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Villanueva MS, Wheeler DP, Applin S, Hodge TW, Zack B, Rebeiro PF. Continuous care engagement in clinical practice: perspectives on selected current strategies for people with HIV in the United States. Expert Rev Anti Infect Ther 2024; 22:1043-1053. [PMID: 39417530 DOI: 10.1080/14787210.2024.2412988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024]
Abstract
INTRODUCTION Modern antiretroviral therapy is associated with reduced rates of HIV-related morbidity and mortality. HIV viral suppression and retention in care are critically important outcomes requiring successful continuous patient engagement. However, barriers to such engagement are complex and require innovative solutions. AREAS COVERED A multistakeholder group of experts comprising clinicians and service delivery researchers assembled to clarify what constitutes engagement in HIV care and identify overarching themes that inform strategies in this field. This article captures this expert opinion and adds relevant literature on selected current best practices. EXPERT OPINION The multistakeholder group felt strongly that a better understanding of the facilitators of continuous care engagement was critical. Unlike 'retention in care,' 'engagement in care' for an individual is nuanced, flexible, evolves and requires ongoing communication between patients, providers, and other key stakeholders. The following approaches highlight care engagement strategies at different stakeholder levels: 1) patient-level: personalized care and incentivization; 2) clinic-level: wraparound, co-localized, patient-centered low-barrier care, a diverse multidisciplinary team, patient support networks, and expanded use of telemedicine; 3) healthcare system-level: utilization of external partnerships. We propose a series of diverse and complementary approaches based on a more nuanced understanding of the qualitative aspects of engagement in care.
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Affiliation(s)
| | | | | | - Theo W Hodge
- Infectious Diseases, Washington Health Institute, Washington, DC, USA
| | | | - Peter F Rebeiro
- Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA
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Wiginton JM, Eaton LA, Earnshaw VA, Watson RJ, Kalichman SC. Socio-cognitive facilitators of ART-adherence among predominantly black sexual and gender minoritized persons living with HIV in Atlanta, Georgia: a latent profile analysis. J Behav Med 2024; 47:1012-1027. [PMID: 39214949 DOI: 10.1007/s10865-024-00510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
The Integrated Change Model describes several social and cognitive factors (e.g., health attitudes, social support, self-efficacy) that can affect medication adherence. Guided by this model, we sought to identify profiles of socio-cognitive facilitators of ART (antiretroviral therapy) adherence among diversely minoritized persons living with HIV enrolled in a behavioral intervention trial in Atlanta, Georgia (N = 477). To do this, we performed latent profile analysis on baseline responses to scales assessing 6 indicators of interest: HIV-care self-efficacy, social support, TasP (treatment-as-prevention) beliefs, trust in healthcare providers, perceived need for ART, and trust in ART. We regressed emergent profiles on internalized, enacted, and microaggressive HIV stigma and compared prospective 30-day ART adherence and several cross-sectional HIV outcomes across profiles. Mean age was 29 years; 83% of participants were non-Hispanic Black, 53% were gay/homosexual-identifying, and 12% were gender expansive. Three profiles emerged: "Constrained/Capable" (6%), featuring high self-efficacy but low-moderate provider trust, social support, TasP beliefs, ART trust, and ART need; "Conflicted" (13%), featuring high TasP beliefs, provider trust, and ART need but moderate self-efficacy, ART trust, and social support; and "Motivated" (81%), featuring high levels of all indicators. Greater internalized, enacted, and microaggressive stigma were positively associated with "Conflicted" relative to "Motivated" profile membership. ART-nonadherence, unsuppressed viral load, and viral load unawareness were more likely for the "Conflicted" relative to the "Motivated" profile. Personalized HIV care tailored to such profiles may improve ART adherence and related outcomes for minoritized persons living with HIV.
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Affiliation(s)
- John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, 9500 Gilman Dr La Jolla, San Diego, CA, 92093, USA.
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Valeria A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Liang E, Nkwonta CA, Goldsamt LA, Navarra AMD. A qualitative assessment of retention in HIV care among adolescents and young adults (AYA) living with HIV in New York City. AIDS Care 2024; 36:1596-1605. [PMID: 38976575 PMCID: PMC11511637 DOI: 10.1080/09540121.2024.2373402] [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: 11/15/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
Retention in HIV care is a critical precursor to ending the epidemic yet remains suboptimal in the United States. Gaining an understanding of the challenges faced by adolescents and young adults (AYA) living with HIV is essential to improving retention in HIV care. This study explored the barriers and facilitators to retention in care among Black and Hispanic AYA living with HIV. Audio-recorded semi-structured interviews were conducted with 20 AYA living with HIV ages 16-29 years in New York City. Our methods entailed an inductive content analysis to explore key concepts, reconcile codes, and identify a theme, categories, and subcategories. Bronfenbrenner's socioecological model evolved as an organizing framework around barriers and facilitators to retention in care at the individual, interpersonal, healthcare system, and structural level. Data analysis yielded one overarching theme-the influence of psychosocial factors on retention in HIV care. Psychological struggles, powerlessness, clinic-level characteristics, and socioeconomic struggles were barriers reported by participants. Self-responsibility, social support, patient-friendly healthcare services, and socioeconomic resources emerged as facilitators. Retention in HIV care among AYA living with HIV is a multifaceted and complex phenomenon that involves multiple systems. Strengthening patients, healthcare system, and community partnerships can help address some of the HIV-related health disparities.
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Affiliation(s)
- Eva Liang
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Goldstein ND, Jones J, Kahal D, Burstyn I. Inferring Population HIV Viral Load From a Single HIV Clinic's Electronic Health Record: Simulation Study With a Real-World Example. Online J Public Health Inform 2024; 16:e58058. [PMID: 38959056 PMCID: PMC11255534 DOI: 10.2196/58058] [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] [Received: 03/04/2024] [Revised: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Population viral load (VL), the most comprehensive measure of the HIV transmission potential, cannot be directly measured due to lack of complete sampling of all people with HIV. OBJECTIVE A given HIV clinic's electronic health record (EHR), a biased sample of this population, may be used to attempt to impute this measure. METHODS We simulated a population of 10,000 individuals with VL calibrated to surveillance data with a geometric mean of 4449 copies/mL. We sampled 3 hypothetical EHRs from (A) the source population, (B) those diagnosed, and (C) those retained in care. Our analysis imputed population VL from each EHR using sampling weights followed by Bayesian adjustment. These methods were then tested using EHR data from an HIV clinic in Delaware. RESULTS Following weighting, the estimates moved in the direction of the population value with correspondingly wider 95% intervals as follows: clinic A: 4364 (95% interval 1963-11,132) copies/mL; clinic B: 4420 (95% interval 1913-10,199) copies/mL; and clinic C: 242 (95% interval 113-563) copies/mL. Bayesian-adjusted weighting further improved the estimate. CONCLUSIONS These findings suggest that methodological adjustments are ineffective for estimating population VL from a single clinic's EHR without the resource-intensive elucidation of an informative prior.
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Affiliation(s)
- Neal D Goldstein
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Justin Jones
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | | | - Igor Burstyn
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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McGee-Avila JK, Suneja G, Engels EA, Rositch AF, Horner MJ, Luo Q, Shiels MS, Islam JY. Cancer Treatment Disparities in People With HIV in the United States, 2001-2019. J Clin Oncol 2024; 42:1810-1820. [PMID: 38513161 PMCID: PMC11095899 DOI: 10.1200/jco.23.02366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE People with HIV (PWH) have worse cancer outcomes, partially because of inequities in cancer treatment. We evaluated cancer treatment disparities among PWH, including an assessment of changes in disparities over time. METHODS We used data from the HIV/AIDS Cancer Match Study, a population-based HIV and cancer registry linkage to examine diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and cancers of the cervix, lung, anus, prostate, colon, and female breast. Outcomes included receipt of (1) any cancer treatment and (2) standard therapy among patients with local-stage cancer. We assessed associations between HIV and each outcome by estimating adjusted prevalence odds ratios (aORs) with 95% CI and trends over time. We identified predictors of nonreceipt of cancer treatment in PWH. RESULTS From 2001 to 2019, compared with people with cancer without HIV (n = 2,880,955), PWH (n = 16,334) were more likely to not receive cancer treatment for cervical cancer (aOR, 2.03 [95% CI, 1.52 to 2.70]), DLBCL (aOR, 1.53 [95% CI, 1.38 to 1.70]), HL (aOR, 1.39 [95% CI, 1.19 to 1.63]), lung cancer (aOR, 1.79 [95% CI, 1.65 to 1.93]), prostate cancer (aOR, 1.32 [95% CI, 1.21 to 1.44]), colon cancer (aOR, 1.73 [95% CI, 1.43 to 2.08]), and breast cancer (aOR, 1.38 [95% CI, 1.07 to 1.77]). Similar associations were observed in PWH with local-stage cancers although no difference was observed for anal cancers. The association between HIV and nonreceipt of cancer treatment significantly decreased over time for breast, colon, and prostate cancers (all P trend <.0001), but PWH remained less likely to receive treatment in 2014-2019 for DLBCL, cervix, and lung cancers. Among PWH, Black individuals, people who inject drugs, and those 65 years and older were less likely to receive cancer treatment. CONCLUSION Disparities in receipt of cancer treatment persist for PWH in the United States in contemporary time periods. Solutions to address inequitable receipt of cancer treatment among PWH are urgently needed.
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Affiliation(s)
- Jennifer K. McGee-Avila
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, UH
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Anne F. Rositch
- Deparment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marie-Josephe Horner
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Qianlai Luo
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Meredith S. Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Eshak TB, Hobkirk AL, Whitener CJ, Conyers LM, Hwang W, Sznajder KK. Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV. AIDS Behav 2024; 28:1612-1620. [PMID: 38281250 DOI: 10.1007/s10461-024-04275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.
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Affiliation(s)
- Tarek B Eshak
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA, USA
| | - Cynthia J Whitener
- Department of Medicine, Penn State University, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Liza M Conyers
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
| | - Kristin K Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
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Pitpitan EV, Horvath KJ, Aldous J, Stockman JK, Patterson TL, Liang M, Barrozo C, Moore V, Penninga K, Smith LR. Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV. Trials 2024; 25:212. [PMID: 38520030 PMCID: PMC10958824 DOI: 10.1186/s13063-024-08042-8] [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: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, San Diego, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA.
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Megan Liang
- San Diego State University Research Foundation, San Diego, USA
| | | | | | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
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Zaleta AK, Fortune EE, Miller MF, Olson JS, Hollis-Hansen K, Dohn SK, Kwait JL. HIV Support Source: Development of a Distress Screening Measure for Adults with HIV. AIDS Behav 2024; 28:713-727. [PMID: 38261220 DOI: 10.1007/s10461-023-04261-3] [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: 12/26/2023] [Indexed: 01/24/2024]
Abstract
To provide an effective, multidimensional, and psychometrically valid measure to screen for distress among people with HIV, we developed and assessed the psychometric properties of HIV Support Source, a distress screening, referral, and support program designed to identify the unmet needs of adults with HIV and link them to desired resources and support. Development and testing were completed in three phases: (1) item generation and initial item pool testing (N = 375), (2) scale refinement via exploratory factor analysis (N = 220); external/internal item quality, and judging theoretical and practical implications of items, and (3) confirmatory validation (N = 150) including confirmatory factor analysis along with reliability and validity analyses to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk subscales. The final measure comprises 17-items representing four domains of concern: emotional well-being, financial and practical needs, physical well-being, and HIV treatment and sexual health, plus one screening item assessing tobacco and substance use. Our analyses showed strong internal consistency reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales was 0.90 and 0.79, respectively. HIV Support Source is a reliable and valid multidimensional measure of distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess and support the unmet needs of adults with HIV.
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Affiliation(s)
- Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
- Cancer Care, New York, NY, USA
| | - Erica E Fortune
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
| | - Melissa F Miller
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA.
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
| | - Kelseanna Hollis-Hansen
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
- UT Southwestern Medical Center, O'Donnell School of Public Health, Dallas, TX, USA
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Tucker E, Reyes Nieva H, Schiffer K, Yin MT, Castor D, Gordon P, Elhadad N, Zucker J. Using a Health Information Exchange to Characterize Changes in HIV Viral Load Suppression and Disparities During the COVID-19 Pandemic in New York City. Open Forum Infect Dis 2023; 10:ofad584. [PMID: 38156044 PMCID: PMC10754646 DOI: 10.1093/ofid/ofad584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background HIV viral suppression requires sustained engagement in care. The COVID-19 pandemic challenged care accessibility for many people living with HIV (PLWH). We used health information exchange data to evaluate the effect of pandemic-related disruptions in HIV care on viral load suppression (VLS) and to examine racial/ethnic disparities in VLS. Methods We performed a retrospective observational cohort study of PLWH using data from a regional health information exchange in the New York City region between 1 January 2018 and 31 December 2022. We established 2 cohorts: PLWH who received HIV care in 2020 (cohort A) and PLWH who did not receive HIV care in 2020 (cohort B). We categorized HIV VLS outcomes as suppressed or not suppressed and calculated the prevalence of VLS between 2018 and 2022. We compared proportions using chi-square tests and used unadjusted and adjusted logistic regression to estimate the association among variables, including race/ethnicity, cohort, and VLS. Results Of 5 301 578 patients, 34 611 met our inclusion criteria for PLWH, 11 653 for cohort A, and 3141 for cohort B. In 2019, cohort B had a lower prevalence of VLS than cohort A (86% vs 89%, P < .001). Between 2019 and 2021, VLS dropped significantly among cohort B (86% to 81%, P < .001) while staying constant in cohort A (89% to 89%, P = .62). By 2022, members of cohort B were less likely than cohort A to be receiving HIV care in New York City (74% vs 88%, P < .001). Within both cohorts, Black and Hispanic patients had lower odds of VLS than White patients. Conclusions In New York City, VLS remained high among PLWH who continued to receive care in 2020 and dropped among PLWH who did not receive care. VLS was lower among Black and Hispanic patients even after controlling for receipt of care.
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Affiliation(s)
- Emma Tucker
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Harry Reyes Nieva
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kayla Schiffer
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Michael T Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Jason Zucker
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
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Pitpitan EV, Wiginton JM, Bejarano-Romero R, Baker DA. Promoting HIV care continuum outcomes among people who use drugs and alcohol: a systematic review of randomized trials evaluating behavioral HIV care interventions published from 2011 to 2023. BMC Public Health 2023; 23:2182. [PMID: 37936103 PMCID: PMC10629072 DOI: 10.1186/s12889-023-17113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Substance use remains a robust predictor of HIV infection and a serious impediment to HIV care continuum progression for people living with HIV. The primary research question of this systematic review is focused on understanding the extent to which behavioral HIV care interventions have been efficacious in helping people who live with HIV and who use substances along the HIV care continuum. METHODS Using PubMed and ProQuest databases, we performed a systematic review of randomized trials of behavioral HIV care continuum interventions among people who use substances published from 2011 to August 2023, since the beginning of the treatment-as-prevention era. RESULTS We identified 11 studies (total participants: N = 5635), ten intentionally targeting substance-using populations. Four studies involved samples using ≥ 1 substance (e.g., alcohol, opioids, stimulants, marijuana); four involved injection drug use; one involved methamphetamine use; and one involved alcohol use. One study targeted a population with incidental substance use (i.e., alcohol, injection drug use, non-injection drug use reported in most participants). Each study defined one or more HIV care outcomes of interest. Viral suppression was an outcome targeted in 9/11 studies, followed by uptake of antiretroviral therapy (ART; 7/11), ART adherence (6/11), retention in care (5/11), and linkage to care (3/11). While most (nine) of the studies found significant effects on at least one HIV care outcome, findings were mostly mixed. Mediated (2/11) and moderated (2/11) effects were minimally examined. CONCLUSIONS The results from this systematic review demonstrate mixed findings concerning the efficacy of previous HIV care interventions to improve HIV care continuum outcomes among people who use substances. However, heterogeneity of study components (e.g., diversity of substances used/assessed, self-report vs. objective measures, attrition) prevent broad deductions or conclusions about the amenability of specific substance-using populations to HIV care intervention. More coordinated, comprehensive, and targeted efforts are needed to promote and disentangle intervention effects on HIV care continuum outcomes among substance-using populations.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Raul Bejarano-Romero
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
| | - Dania Abu Baker
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
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Allison WE, Choi AN, Kawasaki K, Desai A, Tsevat J, Melhado TV. Hepatitis C Knowledge, Attitudes, and Perceptions Among People With HIV in South Texas. Health Promot Pract 2023; 24:973-981. [PMID: 37440490 DOI: 10.1177/15248399231169924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Direct-acting antivirals are overwhelmingly effective in curing hepatitis C (HCV). Barriers to HCV treatment exist for those co-infected with both HIV and HCV. Southern states represent the epicenter of the HIV epidemic in the United States. This study assessed HCV knowledge, attitudes, and perceptions in 318 co-infected individuals attending Ryan White HIV/AIDS Program (RWHAP) clinics in three South Texas cities. Two groups were compared, those tested for HCV and aware of their results (Group 1) and those uncertain if they were tested or tested and unaware of their results (Group 2). HCV knowledge was poor overall. Group 1 had a significantly higher mean HCV knowledge score than Group 2 by t-test (48.6 vs. 38.8; p < .01), but not by multivariable linear regression (p=.14). Factors predictive of greater HCV knowledge included self-identification as lesbian, gay, bisexual, transgender, queer and post high school educational attainment. Significantly more in Group 1 compared with Group 2 agreed that HCV medications would keep a person healthier for longer. Spanish speakers were more likely to disagree with a statement that people of color receive the same treatment for hepatitis C as white people. Study limitations identified include poor generalizability to people with HIV (PWH) receiving care in non-RWHAP settings and rural communities. Despite limitations, this study augments the paucity of information about knowledge, attitudes, and perceptions of HCV in PWH and can inform interventions to combat barriers to HCV treatment and to maximize opportunities for HCV screening, diagnosis, and linkage to curative care.
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Affiliation(s)
- Waridibo E Allison
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Aro N Choi
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Keito Kawasaki
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anmol Desai
- The University of Texas at Austin, Austin, TX, USA
| | - Joel Tsevat
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Trisha V Melhado
- The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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12
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Govere SM, Kalinda C, Chimbari MJ. The impact of same-day antiretroviral therapy initiation on retention in care and clinical outcomes at four eThekwini clinics, KwaZulu-Natal, South Africa. BMC Health Serv Res 2023; 23:838. [PMID: 37553685 PMCID: PMC10408100 DOI: 10.1186/s12913-023-09801-0] [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: 08/25/2022] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Same-day initiation (SDI) of antiretroviral therapy (ART) increases ART uptake, however retention in care after ART initiation remains a challenge. Public health behaviours, such as retention in HIV care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new Human Immunodeficiency Virus (HIV) transmission and improving health outcomes among HIV patients. METHODS We evaluated 6-month retention in care, and clinical outcomes of an ART cohort comprising of SDI and delayed ART initiators. We conducted a 6 months' observational prospective cohort study of 403 patients who had been initiated on ART. A structured questionnaire was used to abstract data from patient record review which comprised the medical charts, laboratory databases, and Three Interlinked Electronic Registers.Net (TIER.Net). Treatment adherence was ascertained by patient visit constancy for the clinic scheduled visit dates. Retention in care was determined by status at 6 months after ART initiation. RESULTS Among the 403 participants enrolled in the study and followed up, 286 (70.97%) and 267 (66.25%) complied with scheduled clinics visits at 3 months and 6 months, respectively. One hundred and thirteen (28.04%) had been loss to follow-up. 17/403 (4.22%) had died and had been out of care after 6 months. 6 (1.49%) had been transferred to other health facilities and 113 (28.04%) had been loss to follow-up. Among those that had been lost to follow-up, 30 (33.63%) deferred SDI while 75 (66.37%) initiated ART under SDI. One hundred and eighty-nine (70.79%) participants who had remained in care were SDI patients while 78 (29.21%) were SDI deferred patients. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002-2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07-4.061), age (OR: 0.941; 95% CI: 0.734-2.791), ART start date (OR: 0.078; 95% CI: 0.042-0.141), partner HIV status (OR: 0.621; 95% CI: 0.387-0.995) and the number of hospitalizations after HIV diagnosis (OR: 0.173; 95% CI: 0.092-0.326). were significantly associated with viral load detection. Furthermore, SDI patients who defaulted treatment were 2.4 (95% CI: 1.165-4.928) times more likely to have increased viral load than those who had been returned in care. CONCLUSION Viral suppression under SDI proved higher but with poor retention in care. However, the results also emphasise a vital need, to not only streamline processes to increase immediate ART uptake further, but also to ensure retention in care.
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Affiliation(s)
- Sabina M Govere
- School of Nursing and Public Health, Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa.
| | - Chester Kalinda
- School of Nursing and Public Health, Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
- Bill and Joyce Cummings Institute of Global Health and Institute of Global Health Equity Research (IGHER), University of Global Health Equity Kigali Heights, Kigali, Rwanda
| | - Moses J Chimbari
- School of Nursing and Public Health, Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health, Great Zimbabwe University, P.O Box 1235, Masvingo, Zimbabwe
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Shelton BA, Becker DJ, MacLennan PA, Sen B, Budhwani H, Locke JE. Racial Disparities in Access to the Kidney Transplant Waitlist Among People with Human Immunodeficiency Virus. AIDS Patient Care STDS 2023; 37:394-402. [PMID: 37566535 PMCID: PMC10457613 DOI: 10.1089/apc.2023.0037] [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] [Indexed: 08/13/2023] Open
Abstract
The epidemiology of human immunodeficiency virus (HIV) has shifted such that Black individuals disproportionately represent incident HIV diagnoses. While risk of end-stage kidney disease (ESKD) among people with HIV (PWH) has declined with effective antiretroviral therapies, a substantial racial disparity in ESKD burden exists with the greatest prevalence among Black PWH. Disparities in waitlisting for kidney transplantation, the optimal treatment for ESKD, exist for both PWH and Black individuals without HIV, but it is unknown whether these characteristics together exacerbate such disparities. Six hundred two thousand six ESKD patients were identified from the United States Renal Data System (January 1, 2007 to December 31, 2017), and HIV-status was determined through Medicare claims. Cox proportional hazards regression was used to determine waitlisting rates. Multiplicative interaction terms between HIV-status and race were examined. The 6250 PWH were significantly younger, more commonly Black, and less commonly female than those without HIV. HIV-status and race were independently associated with 50% and 12% lower likelihood of waitlisting, respectively [adjusted hazard ratio (aHR): 0.50, 95% confidence interval (CI): 0.36-0.69, p < 0.001; aHR: 0.88, 95% CI: 0.87-0.90, p < 0.001]. There was also a significant interaction present between HIV-status and Black race (aHR: 0.80, 95% CI: 0.66-0.98, p < 0.001) such that, while HIV-status and Black race were independently associated with decreased waitlisting, the interaction of Black race and HIV-status exacerbated those disparities. While limited by lack of HIV-specific data that may impact inferences with respect to race, additional studies are urgently needed to understand the interplay between HIV risk factors, HIV-stigma, and racism, and how intersectionality may exacerbate disparities in transplantation among PWH.
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Affiliation(s)
- Brittany A. Shelton
- Department of Public Health, University of Tennessee Knoxville, Knoxville, Tennessee, USA
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David J. Becker
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul A. MacLennan
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bisakha Sen
- Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Jayme E. Locke
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Crockett KB, Schember CO, Bian A, Rebeiro PF, Keruly J, Mayer K, Mathews C, Moore RD, Crane H, Geng E, Napravnik S, Shepherd BE, Mugavero MJ, Turan B, Pettit AC. Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015. Clin Infect Dis 2023; 76:2163-2170. [PMID: 36757336 PMCID: PMC10273374 DOI: 10.1093/cid/ciad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. METHODS Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. RESULTS Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. CONCLUSIONS Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Mathews
- School of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Disease, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Hong C, Ochoa AM, Wilson BDM, Wu ESC, Thomas D, Holloway IW. The associations between HIV stigma and mental health symptoms, life satisfaction, and quality of life among Black sexual minority men with HIV. Qual Life Res 2023; 32:1693-1702. [PMID: 36648570 PMCID: PMC10953729 DOI: 10.1007/s11136-023-03342-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: 01/03/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE With the advancement of antiretroviral therapy (ART), HIV/AIDS has become a manageable illness, similar to other chronic conditions. This study examined the associations between HIV stigma and patient-reported outcomes including mental health symptoms, life satisfaction, and quality of life among Black sexual minority men with HIV. METHODS We analyzed baseline data from a randomized comparison trial of a mobile app intervention aimed to address the social work and legal needs of Black sexual minority men with HIV in Los Angeles County. We used validated scales including the Berger HIV stigma scale, the Patient Health Questionnaire-9 & the General Anxiety Disorder-7, the Satisfaction with Life Scale, and the Ladder Scale to assess HIV stigma, depressive symptoms, anxiety, life satisfaction, and quality of life, and we conducted multivariable linear regression to examine their associations. RESULTS Participants experienced HIV stigma especially about disclosure concerns (e.g., 81.9% participants indicated "I am very careful who I tell that I have HIV") and public attitudes (52.3% believed "Most people with HIV are rejected when others find out"). In the multivariable models, higher overall stigma scores were associated with higher likelihood of experiencing depression (adjusted b = 0.235, p < 0.001) and anxiety (adjusted b = 0.188, p = 0.002), and lower life satisfaction (adjusted b = - 0.236, p < 0.001) and quality of life (adjusted b = - 0.053, p = 0.013), adjusting for clinical characteristics including ART initiation, viral load suppression, and medication adherence. In addition, being attacked or harassed in the past year were significantly associated with lower life satisfaction and quality of life (adjusted b = - 3.028, p = 0.046; adjusted b = - 1.438, p = 0.002). CONCLUSION Our findings highlight the need for focused HIV stigma reduction interventions to promote the overall well-being of Black sexual minority men with HIV. Strategies to promote the patient-reported outcomes may benefit from trauma-informed approaches.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA.
| | - Ayako Miyashita Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
| | - Bianca D M Wilson
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth S C Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
| | | | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
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16
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Tran N, Nishi A, Young LE, Endo A, Cumberland WG, Young SD. The role of perceived health in retention disparity: A HIV-testing-related behavioral intervention among African American and Latinx men who have sex with men in the United States. Prev Med Rep 2023; 33:102195. [PMID: 37223563 PMCID: PMC10201871 DOI: 10.1016/j.pmedr.2023.102195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/15/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Retention in healthcare and health behavior remains a critical issue, contributing to inequitable distribution of intervention benefits. In diseases such as HIV, where half of the new infections occur among racial and sexual minorities, it is important that interventions do not enlarge pre-existing health disparities. To effectively combat this public health issue, it is crucial that we quantify the magnitude of racial/ethnic disparity in retention. Further, there is a need to identify mediating factors to this relationship to inform equitable intervention design. In the present study, we assess the racial/ethnic disparity in retention in a peer-led online behavioral intervention to increase HIV self-testing behavior and identify explanatory factors. The research used data collected from the Harnessing Online Peer Education (HOPE) HIV Study that included 899 primarily African American and Latinx men who have sex with men (MSM) in the United States. Results show that African American participants had higher lost-to-follow-up rates at 12-week follow-up compared to Latinx participants (11.1% and 5.8% respectively, Odds Ratio = 2.18, 95% confidence interval: 1.12 - 4.11, p = 0.02), which is substantially mediated by participants' self-rated health score (14.1% of the variation in the African American v.s. Latinx difference in lost-follow-up, p = 0.006). Thus, how MSM perceive their health may play an important role in their retention in HIV-related behavioral intervention programs and its racial/ethnic disparity.
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Affiliation(s)
- Nathan Tran
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Akihiro Nishi
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Lindsay E. Young
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA 90089, USA
| | - Akira Endo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan
| | - William G. Cumberland
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sean D. Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA 92617, USA
- Department of Informatics, University of California, Irvine, Irvine, CA 92617, USA
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17
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Hickey MD, Sergi F, Zhang K, Spinelli MA, Black D, Sola C, Blaz V, Nguyen JQ, Oskarsson J, Gandhi M, Havlir DV. Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV. J Telemed Telecare 2023; 29:187-195. [PMID: 33342328 PMCID: PMC8214632 DOI: 10.1177/1357633x20976036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has required a shift of many routine primary care visits to telemedicine, potentially widening disparities in care access among vulnerable populations. In a publicly-funded HIV clinic, we aimed to evaluate a pre-visit phone-based planning intervention to address anticipated barriers to telemedicine. METHODS We conducted a pragmatic randomized controlled trial of patients scheduled for a phone-based HIV primary care visit at the Ward 86 HIV clinic in San Francisco from 15 April to 15 May 2020. Once reached by phone, patients were randomized to either have a structured pre-visit planning intervention to address barriers to an upcoming telemedicine visit versus a standard reminder call. The primary outcome was telemedicine visit attendance. RESULTS Of 476 scheduled telemedicine visits, 280 patients were reached by a pre-visit call to offer enrollment. Patients were less likely to be reached if virally unsuppressed (odds ratio (OR) 0.11, 95% confidence intervals (CI) 0.03-0.48), CD4 < 200 (OR 0.24, 95% CI 0.07-0.85), or were homeless (OR 0.24, 95% CI 0.07-0.87). There was no difference between intervention and control in scheduled visit attendance (83% v. 78%, OR 1.38, 95% CI 0.67-2.81). CONCLUSIONS A structured phone-based planning call to address barriers to telemedicine in a public HIV clinic was less likely to reach patients with poorly-controlled HIV and patients experiencing homelessness, suggesting additional interventions may be needed in this population to ensure access to telemedicine-based care. Among patients reachable by phone, telemedicine visit attendance was high and not improved with a structured pre-visit intervention, suggesting that standard reminders may be adequate in this population.
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Affiliation(s)
- Matthew D Hickey
- Division of HIV, ID and Global Medicine, University of California, USA
| | | | - Kevin Zhang
- Feinberg School of Medicine, Northwestern University, USA
| | | | - Douglas Black
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Cyril Sola
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Vanessa Blaz
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Janet Q Nguyen
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Jon Oskarsson
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Diane V Havlir
- Division of HIV, ID and Global Medicine, University of California, USA
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18
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Budge M, Opara I, Weser VU, Sands BE, Hieftje KD. Black Adolescent Females' Perceptions of PrEP for HIV Risk Reduction. J Int Assoc Provid AIDS Care 2023; 22:23259582231206934. [PMID: 37853731 PMCID: PMC10588402 DOI: 10.1177/23259582231206934] [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: 10/27/2022] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
Preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is approved for use in adolescents, though uptake remains low. Black adolescent females experience higher rates of HIV transmission compared to adolescent females of other racial/ethnic groups. Increasing PrEP awareness and education among this population may be an effective strategy to mitigate disparities in HIV transmission among Black adolescent females. Twenty-seven Black adolescent females participated in focus groups which were coded using the constant comparative method of qualitative analysis to identify major themes: (1) PrEP is not commonly framed as an HIV prevention strategy for heterosexual Black adolescent females, (2) PrEP use among peers is perceived as mostly positive, (3) Adoption of PrEP among Black adolescent females is impeded by perceived barriers such as stigma, negative side effects, and adherence concerns. These findings may inform the development of targeted culturally tailored marketing and educational campaigns centered on Black heterosexual adolescent females to increase PrEP awareness and uptake in this population disproportionately affected by HIV.
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Affiliation(s)
| | - Ijeoma Opara
- Yale University School of Public Health, New Haven, CT, USA
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19
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Schember CO, Scott SE, Jenkins CA, Rebeiro PF, Turner M, Furukawa SS, Bofill C, Yan Z, Jackson GP, Pettit AC. Electronic Patient Portal Access, Retention in Care, and Viral Suppression Among People Living With HIV in Southeastern United States: Observational Study. JMIR Med Inform 2022; 10:e34712. [PMID: 35877160 PMCID: PMC9361138 DOI: 10.2196/34712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Approximately 1.1 million people living with HIV live in the United States, and the incidence is highest in Southeastern United States. Electronic patient portal prevalence is increasing and can improve engagement in primary medical care. Retention in care and viral suppression-measures of engagement in HIV care-are associated with decreased HIV transmission, morbidity, and mortality. OBJECTIVE We aimed to determine if patient portal access among people living with HIV was associated with retention and viral suppression. METHODS We conducted an observational cohort study among people living with HIV in care at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from 2011-2016. Individual access was defined as patient portal account registration at any point in the year prior. Retention was defined as ≥2 kept appointments or HIV lab measurements ≥3 months apart within a 12-month period. Viral suppression was defined as the last viral load in the calendar year <200 copies/mL. We calculated adjusted prevalence ratios (aPRs) and 95% CIs using modified Poisson regression with generalized estimating equations to estimate the association of portal access with retention and viral suppression. RESULTS We included 4237 people living with HIV contributing 16,951 person-years of follow-up (median 5, IQR 3-5 person-years). The median age was 43 (IQR 33-50) years. Of the 4237 people living with HIV, 78.1% (n=4237) were male, 40.8% (n=1727) were Black non-Hispanic, and 56.5% (n=2395) had access. Access was independently associated with retention (aPR 1.13, 95% CI 1.10-1.17) and viral suppression (aPR 1.18, 95% CI 1.14-1.22). CONCLUSIONS In this population, patient portal access was associated with retention and viral suppression. Future prospective studies should assess the impact of increasing portal access among people living with HIV on these HIV outcomes.
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Affiliation(s)
- Cassandra Oliver Schember
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah E Scott
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Peter F Rebeiro
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sally S Furukawa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carmen Bofill
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Zhou Yan
- Department of Health Information Technology Web Development, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gretchen P Jackson
- Departments of Surgery, Pediatrics and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April C Pettit
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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20
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Dulin AJ, Fava JL, Earnshaw VA, Dale SK, Carey MP, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Agil D, Howe CJ. Development of Long and Short Forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. AIDS Behav 2022; 26:2469-2484. [PMID: 35092536 PMCID: PMC10782857 DOI: 10.1007/s10461-022-03579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/15/2023]
Abstract
Understanding resilience in relation to HIV-related outcomes may help address racial/ethnic disparities, however, significant gaps in its measurement preclude in-depth study. Thus, this research aims to develop and evaluate the psychometric properties of long and short forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. To develop the items, we conducted a mixed methods study (N = 48) and reviewed published resilience measures. We completed content validity index analyses to ensure the items reflected the resilience construct. Next, we conducted 20 cognitive interviews and a field survey (N = 400). The long and short forms demonstrated acceptable to excellent psychometric properties based on factorial validity, internal consistency and convergent validity and on measurement invariance (conducted for the short form only). These measures provide a comprehensive framework to examine resilience and HIV-related outcomes and can inform resilience-building interventions to reduce racial and ethnic health disparities.
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Affiliation(s)
- Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Marta Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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21
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Baseline and Process Factors of Anti-Retroviral Therapy That Predict Loss to Follow-up Among People Living with HIV/AIDS in China: A Retrospective Cohort Study. AIDS Behav 2022; 26:1126-1137. [PMID: 34698955 DOI: 10.1007/s10461-021-03466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
We explored the predictors and predictive models of loss to follow-up (LTFU) during the first year of anti-retroviral therapy (ART). LTFU was defined as the failure to visit the clinic for antiretroviral drugs for ≥ 90 days after the last missed scheduled visit. Based on the electronic medical records of 5953 patients who were HIV positive and began ART between 2016 and 2019 in China, the LTFU rate was 7.24 (95% confidence interval 6.49-7.97) per 100 person-years during the first year of ART. ART baseline factors were associated with LTFU, but were non-optimal predictors. A model including ART process-related factors such as follow-up behaviors and physical health status had an area under the receiver operating characteristic curve of 73.4% for predicting LTFU. Therefore, the medical records of follow-up visits can be used to identify patients with a high risk of LTFU and allow interventions to be implemented proactively.
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22
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Dangerfield DT, Ober AJ, Anderson JN, Gorbach P, Bluthenthal RN. Observational "go-alongs" of follow-up HIV care visits of two virally suppressed Black sexual minority men. Public Health Nurs 2022; 39:153-160. [PMID: 34403517 PMCID: PMC8766864 DOI: 10.1111/phn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE This study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD. METHODS Go-alongs with two virally suppressed BSMM LWHIV supplemented 27 in-depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go-alongs involved accompanying participants' follow-up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient-provider interactions. RESULTS We found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient-provider interactions, and personal motivations to achieve viral suppression. CONCLUSION Clinic accessibility, co-located clinical services, and rapport with clinicians and healthcare staff could be key contextual conditions that facilitate retention in care among BSMM LWHIV.
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Affiliation(s)
| | - Allison J. Ober
- Policy and Behavioral Science Researcher, RAND Corporation, Los Angeles, CA, USA
| | - Janeane N. Anderson
- Assitant Professor, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pamina Gorbach
- Professor, University of California Los Angeles, Los Angeles, CA, USA
| | - Ricky N. Bluthenthal
- Professor, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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23
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He N, Cleland CM, Gwadz M, Sherpa D, Ritchie AS, Martinez BY, Collins LM. Understanding Medical Distrust Among African American/Black and Latino Persons Living With HIV With Sub-Optimal Engagement Along the HIV Care Continuum: A Machine Learning Approach. SAGE OPEN 2021; 11:10.1177/21582440211061314. [PMID: 35813871 PMCID: PMC9262282 DOI: 10.1177/21582440211061314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Medical distrust is a potent barrier to participation in HIV care and medication use among African American/Black and Latino (AABL) persons living with HIV (PLWH). However, little is known about sociodemographic and risk factors associated with distrust. We recruited adult AABL PLWH from low socio-economic status backgrounds with insufficient engagement in HIV care (N = 512). Participants completed structured assessments on three types of distrust (of health care providers, health care systems, and counter-narratives), HIV history, and mental health. We used a type of machine learning called random forest to explore predictors of trust. On average, participants were 47 years old (SD = 11 years), diagnosed with HIV 18 years prior (SD = 9 years), and mainly male (64%) and African American/Black (69%). Depression and age were the most important predictors of trust. Among those with elevated depressive symptoms, younger participants had less trust than older, while among those without depression, trust was greater across all ages. The present study adds nuance to the literature on medical distrust among AABL PLWH and identifies junctures where interventions to build trust are needed most.
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Affiliation(s)
- Ning He
- New York University Silver School of Social Work, USA
| | | | - Marya Gwadz
- New York University Silver School of Social Work, USA
| | - Dawa Sherpa
- New York University Silver School of Social Work, USA
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24
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Bazargan M, Cobb S, Assari S, Bazargan-Hejazi S. Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication. Am J Hosp Palliat Care 2021; 39:461-471. [PMID: 34476995 PMCID: PMC10173884 DOI: 10.1177/10499091211036885] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increasing severity of serious illness requires individuals to prepare and make decisions to mitigate adverse consequences of their illness. In a racial and ethnically diverse sample, the current study examined preparedness for serious illness among adults in California. METHODS This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Participants included 542 non-Hispanic White (52%), non-Hispanic Black (28%), and Hispanic (20%) adults who reported at least one chronic medical condition that they perceived to be a serious illness. Race/ethnicity, socio-demographic factors, health status, discrimination, mistrust, and communication with provider were measured. To perform data analysis, we used logistic regression models. RESULTS Our findings revealed that 19%, 24%, and 34% of non-Hispanic White, non-Hispanic Blacks, and Hispanic believed they were not prepared if their medical condition gets worse, respectively. Over 60% indicated that their healthcare providers never engaged them in discussions of their feelings of fear, stress, or sadness related to their illnesses. Results of bivariate analyses showed that race/ethnicity was associated with serious illness preparedness. However, multivariate analysis uncovered that serious illness preparedness was only lower in the presence of medical mistrust in healthcare providers, perceived discrimination, less communication with providers, and poorer quality of self-rated health. CONCLUSION This study draws attention to the need for healthcare systems and primary care providers to engage in effective discussions and education regarding serious illness preparedness with their patients, which can be beneficial for both individuals and family members and increase quality of care.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science & University of California at Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Physician Assistant Program, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science & University of California at Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science & University of California at Los Angeles (UCLA), Los Angeles, CA, USA
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25
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Rajabiun S, Lennon-Dearing R, Hirschi M, Davis B, Williams B, Sprague Martinez L, Campos M. Ending the HIV Epidemic: One Southern Community Speaks. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:647-664. [PMID: 34251984 PMCID: PMC8429130 DOI: 10.1080/19371918.2021.1947929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Memphis, Tennessee and its surrounding counties have been profoundly affected by the HIV epidemic. Using a participatory research approach this study identified from a community perspective: 1) the barriers and facilitators for providing support to achieve viral suppression to the most at-risk groups living with HIV in the Memphis Transitional Grant Area and 2) opportunities to strengthen the health care system through the use of community health workers (CHWs) to do outreach and engage with people living with HIV. Themes of barriers include intersectional stigma, HIV criminal laws, abstinence-only sex education, housing, transportation, and limited access to HIV case management and mental health services. Strategies to address these barriers included HIV education to youth in schools and community-wide campaigns, more testing sites, involving faith leaders, funding for housing options, innovative transportation services, rapid start of culturally appropriate HIV medical treatment, intensive case management services, and mental health counseling. Two opportunities to utilize CHWs to address the barriers identified in this geographic area are as policy advocates and as an integrated member of the HIV primary care team. The findings of this study can inform a strategy to build the CHW workforce which may have widespread implications for ending the HIV epidemic in this geographic area and across the United States.
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Affiliation(s)
- Serena Rajabiun
- Lowell Zuckerberg College of Health Sciences, University of Massachusetts
| | | | | | | | | | | | - Maria Campos
- School of Social Work, Boston University, Boston, Massachusetts, USA
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26
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Davoust M, Drainoni ML, Baughman A, Campos Rojo M, Estes T, Rajabiun S, Ross-Davis K, McCann K, Sullivan M, Todd L, Wolfe HL, Sprague Martinez L. "He Gave Me Spirit and Hope": Client Experiences with the Implementation of Community Health Worker Programs in HIV Care. AIDS Patient Care STDS 2021; 35:318-326. [PMID: 34375140 DOI: 10.1089/apc.2021.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Community health workers (CHWs) are members of the frontline health workforce who serve as intermediaries between health services and communities. In the United States, the role of CHWs has begun to expand as they have been shown to improve outcomes and reduce inequities in care for chronic conditions. This study used qualitative methods to explore the experiences of clients in CHW programs to inform their implementation in HIV care. Thirty clients from 6 Ryan White HIV/AIDS Program care settings across the United States participated in individual semistructured interviews to learn more about their experiences working with a CHW. Four key themes arose from the client perspective. First, CHWs embodied key qualities. Some of the qualities clients attributed to CHWs included being caring and supportive, along with capable of fostering personal connections. Second, CHWs met clients where they were. Clients described the CHW approach as more holistic compared with other care team members; they emphasized CHWs were able to focus on whatever was needed in that moment. Third, CHWs occupied a unique role in the HIV care team. Clients noted CHWs had more time to dedicate to their interactions; they also saw CHWs as representing a different level of authority. Finally, CHWs influenced how clients engaged with care and accessed resources. This included empowering clients to access resources independently in the future. Overall, clients' perceptions of CHWs in terms of their qualities, approach, role, and influence on the HIV care experience suggest they are a valuable resource on the care team.
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Affiliation(s)
- Melissa Davoust
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Allyson Baughman
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Maria Campos Rojo
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Terry Estes
- Southwest Louisiana AIDS Council, Lake Charles, Louisiana, USA
| | - Serena Rajabiun
- Department of Public Health, University of Massachusetts—Lowell, Lowell, Massachusetts, USA
| | - Kelly Ross-Davis
- 1917 Clinic at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine McCann
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Marena Sullivan
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - LaWanda Todd
- Division of Infectious Diseases and International Travel Health, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Sprague Martinez
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
- Macro Department, Boston University School of Social Work, Boston, Massachusetts, USA
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27
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Trepka MJ, Sheehan DM, Dawit R, Li T, Fennie KP, Gebrezgi MT, Brock P, Beach MC, Ladner RA. Differential Role of Psychosocial, Health Care System and Neighborhood Factors on the Retention in HIV Care of Women and Men in the Ryan White Program. J Int Assoc Provid AIDS Care 2021; 19:2325958220950087. [PMID: 32815475 PMCID: PMC7444131 DOI: 10.1177/2325958220950087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We investigated potential differential impact of barriers to HIV care retention among women relative to men. Client intake, health assessment, service, and laboratory information among clients receiving medical case management during 2017 in the Miami-Dade County Ryan White Program (RWP) were obtained and linked to American Community Survey data by ZIP code. Cross-classified multilevel logistic regression analysis was conducted. Among 1609 women and 5330 men, 84.6% and 83.7% were retained in care. While simultaneously controlling for all demographic characteristics, vulnerable/enabling factors, and neighborhood indices in the model, younger age, being US born, not working, and having a medical provider with low volume (<10) of clients remained associated with non-retention in care among women and men; while having ≥3 minors in the household and being perinatally infected were additionally associated with retention only for women. Both gender-specific and gender-non-specific barriers should be considered in efforts to achieve higher retention rates.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), 5450Florida International University, Miami, FL, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Division of Natural Sciences, 10648New College of Florida, Sarasota, FL, USA
| | - Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, FL, USA
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28
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Avoundjian T, Troszak L, Cave S, Shimada S, McInnes K, Midboe AM. Correlates of personal health record registration and utilization among veterans with HIV. JAMIA Open 2021; 4:ooab029. [PMID: 34278241 DOI: 10.1093/jamiaopen/ooab029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective We examined correlates of registration and utilization of the Veteran Health Administration's (VHA) personal health record (PHR), My HealtheVet (MHV), among a national cohort of veterans living with HIV. Materials and Methods Using VHA administrative data, we matched veterans with HIV who registered for MHV in fiscal year 2012-2018 (n = 8589) to 8589 veterans with HIV who did not register for MHV. We compared demographic and geographic characteristics, housing status, comorbidities, and non-VHA care between MHV registrants and nonregistrants to identify correlates of MHV registration. Among registrants, we examined the association between these characteristics and MHV tool use (prescription refill, record download, secure messaging, view labs, and view appointments). Results MHV registrants were more likely to be younger, women, White, and to have bipolar disorder, depression, or post-traumatic stress disorder diagnosis than nonregistrants. Having a substance use disorder (SUD) diagnosis or a higher Elixhauser score was associated with lower odds of MHV registration. Among registrants, women were less likely to use prescription refill. Patients who were at risk of homelessness in the past year were less likely to use secure messaging and, along with those who were homeless, were less likely to use view labs and prescription refill. Bipolar disorder and depression were associated with increased secure messaging use. Diagnoses of SUD and alcohol use disorder were both associated with lower rates of prescription refill. Discussion Among veterans living with HIV, we identified significant differences in PHR registration and utilization by race, sex, age, housing status, and diagnosis.
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Affiliation(s)
- Tigran Avoundjian
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Lara Troszak
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Shayna Cave
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Stephanie Shimada
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Keith McInnes
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA.,Stanford School of Medicine, Stanford University, Stanford, California, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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29
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Zeng C, Zhang J, Sun X, Li Z, Weissman S, Olatosi B, Li X. County-level predictors of retention in care status among people living with HIV in South Carolina from 2010 to 2016: a data-driven approach. AIDS 2021; 35:S53-S64. [PMID: 33867489 PMCID: PMC8098716 DOI: 10.1097/qad.0000000000002832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the geospatial variation of retention in care (RIC) across the counties in South Carolina (SC) from 2010 to 2016 and identify the relevant county-level predictors. DESIGN Aggregated data on county-level RIC among HIV patients from 2010 to 2016 were retrieved from an electronic HIV/AIDS reporting system in SC Department of Health and Environmental Control. Sociological framework of health was used to select potential county-level predictors from multiple public datasets. METHODS Geospatial mapping was used to display the spatial heterogeneity of county-level RIC rate in SC. Generalized linear mixed effect regression with least absolute shrinkage and selection operator (LASSO) was employed to identify county-level predictors related to the change of RIC status over time. Confusion matrix and area under the curve statistics were used to evaluate model performance. RESULTS More than half of the counties had their RIC rates lower than the national average. The change of county-level RIC rate from 2010 to 2016 was not significant, and spatial heterogeneity in RIC rate was identified. A total of 22 of the 31 county-level predictors were selected by LASSO for predicting county-level RIC status. Counties with lower collective efficacy, larger proportions of men and/or persons with high education were more likely to have their RIC rates lower than the national average. In contrast, numbers of accessible mental health centres were positively related to county-level RIC status. CONCLUSION Spatial variation in RIC could be identified, and county-level factors associated with accessible healthcare facilities and social capital significantly contributed to these variations. Structural and individual interventions targeting these factors are needed to improve the county-level RIC and reduce the spatial variation in HIV care.
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Affiliation(s)
- Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- University of South Carolina Big Data Health Science Center
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- University of South Carolina Big Data Health Science Center
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
| | - Xiaowen Sun
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- University of South Carolina Big Data Health Science Center
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
| | - Zhenlong Li
- University of South Carolina Big Data Health Science Center
- Geoinformation and Big Data Research Lab, Department of Geography, College of Arts and Sciences
| | - Sharon Weissman
- University of South Carolina Big Data Health Science Center
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- University of South Carolina Big Data Health Science Center
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- University of South Carolina Big Data Health Science Center
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30
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Li F, McCormick TJ, Katz AR, Whiticar PM, Wasserman GM. Patient and provider characteristics associated with retention in HIV medical care and viral suppression among in care patients in Hawaii. Int J STD AIDS 2021; 32:919-926. [PMID: 33908838 DOI: 10.1177/09564624211002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The percentages of retention in care and viral suppression among persons living with HIV (PLWH) in the United States from 2015 to 2018 were far below the 2020 national goals. This study aims to examine disparities in retention in care and viral suppression. The study population included PLWH diagnosed through 2016, residing in Hawaii at year-end 2016 and 2017, and who were in care in 2017 defined as having ≥1 CD4/viral load tests in 2017. Care providers were categorized as "very frequent" (≥50 patients), "frequent" (25-49 patients), "occasional" (10-24 patients), and "infrequent" (<10 patients). Among the 1752 patients included, 28.0% were not retained in care in 2017 (i.e., <2 CD4/VL tests performed at least 3 months apart), of whom 89.2% had only a single viral load test. Patients receiving care from the "infrequent" group of providers were less likely to be retained in care (adjusted odds ratio (aOR) = 0.48; 95% CI = 0.33, 0.69) or virally suppressed (aOR = 0.39; 95% CI = 0.24, 0.63), than patients receiving care from the "very frequent" group of providers. Percentages of three-year (2016-2018) in care and viral suppression were lowest among patients receiving care from "infrequent" care providers. Patients <45 years old were less likely to be retained in care (aOR = 0.53; 95% CI = 0.41, 0.68) or be virally suppressed (aOR = 0.59; 95% CI = 0.40, 0.86) than those 45 years or older. Patients of multiple races were less likely to be virally suppressed than whites (aOR = 0.38, 95% CI = 0.23, 0.64). Establishing a long-term relationship with an experienced HIV provider appears beneficial to achieve sustainable viral suppression and provision of uninterrupted HIV medical care.
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Affiliation(s)
- Fenfang Li
- Communicable Disease and Public Health Nursing Division, 11147Hawaii State Department of Health, Honolulu, HI, USA
| | - Timothy J McCormick
- Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, 11147Hawaii State Department of Health, Honolulu, HI, USA
| | - Alan R Katz
- Office of Public Health Studies, Myron B. Thompson School of Social Work, 3939University of Hawaii, Honolulu, HI, USA
| | - Peter M Whiticar
- Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, 11147Hawaii State Department of Health, Honolulu, HI, USA
| | - Glenn M Wasserman
- Communicable Disease and Public Health Nursing Division, 11147Hawaii State Department of Health, Honolulu, HI, USA
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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Kusemererwa S, Akena D, Nakanjako D, Kigozi J, Nanyunja R, Nanfuka M, Kizito B, Okello JM, Sewankambo NK. Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review. PLoS One 2021; 16:e0246471. [PMID: 33539424 PMCID: PMC7861356 DOI: 10.1371/journal.pone.0246471] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2–1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923.
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Affiliation(s)
- Sylvia Kusemererwa
- Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda
- * E-mail: ,
| | - Dickens Akena
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joanita Kigozi
- Department for Outreaches, Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Regina Nanyunja
- Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - Mastula Nanfuka
- Department of TBSpeed, Makerere University Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Bennet Kizito
- Department of Monitoring and Evaluation, The AIDS Support Organization (TASO), Kampala, Uganda
| | - Joseph Mugisha Okello
- Department of HIV Interventions, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine (LSHTM), Uganda Research Unit, Entebbe, Uganda
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Bazargan M, Cobb S, Assari S. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. Ann Fam Med 2021; 19:4-15. [PMID: 33431385 PMCID: PMC7800756 DOI: 10.1370/afm.2632] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults. METHODS We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models. RESULTS Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, P <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, P <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, P <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; P <.001). CONCLUSIONS Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California
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Satre DD, Parthasarathy S, Silverberg MJ, Horberg M, Young-Wolff KC, Williams EC, Volberding P, Campbell CI. Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study. BMC Health Serv Res 2020; 20:1030. [PMID: 33176760 PMCID: PMC7656679 DOI: 10.1186/s12913-020-05856-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/22/2020] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with health care utilization and HIV clinical outcomes among individuals newly enrolled in insurance coverage following implementation of the ACA. METHODS Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N = 880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1-$999 and > = $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts; viral suppression at HIV RNA < 75 copies/mL). RESULTS Health care use was greatest immediately after enrollment and decreased over 3 years. Those with high deductibles were less likely to use primary care (OR = 0.64, 95% CI = 0.49-0.84, p < 0.01) or psychiatry OR = 0.59, 95% CI = 0.37, 0.94, p = 0.03) than those with no deductible. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR] = 0.40, 95% CI = 0.18-0.86; p = 0.02), but ADAP was associated with more psychiatry visits (RR = 2.22, 95% CI = 1.24-4.71; p = 0.01). Those with high deductibles were less likely to have viral suppression (OR = 0.65, 95% CI = 0.42-1.00; p = 0.05), but ADAP enrollment was associated with viral suppression (OR = 2.20, 95% CI = 1.32-3.66, p < 0.01). Black (OR = 0.35, 95% CI = 0.21-0.58, p < 0.01) and Hispanic (OR = 0.50, 95% CI = 0.29-0.85, p = 0.01) PWH were less likely to be virally suppressed. CONCLUSIONS In this sample of PWH newly enrolled in an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization, high deductibles were associated with worse HIV outcomes, but support from ADAP appeared to help patients achieve viral suppression. Race/ethnic disparities remain important to address even among those with access to insurance coverage.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA.
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Kelly C Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Cynthia I Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
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Kamal S, Glass TR, Doco-Lecompte T, Locher S, Bugnon O, Parienti JJ, Cavassini M, Schneider MP. An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort. Open Forum Infect Dis 2020; 7:ofaa323. [PMID: 32913876 PMCID: PMC7473741 DOI: 10.1093/ofid/ofaa323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background This study tested a theory-based adherence-enhancing intervention: the “Interprofessional Medication Adherence Program” (IMAP) to increase human immunodeficiency virus (HIV) retention in care. Methods We retrospectively compared our intervention center (intervention group [IG]) with a standard of care center (control group [CG]) both participating in the Swiss HIV Cohort Study between 2004 and 2012. Endpoints were defined as >6-month and >12-month gaps in care for intervals of care longer than 6 and 12 months without any blood draw. Inverse probability of treatment weights was used to adjust for differences between patients at the 2 centers. Viral failure was defined as ribonucleic acid ≥50 copies/mL after 24+ weeks on antiretrovirals. Results The IG included 451 patients, CG 311. In the IG, 179 (40%) patients took part in the IMAP for a median of 27 months (interquartile range, 12–45). Gaps in care of ≥6 months were significantly more likely to happen in the CG versus IG (74.6% vs 57%, P < .001). The median time until the first treatment gap was longer in the IG vs CG (120 vs 84 weeks, P < .001). Gaps in care of ≥12 months evaluated in 709 (93%) patients were significantly more likely to occur in the CG compared with the IG (22.6% vs 12.5%, P < .001). The rate of viral failure was significantly lower in the IG (8.3% vs 15.1%, P = .003). Conclusions This study, in a real-world setting, shows the effectiveness of the IMAP to reduce 6- and 12-month gaps in follow up among people with HIV. These results should be confirmed by studies in other settings.
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Affiliation(s)
- Susan Kamal
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Tracy R Glass
- Clinical Statistics and Data Management Group, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Thanh Doco-Lecompte
- HIV Unit, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Locher
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland
| | - Olivier Bugnon
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland Geneva, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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