohol use was categorized using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C): none (AUDIT-C = 0), low (women = 1-2, men = 1-3), medium (women = 3-5, men = 4-5), high/very high (6-12). Multivariable logistic regression models evaluated associations between alcohol use, ART use and viral suppression (a viral load of < 20); we also stratified by gender. Among 931 PWH, medium (OR: 0.43 [95% CI 0.25-0.72]) and high/very high (OR: 0.22 [95% CI 0.11-0.42]) levels of alcohol use were associated with lower odds of being on ART. In a sub-sample of 664, medium use (OR: 0.63 [95% CI 0.41-0.97]) was associated with lower odds of viral suppression. However, this association was not statistically significant when restricting to those on ART, suggesting the relationship between alcohol use and viral suppression is explained by ART use. Among men, high/very high, and among women, medium alcohol use levels were associated with lower odds of being on ART and being virally suppressed. Interventions for PWH who use higher levels of alcohol may be needed to optimize the benefits of Uganda's Universal Test and Treat strategy.
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Affiliation(s)
- Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rose Naigino
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024; 17:589-614. [PMID: 38753455 PMCID: PMC11233252 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N. Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H. Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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Bartels SM, Phan HTT, Hutton HE, Nhan DT, Sripaipan T, Chen JS, Rossi SL, Ferguson O, Nong HTT, Nguyen NTK, Giang LM, Bui HTM, Chander G, Sohn H, Kim S, Tran HV, Nguyen MX, Powell BJ, Pence BW, Miller WC, Go VF. Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial. Implement Sci 2024; 19:40. [PMID: 38867283 PMCID: PMC11170841 DOI: 10.1186/s13012-024-01368-6] [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: 04/11/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians' attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians' knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use. METHODS Design: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians' alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI. PARTICIPANTS ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months. OUTCOMES We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff's alcohol use and clinic-level alcohol expectations in the EBAI arm. DISCUSSION This trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases. TRIAL REGISTRATION NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .
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Affiliation(s)
- Sophia M Bartels
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Huong T T Phan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Heidi E Hutton
- Johns Hopkins Hospital University School of Medicine, Baltimore, MD, USA
| | - Do T Nhan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Teerada Sripaipan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jane S Chen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Sarah L Rossi
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Olivia Ferguson
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Le Minh Giang
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Hao T M Bui
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Hojoon Sohn
- Seoul National University College, Seoul, Korea
| | - Sol Kim
- Seoul National University College, Seoul, Korea
| | | | - Minh X Nguyen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MI, USA
| | - Brian W Pence
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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Knox J, Aharonovich E, Zingman BS, Stohl M, Walsh C, Elliott JC, Fink DS, Durant S, Menchaca R, Sharma A, Denning M, Hasin D. HealthCall: Smartphone Enhancement of Brief Interventions to Improve HIV Medication Adherence Among Patients in HIV Care. AIDS Behav 2024; 28:1912-1922. [PMID: 38478322 DOI: 10.1007/s10461-024-04289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 08/23/2024]
Abstract
Heavy drinking among people living with HIV (PLWH) reduces ART adherence and worsens health outcomes. Lengthy interventions are not feasible in most HIV care settings, and patients infrequently follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed HealthCall as an electronic means of increasing patient involvement in a brief intervention to reduce drinking and improve ART adherence. The objective of the current study is to evaluate the efficacy of HealthCall to improve ART adherence among PLWH who drink heavily when paired with two brief interventions: the National Institute on Alcoholism and Alcohol Abuse (NIAAA) Clinician's Guide (CG) or Motivational Interviewing (MI). Therefore, we conducted a 1:1:1 randomized trial among 114 participants with alcohol dependence at a large urban HIV clinic. Participants were randomized to one of three groups: (1) CG only (n = 37), (2) CG and HealthCall (n = 38), or (3) MI and HealthCall (n = 39). Baseline interventions targeting drinking reduction and ART adherence were ~ 25 min, with brief (10-15 min) booster sessions at 30 and 60 days. The outcome was ART adherence assessed using unannounced phone pill-count method (possible adherence scores: 0-100%) at 30-day, 60-day, 3, 6, and 12 months. Analyses were conducted using generalized linear mixed models with pre-planned contrasts. Of the 114 enrolled patients, 58% were male, 75% identified as Black/African American, 28% were Hispanic, and 62% had less than a high school education. The mean age was 47.5 years (standard deviation [SD] 10 years) and the mean number of years since they were diagnosed with HIV was 18.6 (SD 7.6). Participants assigned to HealthCall to extend the CG had increased levels of ART adherence at 60-day and 6-month follow-up (compared to CG only), although there was no statistically significant difference by 12-month follow-up. Participants who were assigned to HealthCall to extend the MI never had statistically significant higher levels of ART adherence. These results suggest that the use of a smartphone app can be used to initially extend the reach of a brief drinking intervention to improve ART adherence over a short period of time; however, sustained long-term improvements in ART adherence after intervention activity ends remains a challenge.
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Affiliation(s)
- Justin Knox
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA.
- New York State Psychiatric Institute, New York, NY, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Efrat Aharonovich
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Barry S Zingman
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Malka Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY, USA
| | - Jennifer C Elliott
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - David S Fink
- New York State Psychiatric Institute, New York, NY, USA
| | - Sean Durant
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Raquel Menchaca
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anjali Sharma
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Deborah Hasin
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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11
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Engler K, Avallone F, Cadri A, Lebouché B. Patient-reported outcome measures in adult HIV care: A rapid scoping review of targeted outcomes and instruments used. HIV Med 2024; 25:633-674. [PMID: 38282323 DOI: 10.1111/hiv.13599] [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: 05/12/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE There is international interest in the integration of patient-reported outcome measures (PROMs) into routine HIV care, but little work has synthesized the content of published initiatives. We conducted a rapid scoping review primarily to identify their selected patient-reported outcomes and respective instruments. METHODS Four databases were searched on 4 May 2022 (Medline, Embase, CINAHL and PsychINFO) for relevant English language documents published from 2005 onwards. Dual review of at least 20% of records, full texts and data extraction was performed. Outcomes and instruments were classified with an adapted 14-domain taxonomy. Instruments with evidence of validation were described. RESULTS Of 13 062 records generated for review, we retained a final sample of 94 documents, referring to 60 distinct initiatives led mostly in the USA (n = 29; 48% of initiatives), Europe (n = 16; 27%) and Africa (n = 9; 15%). The measured patient-reported outcome domains were: mental health (n = 42; 70%), substance use (n = 23; 38%), self-management (n = 16; 27%), symptoms (n = 12; 20%), sexual/reproductive health (n = 12; 20%), physical health (n = 9; 15%), treatment (n= 8; 13%), cognition (n = 7; 12%), quality of life (n = 7; 12%), violence/abuse (n = 6; 10%), stigma (n = 6; 10%), socioeconomic issues (n = 5; 8%), social support (n = 3; 5%) and body/facial appearance (n = 1; 2%). Initiatives measured 2.6 outcome domains, on average (range = 1-11). In total, 62 distinct validated PROMs were identified, with 53 initiatives (88%) employing at least one (M = 2.2). Overwhelmingly, the most used instrument was any version of the Patient Health Questionnaire to measure symptoms of depression, employed by over a third (26; 43%) of initiatives. CONCLUSION Published PROM initiatives in HIV care have spanned 19 countries and disproportionately target mental health and substance use.
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Affiliation(s)
- Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Francesco Avallone
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Abdul Cadri
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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12
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Byrne M, Monroe AK, Doshi RK, Horberg MA, Castel AD. A Latent Class Analysis of Substance Use and Longitudinal HIV RNA Patterns Among PWH in DC Cohort. AIDS Behav 2024; 28:682-694. [PMID: 38319460 PMCID: PMC10952057 DOI: 10.1007/s10461-023-04257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
People with HIV (PWH) with substance use disorders (SUD) have worse health outcomes than PWH without SUD. Our objective was to characterize substance use patterns and their impact on longitudinal HIV RNA trajectories among those enrolled in an observational study of PWH in care in Washington, DC. Substance use by type (alcohol, cannabis, opioid, stimulant, hallucinogen, inhalant, sedative) was used to identify shared patterns of substance use using Latent Class Analysis (LCA). A multinomial logistic regression model evaluated the association between the resulting substance use classes and the membership probability in longitudinal HIV RNA trajectory groups. There were 30.1% of participants with at least one substance reported. LCA resulted in a three-class model: (1) Low-Level Substance Use, (2) Opioid Use, and (3) Polysubstance. The Opioid and Polysubstance Use classes were more likely to have a mental health diagnosis (45.4% and 53.5%; p < 0.0001). Members in the Opioid Use class were older (median age of 54.9 years (IQR 50.3-59.2) than both the Polysubstance and Low-Level Substance Use Classes (p < 0.0001). There were 3 HIV RNA trajectory groups: (1) Undetectable, (2) Suppressed, and (3) Unsuppressed HIV RNA over 18 months of follow-up. The probability of being in the unsuppressed HIV RNA group trajectory when a member of the Opioid Use or Polysubstance Use classes was 2.5 times and 1.5 times greater than the Low-Level Substance Use class, respectively. The Opioid Use and Polysubstance Use classes, with higher-risk drug use, should be approached with more targeted HIV-related care to improve outcomes.
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Affiliation(s)
- Morgan Byrne
- George Washington University, Washington, DC, USA.
| | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
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13
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Sabri B, Budhathoki C, McFall AM, Mehta SH, Celentano DD, Solomon SS, Srikrishnan AK, Anand S, Vasudevan CK, Lucas GM. Cumulative violence exposures among men who have sex with men living with HIV in India: Psychosocial correlates of HIV care continuum outcomes. PLoS One 2023; 18:e0295225. [PMID: 38039322 PMCID: PMC10691715 DOI: 10.1371/journal.pone.0295225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/17/2023] [Indexed: 12/03/2023] Open
Abstract
Lifetime exposures to violence among men who have sex with men (MSM) are associated with multiple psychosocial health risks and can affect engagement and outcomes of HIV treatment. This study a) explored relationships between levels of exposures to violence and HIV care continuum outcomes among MSM living with HIV in India, and b) identified psychosocial correlates of HIV care continuum outcomes among MSM living with HIV and those with lifetime cumulative exposures to violence (CVE). CVE referred to exposures to violence in both childhood and adulthood. This cross-sectional analysis used survey data collected between August 2016 and May 2017 from 1763 men who have sex with men living with HIV across 10 cities in India, using respondent-driven sampling. We found that higher levels of violence exposure were significantly associated with lower awareness of HIV positive status, and lower likelihood of initiating antiretroviral therapy. Compared with MSM living with HIV that had no CVE, those with CVE were more likely to report perpetration of interpersonal violence, alcohol misuse, depressive symptoms, and HIV transmission risk behaviors and to have two to four co-occurring psychosocial problems. In multivariable analysis with the subset of MSM with CVE, psychosocial correlates significantly associated with at least one HIV care continuum outcome were HIV transmission risk behaviors, perpetration of interpersonal violence, depression, and alcohol misuse. The findings highlight the need for integrating care for lifetime violence exposures and associated behavioral problems in HIV care settings for men who have sex with men living with HIV in India.
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Affiliation(s)
- Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Allison M. McFall
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Shruti H. Mehta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - David D. Celentano
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sunil S. Solomon
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | - Gregory M. Lucas
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
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14
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Puryear SB, Mwangwa F, Opel F, Chamie G, Balzer LB, Kabami J, Ayieko J, Owaraganise A, Kakande E, Agengo G, Bukusi E, Kabageni S, Omoding D, Bacon M, Schrom J, Woolf‐King S, Petersen ML, Havlir DV, Kamya M, Hahn JA. Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial. J Int AIDS Soc 2023; 26:e26187. [PMID: 38054564 PMCID: PMC10698822 DOI: 10.1002/jia2.26187] [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: 04/05/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Unhealthy alcohol use significantly contributes to viral non-suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub-Saharan Africa (SSA). METHODS As part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills-based alcohol intervention among PWH with self-reported unhealthy alcohol use (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C], prior 3 months, ≥3/female; ≥4/male) and at risk of viral non-suppression, defined as either recent HIV viral non-suppression (≥400 copies/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3-month in-person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (<400 copies/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT-C or phosphatidylethanol (PEth), an alcohol biomarker, ≥50 ng/ml at 24 weeks. RESULTS Between April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol-serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93-1.1). Among PWH with baseline viral non-suppression, 24-week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93-1.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79-0.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56-0.88) than men (RR 0.93, 95% CI: 0.85-1.01) and among participants with a baseline PEth⩽200 ng/ml (RR 0.68, 95% CI: 0.53-0.87) versus >200 ng/ml (RR 0.97, 95% CI: 0.92-1.02). CONCLUSIONS In a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non-suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV-associated co-morbidities.
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Affiliation(s)
- Sarah B. Puryear
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Fred Opel
- Kenya Medical Research InstituteKisumuKenya
| | - Gabriel Chamie
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Laura B. Balzer
- Division of BiostatisticsSchool of Public HealthUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Jane Kabami
- Infectious Diseases Research CollaborationMbararaUganda
| | | | | | | | | | | | | | | | - Melanie Bacon
- National Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
| | - John Schrom
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Maya L. Petersen
- Division of BiostatisticsSchool of Public HealthUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Diane V. Havlir
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Moses Kamya
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Judith A. Hahn
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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15
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Ghosh A, Singh GK, Yadav N, Singh P, Kathiravan S. Brief interventions for alcohol misuse among people living with HIV: a meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:766-786. [PMID: 37921633 DOI: 10.1080/00952990.2023.2248647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 11/04/2023]
Abstract
Background: One-third of people living with HIV (PLHIV) have alcohol misuse or alcohol use disorders which negatively affect course and outcome of HIV.Objectives: The meta-analysis sought to evaluate the effectiveness of brief interventions (BI) on alcohol and HIV outcomes in PLHIV with alcohol misuse.Methods: We included clinical trials published between 1990 and September 2022 on adults with harmful/hazardous alcohol use; only randomized clinical trials (RCTs) were included in the meta-analysis. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials.Gov, and the World Health Organization's International Clinical Trials Registry Platform databases. Cochrane's risk-of-bias assessment was used.Results: Eighteen studies were included in the narrative synthesis, and a meta-analysis could be performed on 13 studies. Among the included RCTs, seven showed a low risk and two showed a high risk of bias; others showed some concerns. There was no evidence of publication bias. Compared to the control, BI significantly reduces the drinks per drinking day (N = 5, Hedge's g= -0.45, 95%CI = -0.58, -0.32) and the number of heavy drinking days (N = 4, Hedge'sg = -0.81, 95% CI= -0.94, -0.67) between 3-6 months post-intervention. BI also reduces the odds of mortality by 42% (N = 7, OR = 0.58, 95% CI = 0.34, 0.99) in 6-12 months. BI does not change the alcohol risk scores and transition to harmful alcohol use; it does not improve adherence to Anti-Retroviral Therapy and increase viral suppression.Conclusion: Policymakers must introduce and scale up integrated screening and brief intervention services within HIV clinics and primary care.
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Affiliation(s)
- Abhishek Ghosh
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Geetesh K Singh
- Department of Psychology, SCBS, Rashtriya Raksha University (An Institute of National Importance) Lavad, Gandhinagar, India
| | - Nidhi Yadav
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranshu Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjana Kathiravan
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Beesiga B, Marson K, Fatch R, Emenyonu NI, Adong J, Kekibiina A, Puryear S, Lodi S, McDonell MG, Muyindike WR, Kamya MR, Hahn JA, Chamie G. Effects of a COVID-19 Public Health Lockdown on Drinking and Health Behavior Among Persons with HIV and with Unhealthy Alcohol use in Uganda. AIDS Behav 2023; 27:3213-3222. [PMID: 37000383 PMCID: PMC10063928 DOI: 10.1007/s10461-023-04042-y] [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] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
To better understand the impact of Uganda's initial COVID-19 lockdown on alcohol use, we conducted a cross-sectional survey (August 2020-September 2021) among persons with HIV (PWH) with unhealthy alcohol use (but not receiving an alcohol intervention), enrolled in a trial of incentives to reduce alcohol use and improve isoniazid preventive therapy. We examined associations between bar-based drinking and decreased alcohol use, and decreased alcohol use and health outcomes (antiretroviral therapy [ART] access, ART adherence, missed clinic visits, psychological stress and intimate partner violence), during lockdown. Of 178 adults surveyed whose data was analyzed, (67% male, median age: 40), 82% reported bar-based drinking at trial enrollment; 76% reported decreased alcohol use during lockdown. In a multivariate analysis, bar-based drinking was not associated with greater decreases in alcohol use during lockdown compared to non-bar-based drinking (OR = 0.81, 95% CI: 0.31-2.11), adjusting for age and sex. There was a significant association between decreased alcohol use and increased stress during lockdown (adjusted β = 2.09, 95% CI: 1.07-3.11, P < 0.010), but not other health outcomes.
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Affiliation(s)
- Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Kara Marson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julian Adong
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sarah Puryear
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Lodi
- Boston University School of Public Health, Boston, MA, USA
| | - Michael G McDonell
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Winnie R Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Gabriel Chamie
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, 94110, USA.
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17
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Cohen SM, DePhilippis D, Deng Y, Dziura J, Ferguson T, Fucito LM, Justice AC, Maisto S, Marconi VC, Molina P, Paris M, Rodriguez-Barradas MC, Simberkoff M, Petry NM, Fiellin DA, Edelman EJ. Perspectives on contingency management for alcohol use and alcohol-associated conditions among people in care with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1783-1797. [PMID: 37524371 PMCID: PMC10828101 DOI: 10.1111/acer.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Contingency management (CM) is an evidence-based approach for reducing alcohol use; however, its implementation into routine HIV primary care-based settings has been limited. We evaluated perspectives on implementing CM to address unhealthy alcohol use and associated conditions for people with HIV in primary care settings. METHODS From May 2021 to August 2021, we conducted two focus groups with staff involved in delivering the intervention (n = 5 Social Workers and n = 4 Research Coordinators) and individual interviews (n = 13) with a subset of participants involved in the multi-site Financial Incentives, Randomization, and Stepped Treatment (FIRST) trial. Qualitative data collection and analyses were informed by the Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework, including evidence (perception of CM), context (HIV primary care clinic and CM procedures), and facilitation (feasibility outside the research setting). RESULTS Several major themes were identified. Regarding the evidence, participants lacked prior experience with CM, but the intervention was well received and, by some, perceived to lead to lasting behavior change. Regarding the clinical context for the reward schedule, the use of biochemical testing, specifically fingerstick phosphatidylethanol testing, and the reward process were perceived to be engaging and gratifying for both staff and patients. Participants indicated that the intervention was enhanced by its co-location within the HIV clinic. Regarding facilitation, participants suggested addressing the intervention's feasibility for non-research use, simplifying the reward structure, and rewarding non-abstinence in alcohol use. CONCLUSIONS Among patients and staff involved in a clinical trial, CM was viewed as a helpful, positive, and feasible approach to addressing unhealthy alcohol use and related conditions. To enhance implementation, future efforts may consider simplified approaches to the reward structure and expanding rewards to non-abstinent reductions in alcohol consumption.
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Affiliation(s)
- Shawn M. Cohen
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
| | - Dominick DePhilippis
- Veterans Affairs Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, D.C. 20420, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, USA
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Yale School of Public Health, New Haven, CT 06510, USA
- Veterans Affairs Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, USA
| | | | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical Center, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30033, USA
| | - Patricia Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine
| | | | - Michael Simberkoff
- Veterans Affairs NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, USA
| | - Nancy M. Petry
- Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT
| | - David A. Fiellin
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
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Lesko CR, Gnang JS, Fojo AT, Hutton HE, McCaul ME, Delaney JA, Cachay ER, Mayer KH, Crane HM, Batey DS, Napravnik S, Christopoulos KA, Lau B, Chander G. Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019. Ann Epidemiol 2023; 85:6-12. [PMID: 37442307 PMCID: PMC10538410 DOI: 10.1016/j.annepidem.2023.07.002] [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: 09/23/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death. METHODS We followed a cohort of 1781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy). RESULTS Our sample (86% male, 54% White) had median age of 35 years. Over 102 months, people with no, moderate, and unhealthy alcohol use averaged 62.3, 61.1, and 59.5 months virally suppressed, respectively. People who reported unhealthy or moderate alcohol use spent 5.1 (95% confidence intervals (CI): 0.8, 9.3) and 7.6 (95%CI: 3.1, 11.7) more months lost to care than nondrinkers. Compared to no use, unhealthy alcohol use was associated with 3.4 (95%CI: -5.6, -1.6) fewer months in care, not virally suppressed. There were no statistically significant differences after adjustment for demographic and clinical characteristics. CONCLUSIONS Moderate or unhealthy drinking at enrollment in HIV care was associated with poor retention in care. Alcohol use was not associated with time spent virally suppressed.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Jeanine S Gnang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mary E McCaul
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Joseph A Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Epidemiology, University of Washington, Seattle, WA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA
| | - Sonia Napravnik
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Geetanjali Chander
- School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Medicine, School of Medicine, University of Washington, Seattle, WA
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19
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Hahn JA, Ngabirano C, Fatch R, Emenyonu NI, Cheng DM, Adong J, Tumwegamire A, Terrault NA, Linas BP, Jacobson KR, Muyindike WR. Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use. AIDS 2023; 37:1535-1543. [PMID: 37260251 PMCID: PMC10355800 DOI: 10.1097/qad.0000000000003613] [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: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Isoniazid (INH) preventive therapy is recommended to prevent tuberculosis (TB) disease for persons with HIV (PWH), except for those with regular and heavy alcohol consumption, due to hepatotoxicity concerns. We aimed to quantify the incidence of severe INH-related toxicity among PWH with and without recent alcohol consumption. DESIGN A prospective study of PWH receiving INH. METHODS We included PWH in southwest Uganda with recent (prior 3 months) ( n = 200) or no (prior year) self-reported alcohol consumption ( n = 101), on antiretroviral therapy, TB infected (≥5 mm on tuberculin skin test), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2× or less the upper limit of normal (ULN). Grade 3+ INH-related toxicity was ALT or AST at least 5× the ULN or severe symptoms; we stopped IPT upon detection. Grade 2 INH-related toxicity was ALT or AST 2-5× the ULN or moderate symptoms. RESULTS The cumulative incidence of Grade 3+ INH-related toxicity was 8.3% [95% confidence interval (95% CI) 5.4-12.0]; all resolved after INH cessation. Incidence was 6.0% (95% CI 3.1-10.2) among those reporting recent alcohol use and 12.9% (95% CI 7.0-21.0) among those reporting no prior year alcohol use. We found no differences by baseline phosphatidylethanol-confirmed alcohol severity. The cumulative incidence of Grade 2 toxicities (without Grade 3+) was 21.7% (95% CI 17.0-27.1); 25.0% (95% CI 19.0-31.8) among those with recent alcohol use and 14.8% (95% CI 8.1-23.9) among those with no prior year alcohol use. CONCLUSION Alcohol use does not appear to increase risk for serious INH-related toxicity among PWH without significant liver enzyme elevations at baseline (≤2x ULN).
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Affiliation(s)
- Judith A. Hahn
- Department of Medicine
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Christine Ngabirano
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Debbie M. Cheng
- School of Public Health, Boston University School of Public Health, Boston, Massachusetts
| | - Julian Adong
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adah Tumwegamire
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Norah A. Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Benjamin P. Linas
- Boston University Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Karen R. Jacobson
- Boston University Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Winnie R. Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
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20
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Parisi CE, Wang Y, Varma DS, Vaddiparti K, Ibañez GE, Carrillo LC, Cook RL. Changes in frequency of cannabis use among people with HIV during the COVID-19 pandemic: a multi-methods study to explore the underlying reasons for change. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:470-480. [PMID: 36898081 PMCID: PMC10695005 DOI: 10.1080/00952990.2023.2176234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 03/12/2023]
Abstract
Background: People with HIV (PWH) report higher rates of cannabis use than the general population. It is unclear how cannabis use among PWH has been impacted by the COVID-19 pandemic and the implications for the health and wellbeing of PWH.Objectives: To describe changes in frequency of cannabis use among a sample of PWH during the pandemic, reasons for those changes, and implications of the findings.Methods: The data are cross-sectional and come from questions asked in a follow-up phone survey administered to a prospective cohort of PWH in Florida between May 2020 and March 2021. Participants who used cannabis were asked about changes in their frequency of cannabis use in a quantitative survey and reasons for changes in a qualitative open-ended question. Qualitative data were analyzed using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino), 13% decreased frequency of cannabis, 11% increased frequency, and 76% reported no change. The most common reasons for increasing frequency of cannabis use were reducing anxiety/stress, trying to relax, coping with grief or reducing symptoms of depression, and reducing boredom during the pandemic. Supply or access issues, health concerns, and having already wanted to reduce cannabis use were common reasons for decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis use frequency during the pandemic. These findings shed light on the behaviors and motivations of PWH who use cannabis and can inform clinical practice and interventions during public health emergencies and beyond.
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Affiliation(s)
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | | | - Gladys E. Ibañez
- Department of Epidemiology, Florida International University, Miami, FL USA
| | | | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL USA
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21
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Bahji A, Gordon KS, Crystal S, Satre DD, Wiliams EC, Edelman EJ, Justice AC. Factors Associated with Bothersome Symptoms in Individuals With and Without HIV Who Report Alcohol Use. AIDS Behav 2023; 27:2455-2462. [PMID: 36622487 PMCID: PMC10225332 DOI: 10.1007/s10461-022-03972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/10/2023]
Abstract
Bothersome symptoms potentially related to drinking are commonly reported by people with and without HIV (PWH/PWoH). However, the relationship between bothersome symptoms and level of alcohol use is often not appreciated by patients or providers. Therefore, among persons reporting prior-year alcohol use, we assessed whether alcohol use level (AUDIT-C score), HIV status, and demographic covariates influenced the likelihood of the patient reporting a bothersome symptom. We used the Veterans Aging Cohort Study (VACS) surveys (2002-2018), including a validated symptoms index. Among 3679 PWH and 3830 PWoH currently drinking alcohol, the most commonly reported symptoms were muscle/joint pain (52%), sleep disturbance (51%), and fatigue (50%). Level of alcohol use was independently associated with 18 of 20 bothersome symptoms, including seven symptoms more common among PWH. Results can help inform PWH/PWoH who drink alcohol about the strong relationship between level of alcohol use and bothersome symptoms, potentially motivating reduced use.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Research in Addiction Medicine Scholars Program, Boston University Medical Centre, Boston, MA, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Wiliams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
- Yale School of Medicine, 367 Cedar Street, ESH A, suite 401, New Haven, CT, 06510, USA.
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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22
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Pytell JD, Li X, Thompson C, Lesko CR, McCaul ME, Hutton H, Batey DS, Cachay E, Mayer KH, Napravnik S, Christopoulos K, Yang C, Crane HM, Chander G, Lau B. The temporal relationship of alcohol use and subsequent self-reported health status among people with HIV. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100020. [PMID: 37476695 PMCID: PMC10357948 DOI: 10.1016/j.ajmo.2022.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 07/22/2023]
Abstract
Background Alcohol use among people with HIV is associated with worse HIV treatment outcomes. Its impact on self-reported health status is unclear. Setting Longitudinal cohort of people with HIV engaged in care across 7 clinics participating in the Centers for AIDS Research Network of Integrated Care Systems between January 2011 and June 2014. Methods A total of 5046 participants were studied. A quantile regression model estimated the association of alcohol use levels with subsequent self-reported health status score, accounting for multiple covariates including depressive symptoms. Women, men who have sex with women, and men who have sex with men were analyzed separately. Results Prevalence of heavy alcohol use was 21%, 31%, and 37% among women, men who have sex with women, and men who have sex with men, respectively. Women with heavy alcohol use had a subsequently decreased median self-reported health status score compared to women with no or moderate alcohol use (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.58-0.99); this association was not explained by the presence of depressive symptoms. There was no observed association of alcohol use level on subsequent self-reported health status among men who have sex with women. Men who have sex with men reporting no alcohol use had a subsequently decreased median self-reported health status compared to moderate alcohol use (OR: 0.88; 95% CI: 0.80-0.97). Conclusion Heavy alcohol use is associated with worsened self-reported health status at subsequent visits among women with HIV and not men with HIV.
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Affiliation(s)
- Jarratt D. Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. McCaul
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - Heidi Hutton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - D. Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA, USA
| | - Kenneth H. Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katerina Christopoulos
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi M. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Akgün KM, Krishnan S, Tate J, Bryant K, Pisani M, Re VL, Rentsch CT, Crothers K, Gordon K, Justice AC. Delirium among people aging with and without HIV: Role of alcohol and Neurocognitively active medications. J Am Geriatr Soc 2023; 71:1861-1872. [PMID: 36786300 PMCID: PMC10258127 DOI: 10.1111/jgs.18265] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND People aging with and without HIV (PWH and PWoH) want to avoid neurocognitive dysfunction, especially delirium. Continued use of alcohol in conjunction with neurocognitively active medications (NCAMs) may be a largely underappreciated cause, especially for PWH who experience polypharmacy a decade earlier than PWoH. We compare absolute and relative risk of delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs. METHODS Using the VACS cohort, we compare absolute and relative risk of inpatient delirium among PWH and PWoH by age, level of alcohol use, and exposure to NCAMs between 2007 and 2019. We matched each case based on age, race/ethnicity, sex, HIV, baseline year, and observation time with up to 5 controls. The case/control date was defined as date of admission for cases and the date corresponding to the same length of time on study for controls. Level of alcohol use was defined using Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Medication exposure was measured from 45 to 3 days prior to index date; medications were classified as anticholinergic NCAM, non-anticholinergic NCAM, or non NCAM and counts generated. We used logistic regression to determine odds ratios (ORs) for delirium associated with medication counts stratified by HIV status and adjusted for demographics, severity of illness, and related diagnoses. RESULTS PWH experienced a higher incidence of delirium (5.6, [95% CI 5.3-5.9/1000 PY]) than PWoH (5.0, [95% CI 4.8-5.1/1000 PY]). In multivariable analysis, anticholinergic and non-anticholinergic NCAM counts and level of alcohol use demonstrated strong independent dose-response associations with delirium. CONCLUSIONS Decreasing alcohol use and limiting the use of neurocognitively active medications may help decrease excess rates of delirium, especially among PWH.
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Affiliation(s)
- Kathleen M. Akgün
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Janet Tate
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | | | - Vincent Lo Re
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christopher T. Rentsch
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Kristina Crothers
- VA Puget Sound Health Care System Seattle Division, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Kirsha Gordon
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Amy C. Justice
- VA Connecticut Health System West Haven Campus, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
- Yale University School of Public Health, New Haven, CT, USA
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24
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Drumright LN, Nance RM, Ruderman SA, Ma J, Whitney BM, Hahn A, Fredericksen RJ, Luu B, Lober WB, Moore RD, Budoff MJ, Keruly JC, Christopoulos K, Puryear S, Willig A, Cropsey K, Mathews WC, Cachay E, Bamford L, Eron JJ, Napravnik S, Mayer KH, O'Cleirigh C, Mccaul ME, Chander G, Feinstein MJ, Saag MS, Kitahata MM, Heckbert SR, Crane HM, Delaney JAC. Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV. HIV Med 2023; 24:703-715. [PMID: 36855253 PMCID: PMC10330202 DOI: 10.1111/hiv.13466] [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: 06/08/2022] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand-supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. DESIGN AND METHODS Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. RESULTS Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. CONCLUSIONS Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.
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Affiliation(s)
- Lydia N Drumright
- University of Washington, Seattle, Washington, USA
- University of Cambridge, Cambridge, UK
| | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | | | - Andrew Hahn
- University of Washington, Seattle, Washington, USA
| | | | - Brandon Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | | | | | | | | | - Sarah Puryear
- University of California, San Francisco, California, USA
| | | | | | | | - Edward Cachay
- University of California, San Diego, California, USA
| | - Laura Bamford
- University of California, San Diego, California, USA
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA
- Johns Hopkins University, Baltimore, Maryland, USA
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Satre DD, Sarovar V, Leyden WA, Leibowitz AS, Lam JO, Hojilla JC, Davy-Mendez T, Hare CB, Silverberg MJ. Age group differences in substance use, social support, and physical and mental health concerns among people living with HIV two years after receiving primary care-based alcohol treatment. Aging Ment Health 2023; 27:1011-1019. [PMID: 35765902 PMCID: PMC9797622 DOI: 10.1080/13607863.2022.2084504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Objectives: People living with HIV (PWH) have seen reduction in HIV-associated morbidity and increase in near-normal life expectancy, yet unhealthy alcohol use poses substantial risks to older as well as younger adults. Further research regarding age-associated physical and mental health concerns among PWH who drink alcohol is needed to inform services, given the expanding age range of patients in care.Methods: We compared age group differences (18-34, 35-44, 45-54, ≥55 years old) in two-year patient-reported outcomes and HIV viral control among PWH enrolled in a primary care-based behavioral alcohol intervention trial; with 90% follow up from baseline.Results: Of 553 PWH, 50 (9%) were 18-34, 85 (15%) were 35-44, 197 (36%) were 45-54, and 221 (40%) were ≥55 years old. Most were men (97%) and White (64%). At two years, PWH ≥55 reported less substance use in the prior 30 days, fewer social contacts, and more pain; younger PWH had lower antiretroviral therapy (ART) adherence. In adjusted analyses, PWH ages 18-34 had higher odds of unhealthy alcohol use, tobacco, cannabis, or other substances compared to those ≥55; with higher odds of anxiety among PWH 35-44 compared with those ≥55; and physical quality of life was worse among those ≥55 compared with younger groups.Conclusions: While older PWH report less substance use than younger PWH and have better ART adherence post-treatment, they are more likely to experience limited social support and worse physical quality of life. Findings can inform interventions to address varying needs of PWH across the lifespan.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Wendy A. Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O. Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - J. Carlo Hojilla
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Charles B. Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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Bertholet N, Saitz R, Hahn JA, Heeren TC, Emenyonu NI, Freiberg M, Winter MR, Kim TW, Magane K, Lloyd-Travaglini C, Fatch R, Bryant K, Forman LS, Rateau L, Blokhina E, Muyindike WR, Gnatienko N, Samet JH. Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:704-712. [PMID: 36799302 PMCID: PMC10198460 DOI: 10.1111/acer.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. METHODS People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3 ) adjusting for covariates. Analyses were conducted separately by site. RESULTS The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively. CONCLUSIONS In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control.
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Affiliation(s)
- Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Richard Saitz
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith A. Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nneka I. Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Vanderbilt University Medical Center, Cardiovascular Division, Nashville, TN, USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Theresa W. Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Kara Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Lindsey Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Winnie R. Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine, Mbarara, Uganda
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
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Hojilla JC, Sarovar V, Lam JO, Park IU, Vincent W, Hare CB, Silverberg MJ, Satre DD. Sexually Transmitted Infection Screening in Key Populations of Persons Living with HIV. AIDS Behav 2023; 27:96-105. [PMID: 35916949 PMCID: PMC9851927 DOI: 10.1007/s10461-022-03747-w] [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] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
Annual screening for bacterial sexually transmitted infections (STI), including gonorrhea/chlamydia (GC/CT) and syphilis, is recommended for persons with HIV (PWH). We used the prevention index to quantify the extent to which STI screening was completed at guideline-recommended frequency in African American and Latinx persons, women, persons with alcohol (AUD) and substance (SUD) use disorders. Data from PWH at Kaiser Permanente Northern California were collected from electronic health records. We defined receipt of GC/CT and syphilis screening consistent with recommendations as a prevention index score ≥ 75%. Among 9655 PWH (17.7% Latinx; 16.2% African American; 9.6% female; 12.4% AUD; 22.1% SUD), prevention index scores for GC/CT and syphilis increased from 2015 to 2019. African American PWH had lower odds of receiving an annual syphilis screen (aOR 0.87 [95% CI 0.79-0.97]). Female sex was associated with lower odds of GC/CT (aOR 0.30 [95% CI 0.27-0.34]) and syphilis (aOR 0.27 [95% CI 0.24-0.310) screening. AUD and SUD were not associated with differences in annual GC/CT or syphilis screening. Key PWH subgroups experience ongoing challenges to annual STI screening despite comparable healthcare access.
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Affiliation(s)
- J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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Muacevic A, Adler JR, Kandi V. Clinical Research: A Review of Study Designs, Hypotheses, Errors, Sampling Types, Ethics, and Informed Consent. Cureus 2023; 15:e33374. [PMID: 36751199 PMCID: PMC9898800 DOI: 10.7759/cureus.33374] [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] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Recently, we have been noticing an increase in the emergence and re-emergence of microbial infectious diseases. In the previous 100 years, there were several incidences of pandemics caused by different microbial species like the influenza virus, human immunodeficiency virus (HIV), dengue virus, severe acute respiratory syndrome Coronavirus (SARS-CoV), middle east respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 that were responsible for severe morbidity and mortality among humans. Moreover, non-communicable diseases, including malignancies, diabetes, heart, liver, kidney, and lung diseases, have been on the rise. The medical fraternity, people, and governments all need to improve their preparedness to effectively tackle health emergencies. Clinical research, therefore, assumes increased significance in the current world and may potentially be applied to manage human health-related problems. In the current review, we describe the critical aspects of clinical research that include research designs, types of study hypotheses, errors, types of sampling, ethical concerns, and informed consent.
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Low-Burden Universal Substance Use Screening in a Primary Care Clinic to Lower Implementation Barriers. J Behav Health Serv Res 2023; 50:108-118. [PMID: 35948799 PMCID: PMC9365203 DOI: 10.1007/s11414-022-09814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/26/2022]
Abstract
Universal substance use screening in primary care can proactively identify patients for intervention, though implementation is challenging. This project developed a strategy for universal low time- and labor-cost screening, brief intervention, and referral for treatment (SBIRT) in an HIV primary care clinic at an academic medical center in the Southeastern USA. Screening was implemented using a tablet computer that calculated results in real time and suggested motivational language for provider response. A brief intervention (BNI) was conducted by a trained professional as needed, preventing the need for all clinic providers to be competent in motivational interviewing (MI). More than 1868 patients were screened in 12 months, with an MI intervention conducted for 101 patients with higher risk use. Forty-four patients were referred for in-clinic treatment, compared to nine in the previous year. Computer-based, self-administered screening with real-time linkage to a BNI can allow recommended screening with low provider burden.
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Kim GS, Kim Y, Park MK, Lee SA, Lee Y, Shim MS. Barriers and facilitators on the HIV care continuum among adults living with HIV in high-income countries: a scoping review protocol. Syst Rev 2022; 11:222. [PMID: 36243736 PMCID: PMC9569070 DOI: 10.1186/s13643-022-02097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the life expectancy of people living with HIV increases with the advancements in antiretroviral treatment, the continuity of long-term therapy and health care for people living with HIV has gained more importance. However, the estimated proportion of people living with HIV who have access to treatment or are virally suppressed is unsatisfactory. Therefore, it is necessary to build strategies to improve treatment continuity by identifying the barriers and facilitators that affect the HIV care continuum. To enable this, we will conduct a scoping review to explore the barriers and facilitators related to the care continuum in high-income countries for adults living with HIV. METHODS The review question will be identified based on the JBI guidelines for the development of scoping review protocols. Studies exploring the barriers to and facilitators of the HIV care continuum among adults living with HIV in high-income countries will be included in this review. A literature search will be conducted on the databases (platform) of MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (Ovid), and the Cochrane Central Register of Controlled Trials (Cochrane Library). Four researchers will screen articles for inclusion and subsequently build a charting form and collate the data to provide results. DISCUSSION The results of this scoping review will provide comprehensive evidence for the barriers and facilitators to be considered in the care continuum of people living with HIV. Importantly, the results will provide insight for healthcare providers and researchers to develop interventions and research the continuity in caring for people living with HIV.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Yonsei Evidence Based Nursing Centre of Korea: A JBI Affiliated Group, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Youngin Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Sang A Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T. Morrissey Blvd., Boston, MA, 02125-3393, USA
| | - Youngjin Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Mi-So Shim
- College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
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31
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Richards VL, Leeman RF, Wang Y, Cook C, Prins C, Ennis N, Spencer EC, Cook RL. Identifying the best measures of alcohol consumption to predict future HIV viral suppression trajectories. AIDS Behav 2022; 26:3242-3253. [PMID: 35380289 PMCID: PMC9474662 DOI: 10.1007/s10461-022-03674-w] [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: 03/23/2022] [Indexed: 11/01/2022]
Abstract
Alcohol use is associated with poor outcomes among people living with HIV (PLWH), but it remains unclear which alcohol use measures best predict future HIV viral non-suppression over time. This study aimed to compare the ability of five alcohol use measures to predict risk of suboptimal HIV viral load trajectories over 36 months. We analyzed data from a cohort of PLWH in Florida including survey data linked to the state HIV surveillance system on prospective HIV viral loads over 36 months (n = 783; 66% male; 55% Black; Mage=46, SD = 11). Four trajectory patterns for HIV viral load were identified: consistently low (65.1%), decreasing (15.9%), increasing (10.6%), and consistently high (8.4%). Past year alcohol use frequency (OR = 2.1, CI:1.0-4.4), drinks consumed on a typical drinking day (OR = 2.2, CI:1.2-4.1), frequency of binge drinking (OR = 2.6, CI:1.3-5.2), and alcohol-related problems score (OR = 1.7, CI:1.1-2.7) were the measures predictive of the risk of future viral non-suppression above specific thresholds.
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Affiliation(s)
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Cindy Prins
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Emma C Spencer
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Madkour AS, Felker-Kantor E, Welsh DA, Molina PE, Theall KP, Ferguson T. Lifetime Alcohol Use Trajectories and Health Status Among Persons Living with HIV (PLWH). J Stud Alcohol Drugs 2022; 83:695-703. [PMID: 36136440 PMCID: PMC9523753 DOI: 10.15288/jsad.21-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/20/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We characterized lifetime drinking trajectories among persons living with HIV (PLWH) and examined how trajectories are related to health. METHOD Adults (ages 20-71) were recruited between 2015 and 2017 for a cohort study examining the impact of alcohol use on geriatric comorbidities in PLWH in New Orleans. The New Orleans Alcohol Use in HIV (NOAH) Study (n = 356; 68.8% male) included in-person interviews, anthropometric measurements, and biospecimen collection. Average monthly drinks per decade of life was derived from participants' reported average quantity and frequency of alcoholic beverages for each decade. Health indicators included CD4 count, viral load, health-related quality of life, frailty, comorbidities, body mass index, heavy drinking, anxiety, depression, and posttraumatic stress disorder. Participants also reported lifetime experiences with homelessness and incarceration. Latent curve modeling was applied in MPlus to derive lifetime drinking trajectories. Latent trajectory parameters were modeled as predictors of physical, mental, and social health, controlling for demographics. RESULTS Alcohol consumption increased significantly between the teen years and midlife (31-40), declining thereafter through ages 50-60. Significant interindividual differences were observed in all trajectory parameters. Persons with higher starting points of alcohol consumption showed worse mental health (depression and anxiety) and social experiences (homelessness and incarceration history) at study baseline. A steeper increase in volume of alcohol consumption after ages 10-20 was associated with worse health-related quality of life, greater frailty and comorbidities, and greater odds of current heavy drinking. CONCLUSIONS Understanding lifetime alcohol consumption patterns is important in addressing physical and mental health among adult PLWH.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Erica Felker-Kantor
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - David A. Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Patricia E. Molina
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Physiology, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Katherine P. Theall
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Tekeda Ferguson
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health, Louisiana State University, New Orleans, Louisiana
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Morford KL, Muvvala SB, Chan PA, Cornman DH, Doernberg M, Porter E, Virata M, Yager JE, Fiellin DA, Edelman EJ. Patients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study. J Subst Abuse Treat 2022; 139:108767. [PMID: 35341613 PMCID: PMC9187601 DOI: 10.1016/j.jsat.2022.108767] [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: 09/08/2021] [Revised: 12/22/2021] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND While substance use disorders (SUD) disproportionately impact people with HIV (PWH), HIV clinics inconsistently provide evidence-based medications for addiction treatment (MAT). Patient receptivity to MAT is critical to enhance addiction treatment in these settings. However, we know little from patients about how to best integrate MAT into HIV clinics. METHODS This qualitative study used four focus groups informed by the Promoting Action on Research Implementation in Health Services framework to identify barriers and facilitators to receiving opioid, alcohol, and tobacco use disorder care in HIV clinics. The study population included 28 patients with HIV and SUD receiving care at one of four HIV clinics in the northeastern United States. Focus groups were recorded and transcribed for content analysis. The study also performed a brief survey assessing demographics and behaviors. RESULTS Focus groups revealed several major themes related to MAT in HIV clinics. Barriers included stigma around MAT, knowledge deficits about available MAT options and the impact of substance use on PWH, concerns about medication side effects, substance use screening without adequate clinician follow-up, and peers who discouraged MAT. Facilitators included recognition of substance use as a threat to overall health, integrated care from HIV clinicians, and support for addiction treatment from peers with lived experience. CONCLUSIONS Efforts to enhance MAT in HIV clinics should include patient education to help them recognize addiction as a chronic disease with available medication treatment options; clinician and staff training to promote integrated, multidisciplinary screening and treatment; and thoughtful inclusion of peers with lived experience.
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Affiliation(s)
- Kenneth L Morford
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States.
| | - Srinivas B Muvvala
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States
| | - Philip A Chan
- Department of Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, United States
| | - Deborah H Cornman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, United States
| | - Molly Doernberg
- Yale School of Public Health, 60 College Street, New Haven, CT 06510, United States
| | - Elizabeth Porter
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
| | - Michael Virata
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States
| | - Jessica E Yager
- SUNY Downstate, 450 Clarkson Ave, Suite J, Brooklyn, NY 11203, United States
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, United States; Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue #260, New Haven, CT 06519, United States
| | - E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, United States; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, United States
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Hasin DS, Aharonovich E, Zingman BS, Stohl M, Walsh C, Elliott JC, Fink DS, Knox J, Durant S, Menchaca R, Sharma A. HealthCall: A randomized trial assessing a smartphone enhancement of brief interventions to reduce heavy drinking in HIV care. J Subst Abuse Treat 2022; 138:108733. [PMID: 35131124 PMCID: PMC9167215 DOI: 10.1016/j.jsat.2022.108733] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Heavy drinking among people living with HIV (PLWH) worsens their health outcomes and disrupts their HIV care. Although brief interventions to reduce heavy drinking in primary care are effective, more extensive intervention may be needed in PLWH with moderate-to-severe alcohol use disorder. Lengthy interventions are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed the "HealthCall" app to provide continued engagement after brief intervention, reduce drinking, and improve other aspects of HIV care with minimal demands on providers. We conducted a randomized trial of its efficacy. METHODS The study recruited alcohol-dependent PLWH (n = 114) from a large urban HIV clinic. Using a 1:1:1 randomized design, the study assigned patients to: Motivational Interviewing (MI) plus HealthCall (n = 39); NIAAA Clinician's Guide (CG) plus HealthCall (n = 38); or CG-only (n = 37). Baseline MI and CG interventions took ~25 min, with brief (10-15 min) 30- and 60-day booster sessions. HealthCall involved daily use of the smartphone app (3-5 min/day) to report drinking and health in the prior 24 h. Outcomes assessed at 30 and 60 days and at 3, 6 and 12 months included drinks per drinking day (DpDD; primary outcome) and number of drinking days, analyzed with generalized linear mixed models and pre-planned contrasts. RESULTS Study retention was excellent (85%-94% across timepoints). At 30 days, DpDD among patients in MI + HealthCall, CG + HealthCall, and CG-only was 3.80, 5.28, and 5.67, respectively; patients in MI + HealthCall drank less than CG-only and CG + HealthCall (IRRs = 0.62, 95% CI = 0.46, 0.84, and 0.64, 95% CI = 0.48, 0.87, respectively). At 6 months (end-of-treatment), DpDD was lower in CG + HealthCall (DpDD = 4.88) than MI + HealthCall (DpDD = 5.88) or CG-only (DpDD = 6.91), although these differences were not significant. At 12 months, DpDD was 5.73, 5.31, and 6.79 in MI + HealthCall, CG + HealthCall, and CG-only, respectively; DpDD was significantly lower in CG + HealthCall than CG-only (IRR = 0.71, 95% CI = 0.51, 0.98). CONCLUSIONS During treatment, patients in MI + HealthCall had lower DpDD than patients in other conditions; however, at 12 months, drinking was lowest among patients in CG + HealthCall. Given the importance of drinking reduction and the low costs/time required for HealthCall, pairing HealthCall with brief interventions merits widespread consideration.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Barry S Zingman
- Montefiore Medical Center and Albert Einstein College of Medicine, 3444 Kossuth Ave, The Bronx, NY 10467, USA.
| | - Malka Stohl
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Claire Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - David S Fink
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Justin Knox
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Sean Durant
- Montefiore Medical Center and Albert Einstein College of Medicine, 3444 Kossuth Ave, The Bronx, NY 10467, USA.
| | - Raquel Menchaca
- Montefiore Medical Center and Albert Einstein College of Medicine, 3444 Kossuth Ave, The Bronx, NY 10467, USA.
| | - Anjali Sharma
- Montefiore Medical Center and Albert Einstein College of Medicine, 3444 Kossuth Ave, The Bronx, NY 10467, USA.
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35
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Gordon KS, Becker WC, Bryant KJ, Crystal S, Maisto SA, Marshall BDL, McInnes DK, Satre DD, Williams EC, Edelman EJ, Justice AC. Patient-Reported Bothersome Symptoms Attributed to Alcohol Use Among People With and Without HIV. AIDS Behav 2022; 26:3589-3596. [PMID: 35553287 PMCID: PMC10084471 DOI: 10.1007/s10461-022-03628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Helping people with HIV (PWH) and without HIV (PWoH) understand the relationship between physical symptoms and alcohol use might help motivate them to decrease use. In surveys collected in the Veterans Aging Cohort Study from 2002 to 2018, PWH and PWoH were asked about 20 common symptoms and whether they thought any were caused by alcohol use. Analyses were restricted to current alcohol users (AUDIT-C > 0). We applied generalized estimating equations. The outcome was having any Symptoms Attributed to Alcohol use (SxAA). Primary independent variables were each of the 20 symptoms and HIV status. Compared to PWoH, PWH had increased odds of SxAA (OR 1.54; 95% CI 1.27, 1.88). Increased AUDIT-C score was also associated with SxAA (OR 1.32; 95% CI 1.28, 1.36), as were trouble remembering, anxiety, and weight loss/wasting. Evidence that specific symptoms are attributed to alcohol use may help motive people with and without HIV decrease their alcohol use.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - William C Becker
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Stephen Crystal
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Stephen A Maisto
- Syracuse University College of Arts and Sciences, Syracuse, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - D Keith McInnes
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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36
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Oldfield BJ, Li Y, Vickers-Smith R, Barry DT, Crystal S, Gordon KS, Kerns RD, Williams EC, Marshall BDL, Edelman EJ. Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV. Alcohol Clin Exp Res 2022; 46:600-613. [PMID: 35257397 PMCID: PMC9018502 DOI: 10.1111/acer.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use. METHODS We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use. RESULTS Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self-reported opioid use. CONCLUSIONS Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.
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Affiliation(s)
- Benjamin J Oldfield
- Fair Haven Community Health Care, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Yu Li
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, New Jersey, USA
| | - Kirsha S Gordon
- Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Robert D Kerns
- Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development, VA Puget Sound, Seattle, Washington, USA
| | | | - E Jennifer Edelman
- Yale School of Medicine, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
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37
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Lesko CR, Hutton HE, Edwards JK, McCaul ME, Fojo AT, Keruly JC, Moore RD, Chander G. Alcohol Use Disorder and Recent Alcohol Use and HIV Viral Non-Suppression Among People Engaged in HIV Care in an Urban Clinic, 2014-2018. AIDS Behav 2022; 26:1299-1307. [PMID: 34626264 PMCID: PMC8940688 DOI: 10.1007/s10461-021-03487-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 01/28/2023]
Abstract
We estimated joint associations between having history of alcohol use disorder (AUD) (based on prior ICD-9/ICD-10 codes) and recent self-reported alcohol use and viral non-suppression (≥ 1 viral load measurement > 20 copies/mL in the same calendar year as alcohol consumption was reported) among patients on ART enrolled in routine care, 2014-2018, in an urban specialty clinic. Among 1690 patients, 26% had an AUD, 21% reported high-risk alcohol use, and 39% had viral non-suppression. Relative to person-years in which people without AUD reported not drinking, prevalence of viral non-suppression was higher in person-years when people with AUD reported drinking at any level; prevalence of viral non-suppression was not significantly higher in person-years when people with AUD reported not drinking or person-years when people without AUD reported drinking at any level. No level of alcohol use may be "safe" for people with a prior AUD with regard to maintaining viral suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanne C Keruly
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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38
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Woolf-King SE, Firkey M, Foley JD, Bricker J, Hahn JA, Asiago-Reddy E, Wikier J, Moskal D, Sheinfil AZ, Ramos J, Maisto SA. Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers. AIDS Behav 2022; 26:3029-3044. [PMID: 35303190 PMCID: PMC8931450 DOI: 10.1007/s10461-022-03649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.
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39
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Underwood ML, Park B, Uebelhoer LS, Gu G, Kunkel LE, Korthuis PT, Cook RR, Sekaly RP, Ribeiro SP, Lancioni CL. Chronic Alcohol Exposure Among People Living with HIV Is Associated with Innate Immune Activation and Alterations in Monocyte Phenotype and Plasma Cytokine Profile. Front Immunol 2022; 13:867937. [PMID: 35371104 PMCID: PMC8971672 DOI: 10.3389/fimmu.2022.867937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/23/2022] [Indexed: 12/25/2022] Open
Abstract
Despite advances in antiretroviral therapy, chronic immune activation continues to be observed among individuals with well-controlled HIV viral loads, and is associated with non-AIDS defining morbidities among people living with HIV. Alcohol use disorder impacts a significant proportion of individuals living with HIV, and alcohol exposure is known to damage the intestinal epithelium which may increase translocation of pathogens and their molecular products, driving systemic immune activation and dysregulation. The aim of this study was to determine if adults living with HIV with well-controlled viral loads, who also suffer from alcohol use disorder with and without hepatitis C virus co-infection (n=23), exhibit evidence of advanced systemic immune activation, intestinal damage, and microbial translocation, as compared to adults living with HIV who are not exposed to chronic alcohol or other substances of abuse (n=29). The impact of a 1-month intervention to treat alcohol-use disorder was also examined. Alcohol-use disorder was associated with evidence of advanced innate immune activation, alterations in monocyte phenotype including increased expression of Toll-like receptor 4, increased burden of stimulatory ligands for Toll-like receptor 4, and alterations in plasma cytokine signature, most notably elevations in soluble CD40 ligand and transforming growth factor beta. Alcohol-associated immune activation was more pronounced among individuals with hepatitis C virus co-infection. Although the 1-month intervention to treat alcohol use disorder did not result in significant reductions in the interrogated indicators of immune activation, our findings suggest that chronic alcohol exposure is a major modifiable risk factor for chronic immune activation and dysregulation among people-living with HIV.
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Affiliation(s)
- Michelle L. Underwood
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Byung Park
- Knight-Cancer Institute, Department of Biostatistics, Oregon Health & Science University, Portland, OR, United States
| | - Luke S. Uebelhoer
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Geoffrey Gu
- Undergraduate Studies, University of Southern California, Los Angeles, CA, United States
| | - Lynn E. Kunkel
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Philip T. Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Department of Public Health, Oregon Health & Science University, Portland, OR, United States
| | - Ryan R. Cook
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rafick Pierre Sekaly
- Department of Pathology & Translational Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Susan Pereira Ribeiro
- Department of Pathology & Translational Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Christina L. Lancioni
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
- *Correspondence: Christina L. Lancioni,
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40
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McGinnis KA, Tate JP, Bryant KJ, Justice AC, O'Connor PG, Rodriguez-Barradas MC, Crystal S, Cutter CJ, Hansen NB, Maisto SA, Marconi VC, Williams EC, Cook RL, Gordon AJ, Gordon KS, Eyawo O, Edelman EJ, Fiellin DA. Change in Alcohol Use Based on Self-Report and a Quantitative Biomarker, Phosphatidylethanol, in People With HIV. AIDS Behav 2022; 26:786-794. [PMID: 34542779 DOI: 10.1007/s10461-021-03438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating characteristics and agreement between TLFB (> 1 and > 2 average drinks/day), AUDIT-C ≥ 4 and PEth ≥ 20 among 275 men with HIV. Median age was 57 years, 80% were African-American; and 17% white. Sixty-eight percent had PEth ≥ 20, 46% reported > 2 average drinks/day on TLFB, 61% reported > 1 average drinks/day on TLFB, and 72% had an AUDIT-C ≥ 4. Relative to PEth, sensitivity for AUDIT-C ≥ 4 was 84% (kappa = 0.36), and for TLFB > 1 average drink/day was 76% (kappa = 0.44). Change in alcohol use appeared greater using TLFB measures than PEth. Strategies to robustly assess alcohol use in PWH may require both self-report and biomarkers.
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Affiliation(s)
- Kathleen A McGinnis
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
| | - Janet P Tate
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | | | - Nathan B Hansen
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Vincent C Marconi
- School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health and Seattle-Denver Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Adam J Gordon
- University of Utah and Salt Lake City VA Health Care System, Salt Lake City, UT, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - E Jennifer Edelman
- Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
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Kalichman SC, Eaton LA, Kalichman MO. Substance Use-Related Intentional Nonadherence to Antiretroviral Therapy Among Young Adults Living with HIV. AIDS Patient Care STDS 2022; 36:26-33. [PMID: 34905404 PMCID: PMC8905232 DOI: 10.1089/apc.2021.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Antiretroviral therapy (ART) reduces HIV disease burden, increases life expectancy, and prevents HIV transmission. Previous research suggests that believing that it is harmful to take ART when using substances (i.e., interactive toxicity beliefs) leads to intentional ART nonadherence; however, these associations have not been investigated among younger adults living with HIV and have not been linked to clinical outcomes. We examined the associations among interactive toxicity beliefs, intentional nonadherence, and HIV clinical outcomes in young adults living with HIV. People living with HIV younger than the age of 36 years who tested positive for at least one substance use biomarker (N = 406) completed a 1-month pretrial run-in study that included computerized interviews, substance use biomarkers, HIV viral load, and unannounced pill counts for ART adherence. Analyses compared three HIV clinical outcome groups: (1) HIV viral unsuppressed, (2) HIV viral suppressed and ART nonadherent, and (3) HIV viral suppressed and ART adherent, on substance use, interactive toxicity beliefs, and substance use-related intentional ART nonadherence. Results showed that a majority of participants reported intentional nonadherence. Participants with unsuppressed HIV reported greater interactive toxicity beliefs and intentional nonadherence. We conclude that intentional nonadherence adds to the detrimental impacts of substance use on ART adherence and interactive toxicity beliefs that foster these behaviors may be amenable to interventions.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA.,Address correspondence to: Seth C. Kalichman, PhD, Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
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42
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Kennedy AJ, McGinnis KA, Merlin JS, Edelman EJ, Gordon AJ, Korthuis PT, Skanderson M, Williams EC, Wyse J, Oldfield B, Bryant K, Justice A, Fiellin DA, Kraemer KL. Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV. J Subst Abuse Treat 2022; 132:108509. [PMID: 34130128 PMCID: PMC8628025 DOI: 10.1016/j.jsat.2021.108509] [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] [Received: 12/31/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Persons with HIV (PWH) and opioid use disorder (OUD) can have poor health outcomes. We assessed whether intensity of behavioral treatment for OUD (BOUD) with and without medication for OUD (MOUD) is associated with improved HIV clinical outcomes. METHODS We used Veterans Aging Cohort Study (VACS) data from 2008 to 2017 to identify PWH and OUD with ≥1 BOUD episode. We assessed BOUD intensity and ≥6 months of MOUD (methadone or buprenorphine) receipt during the 12 months after BOUD initiation. Linear regression models assessed the association of BOUD intensity and MOUD receipt with pre-post changes in log viral load (VL), CD4 cell count, VACS Index 2.0, antiretroviral treatment (ART) initiation, and ART adherence. RESULTS Among 2419 PWH who initiated BOUD, we identified five distinct BOUD intensity trajectories: single visit (39% of sample); low-intensity, not sustained (37%); high-intensity, not sustained (9%); low-intensity, sustained (11%); and high-intensity, sustained (5%). MOUD receipt was low (17%). Among 709 PWH not on ART at the start of BOUD, ART initiation increased with increased BOUD intensity (p < 0.01). Among 1401 PWH on ART at the start of BOUD, ART adherence improved more in higher-intensity BOUD groups (p < 0.01). VL, CD4 count and VACS Index 2.0 did not differ by BOUD or ≥6 months of MOUD treatment. CONCLUSION Among PWH and OUD who initiated BOUD, higher intensity BOUD was associated with improved ART initiation and adherence, but neither BOUD alone nor BOUD plus ≥6 months MOUD was associated with improvements in VL, CD4 count or VACS Index 2.0.
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Affiliation(s)
- Amy J Kennedy
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah; Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - P Todd Korthuis
- Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Emily C Williams
- Department of Health Services, University of Washington, VA Puget Sound Healthcare System, Seattle, WA, USA; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Jessica Wyse
- VA Portland Healthcare System, Portland, OR, USA; School of Public Health, Oregon Health and Sciences University, Portland, OR, USA
| | - Benjamin Oldfield
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Schensul SL, Ha T, Schensul JJ, Grady J, Burleson JA, Gaikwad S, Joshi K, Malye R, Sarna A. Multilevel and Multifactorial Interventions to Reduce Alcohol Consumption and Improve ART Adherence and Related Factors Among HIV Positive Men in Mumbai, India. AIDS Behav 2021; 25:290-301. [PMID: 34014429 DOI: 10.1007/s10461-021-03303-y] [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: 05/09/2021] [Indexed: 01/19/2023]
Abstract
Alcohol use has a deleterious effect on the health status of persons living with HIV, negatively affecting antiretroviral adherence and increasing the risk of transmission. Alcohol use is not an isolated behavior but intimately linked to stigma and poor psychological status among other factors. This paper utilizes a crossover design to test the efficacy of three multilevel interventions, individual counselling (IC), group intervention (GI) and collective advocacy (CA) for change, among HIV positive males who consume alcohol, treated at five ART Centers in urban Maharashtra, India. While GI shows a significant effect on the largest number of outcome variables, IC through its psychosocial emphasis demonstrated a significant impact over time on stigma and depression, and CA with its emphasis on societal change showed positive impact on stigma and advocacy for self and others. Each of the interventions had variable effects on CD4 count and viral load.Clinical Registration Number: NCT03746457; Clinical Trial.Gov.
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Affiliation(s)
- Stephen L Schensul
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Toan Ha
- Department of Infectious Diseases, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - James Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Joseph A Burleson
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Sushma Gaikwad
- T.N. Medical College and B.Y.L. Nair Ch. Hospital, Mumbai, India
| | | | - Rupal Malye
- Lokmanya Tilak Muncicipal Medical College, Mumbai, India
| | - Avina Sarna
- Population Council, India Country Office, New Delhi, India
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Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis. AIDS Behav 2021; 25:3734-3742. [PMID: 34014428 DOI: 10.1007/s10461-021-03270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Alcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18-35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = - 81, - 2; z = - 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.
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McGinnis KA, Skanderson M, Justice AC, Akgün KM, Tate JP, King JT, Rentsch CT, Marconi VC, Hsieh E, Ruser C, Kidwai-Khan F, Yousefzadeh R, Erdos J, Park LS. HIV care using differentiated service delivery during the COVID-19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs. J Int AIDS Soc 2021; 24 Suppl 6:e25810. [PMID: 34713585 PMCID: PMC8554215 DOI: 10.1002/jia2.25810] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The Department of Veterans Affairs (VA) is the largest provider of HIV care in the United States. Changes in healthcare delivery became necessary with the COVID‐19 pandemic. We compared HIV healthcare delivery during the first year of the COVID‐19 pandemic to a prior similar calendar period. Methods We included 27,674 people with HIV (PWH) enrolled in the Veterans Aging Cohort Study prior to 1 March 2019, with ≥1 healthcare encounter from 1 March 2019 to 29 February 2020 (2019) and/or 1 March 2020 to 28 February 2021 (2020). We counted monthly general medicine/infectious disease (GM/ID) clinic visits and HIV‐1 RNA viral load (VL) tests. We determined the percentage with ≥1 clinic visit (in‐person vs. telephone/video [virtual]) and ≥1 VL test (detectable vs. suppressed) for 2019 and 2020. Using pharmacy records, we summarized antiretroviral (ARV) medication refill length (<90 vs. ≥90 days) and monthly ARV coverage. Results Most patients had ≥1 GM/ID visit in 2019 (96%) and 2020 (95%). For 2019, 27% of visits were virtual compared to 64% in 2020. In 2019, 82% had VL measured compared to 74% in 2020. Of those with VL measured, 92% and 91% had suppressed VL in 2019 and 2020. ARV refills for ≥90 days increased from 39% in 2019 to 51% in 2020. ARV coverage was similar for all months of 2019 and 2020 ranging from 76% to 80% except for March 2019 (72%). Women were less likely than men to be on ARVs or to have a VL test in both years. Conclusions During the COVID‐19 pandemic, the VA increased the use of virtual visits and longer ARV refills, while maintaining a high percentage of patients with suppressed VL among those with VL measured. Despite decreased in‐person services during the pandemic, access to ARVs was not disrupted. More follow‐up time is needed to determine whether overall health was impacted by the use of differentiated service delivery and to evaluate whether a long‐term shift to increased virtual healthcare could be beneficial, particularly for PWH in rural areas or with transportation barriers. Programmes to increase ARV use and VL testing for women are needed.
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Affiliation(s)
- Kathleen A McGinnis
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
| | - Melissa Skanderson
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA
| | - Amy C Justice
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Akgün
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Janet P Tate
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph T King
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher T Rentsch
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Vincent C Marconi
- Emory University School of Medicine, Rollins School of Public Health, and the Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Evelyn Hsieh
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher Ruser
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farah Kidwai-Khan
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Roozbeh Yousefzadeh
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph Erdos
- VA CT Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut, USA.,Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lesley S Park
- Stanford Center for Population Health Sciences, Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, California, USA
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Hansoti B, Mishra A, Rao A, Chimoyi L, Redd AD, Reynolds SJ, Stead DF, Black J, Maharaj R, Hahn E, Mda P, Mvandaba N, Nyanisa Y, Chen V, Clark K, Ryan S, Quinn TC. The geography of emergency department-based HIV testing in South Africa: Can patients link to care? EClinicalMedicine 2021; 40:101091. [PMID: 34746712 PMCID: PMC8548925 DOI: 10.1016/j.eclinm.2021.101091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Emergency Departments (EDs) can serve as clinical sites for identification of new HIV infections and their entry into care. We examined if HIV-positive patients who present to EDs in South Africa are able to successfully link to care. METHODS We conducted a one-year longitudinal prospective cohort study in four hospitals across the Eastern Cape, South Africa, with participants followed between July 2016 and July 2018. All adult, non-critical patients presenting to the ED were systematically approached, asked about their HIV status, and, if unknown, offered a point-of-care (POC) HIV test. All HIV-positive patients were further consented to participate in a follow-up study to assess subsequent linkage to care and distance from "home" to ED. Linkage to care was defined as self-reported linkage (telephonic) or evidence of repeated CD4/viral load testing in the National Health Laboratory System (NHLS) at either the 6- or 12-months post index ED visit. FINDINGS A total of 983 HIV-positive patients consented to participate in the study. In the 12 months following their ED visit, 34·1% of patients demonstrated linkage to care (335/983), 23·8% did not link to care (234/983), and 42·1% (414/983) were lost to follow-up. Though not statistically significant, a high percentage of young men (27/50, 54%) and those presenting with a trauma-related complaints (100/205, 48.8%) did not link to care. A considerable proportion of patients (105/454, 23·2%,) resided 50 or more kilometers from their index ED sites, though there was not a significant difference in linkage to care rate between those who lived closer or further from the ED. INTERPRETATION We have shown that strategies to improve linkage to care from the ED should consider the high rates of poor linkage among young men and those presenting to the ED with trauma. Furthermore, innovative linkage to care solutions will need to account for the unique geographical consideration of this population, given that many ED patients will need to continue care at a site distant from the diagnosis site. FUNDING This research was supported by the South African Medical Research Council, the Division of Intramural Research, the National Institute of Allergy and Infectious Diseases, National Institutes of Health, and the Johns Hopkins Center for Global Health.
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Affiliation(s)
- Bhakti Hansoti
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Corresponding author.
| | - Anant Mishra
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Aditi Rao
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, 29 Queens Rd, Parktown, Johannesburg, 2194, South Africa
| | - Andrew D. Redd
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr #7A03, Bethesda, MD 20892, USA
| | - Steven J. Reynolds
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr #7A03, Bethesda, MD 20892, USA
- Department of Family Medicine and Health Sciences, Faculty of Medicine, University of Cape Town, Anzio Rd, Cape Town 7925, South Africa
| | - David F. Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Frere and Cecilia Makiwane Hospitals, Amalinda Main Rd, Braelyn, East London 5201, South Africa
| | - John Black
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Medicine, Livingstone Hospital, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Roshen Maharaj
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
- Department of Emergency Medicine, Livingstone Hospital, Port Elizabeth, South Africa, Stanford Road, Korsten, Port Elizabeth 6020, South Africa
| | - Elizabeth Hahn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Pamela Mda
- Nelson Mandela Hospital Clinical Research Unit, Sisson St, Fort Gale, Mthatha 5100, South Africa
| | - Nomzamo Mvandaba
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Yandisa Nyanisa
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Umtata Part 1, Mthatha, South Africa
| | - Victoria Chen
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Katie Clark
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Sofia Ryan
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
| | - Thomas C. Quinn
- The Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USAs
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 31 Center Dr #7A03, Bethesda, MD 20892, USA
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Edelman EJ, Gan G, Dziura J, Esserman D, Morford KL, Porter E, Chan PA, Cornman DH, Oldfield BJ, Yager J, Muvvala SB, Fiellin DA. Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation. J Acquir Immune Defic Syndr 2021; 87:959-970. [PMID: 33675619 PMCID: PMC8192340 DOI: 10.1097/qai.0000000000002666] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. SETTING Four HIV clinics in the northeastern United States. METHODS Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups. RESULTS Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork. CONCLUSIONS Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.
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Affiliation(s)
- E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Geliang Gan
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Denise Esserman
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Kenneth L. Morford
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Philip A. Chan
- Department of Medicine, Brown University, Providence, RI
| | - Deborah H. Cornman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT
| | | | | | - Srinivas B. Muvvala
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - David A. Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Anyanwu CF, JohnBull TO, Usman IM, Aigbogun EO, Ochai J, Qasem AH, Alkhayyat SS, Alexiou A, Batiha GES. Substance Use, Highly Active Antiretroviral Therapy, and Liver Enzymes: Evidence From a Cross-Sectional Study of HIV-Infected Adult Patients Without Comorbidities on HAART in the University of Port Harcourt Teaching Hospital. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:664080. [PMID: 36303994 PMCID: PMC9580740 DOI: 10.3389/frph.2021.664080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
This study applied a structural equation modeling (SEM) to evaluate the role of substance use (alcohol, smoking, and trado-medicine use) to changes in the liver enzymes (AST, ALT, and ALP) levels in HIV-infected adult patients on a highly active antiretroviral treatment (HAART) for not <1 year. The study was a cross-sectional, part of a randomized comparative trial (Ref: UPH/CEREMAD/REC/19), involving 129 (46 males and 83 females) HIV-infected adult patients. Liver enzyme levels were determined from analyzed blood samples using the Clinical Chemistry Analyser (VS10) manufactured by Vitro Scient, while the study determined substance use using a reliable (Cronbach alpha = 0.805) rapid-exploratory survey questionnaire. Liver enzyme values were further categorized into: normal or abnormal using normal reference ranges (ALT = 7–55 U/L, AST = 8–48 U/L, and ALP = 40–129 U/L). STATGRAPHICS V16.1.11 (StatPoint Tech., Inc.) and SPSS (IBM® Amos V21.0.0, USA) were used to analyze the data. Among the HIV-HAART patients, 27.9% were alcohol users, 20.9% smokers, and 20.1% trado-medicine users. In addition, ALP (71.3%) abnormality was higher than ALT (34.9%) and AST (28.7%). The result from the SEM provided only a partial support for our hypotheses of direct substance use effects on the liver enzyme levels and abnormalities; with a direct association of alcohol with an elevated AST (b = 0.170, p = 0.05) and smoking with a higher AST (b = 0.484, p < 0.01) and ALT (b = 0.423, p < 0.01) values. Trado-medicine use was not directly associated with enzyme elevation and abnormality. In conclusion, ALP abnormality was the most common, and there is a close association between an elevated ALT and AST, with or without an elevated ALP. The study found that HIV-HAART patients who drink or smoke will have at least one or more abnormal transaminases. The possible explanation to the increased risk among HIV-HAART patients could be associated with the metabolic pressures and supra-additive effects on the livers.
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Affiliation(s)
- Chinwe F. Anyanwu
- Department of Pharmacology, Faculty of Basic Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria
| | - Tamuno-Olobo JohnBull
- Department of Human Anatomy, Faculty of Basic Medical Sciences, Niger Delta University, Amassoma, Nigeria
- *Correspondence: Eric O. Aigbogun Jr.
| | - Ibe M. Usman
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Kampala, Uganda
| | - Eric O. Aigbogun
- Department of Public Health Science, Faculty of Science and Technology, Cavendish University, Kampala, Uganda
- Tamuno-Olobo JohnBull
| | - Joy Ochai
- Human Anatomy Department, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Ahmed H. Qasem
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Shadi S. Alkhayyat
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Athanasios Alexiou
- Novel Global Community Educational Foundation, Hebersham, NSW, Australia
- AFNP Med Austria, Wien, Austria
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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Pierre F, Forman LS, Winter M, Cheng D, Ngabirano C, Emenyonu N, Hunt PW, Huang Y, Muyindike W, Samet J, Hahn JA, So-Armah K. Alcohol Consumption and Tryptophan Metabolism Among People with HIV Prior to Antiretroviral Therapy Initiation: The Uganda ARCH Cohort Study. Alcohol Alcohol 2021; 57:219-225. [PMID: 34027552 PMCID: PMC8919408 DOI: 10.1093/alcalc/agab033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Alcohol is hypothesized to have effects on the kynurenine pathway of tryptophan catabolism, a potential mechanism for alcohol-induced depression and aggression. A biomarker of this pathway, the plasma kynurenine to tryptophan ratio (K/T ratio), has been associated with HIV progression, mortality and depression. Our aim was to assess whether hazardous alcohol consumption is associated higher K/T ratio among people with HIV. METHODS Participants were a subset of the Uganda Alcohol Research Collaboration on HIV/AIDS Cohort. Alcohol consumption was categorized (abstinent, moderate and hazardous alcohol use) using the Alcohol Use Disorders Identification Test-Consumption and phosphatidylethanol (PEth). K/T ratio was the primary outcome. We used linear regression adjusted for age, sex, FIB-4, hepatitis B surface antigen, log (HIV viral load) to estimate the association between alcohol consumption and K/T ratio. RESULTS Compared to abstinent participants, hazardous drinkers and moderate drinkers had higher K/T ratio but these differences did not reach statistical significance. CONCLUSIONS Our results suggest that hazardous alcohol consumption, in the context of untreated HIV infection, may not significantly alter kynurenine to tryptophan ratio as a measure of activity of the kynurenine pathway of tryptophan metabolism.
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Affiliation(s)
- Frantz Pierre
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, 72 E Concord St, Boston, MA 02118, USA
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Debbie Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave Boston, MA 02119, USA
| | - Christine Ngabirano
- Mbarara University of Science and Technology Department of Internal Medicine P.O Box 1410 Mbarara Uganda, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Peter W Hunt
- Division of HIV/AIDS, San Francisco General Hospital, San Francisco, CA, USA
| | - Yong Huang
- Department of Bioengineering and Therapeutics, University of California San Francisco, 1700 4th Street, San Francisco, CA 94158, USA
| | - Winnie Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine P.O Box 1410 Mbarara, Uganda
| | - Jeffrey Samet
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave Crosstown, 2nd Floor Boston, MA 02118, USA
| | - Judith A Hahn
- Departments of Medicine and Epidemiology & Biostatistics, University of California San Francisco, 550 16th St., 3rd floor San Francisco, CA 94158-2549, USA
| | - Kaku So-Armah
- Corresponding author: Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor Boston, MA 02118, USA. Tel.: 617 414 6624; E-mail:
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50
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Puryear SB, Fatch R, Beesiga B, Kekibiina A, Lodi S, Marson K, Emenyonu NI, Muyindike WR, Kwarisiima D, Hahn JA, Chamie G. Higher Levels of Alcohol Use Are Associated With Latent Tuberculosis Infection in Adults Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 72:865-868. [PMID: 32374867 DOI: 10.1093/cid/ciaa527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
We assessed associations between hazardous alcohol use and latent tuberculosis infection (LTBI) among adults living with human immunodeficiency virus (HIV) in Uganda. We compared tuberculin skin test positivity across medium, high, and very-high alcohol use levels, classified by AUDIT-C scores. In multivariable analysis, very high use was associated with LTBI (adjusted odds ratio 1.61, 95% confidence interval: 1.03-2.50).
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Affiliation(s)
- Sarah B Puryear
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, USA.,Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Brian Beesiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Allen Kekibiina
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kara Marson
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | | | - Judith A Hahn
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, California, USA
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