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Hascher K, Jaiswal J, LoSchiavo C, Ezell J, Duffalo D, Greene RE, Cox A, Burton WM, Griffin M, John T, Grin B, Halkitis PN. Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care. J Gen Intern Med 2024; 39:2023-2032. [PMID: 38308157 PMCID: PMC11306825 DOI: 10.1007/s11606-024-08635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population's health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings. OBJECTIVE To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs. DESIGN Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018. PARTICIPANTS The study included a sample of 43 young adult SMM (ages 25-27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City. APPROACH Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts. KEY RESULTS Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants' identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers. CONCLUSIONS SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients' preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.
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Affiliation(s)
- Kevin Hascher
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Jerel Ezell
- Department of Community Health Sciences, UC Berkeley, Berkeley, CA, 94720, USA
- Center for Cultural Humility, UC Berkeley, Berkeley, CA, 94720, USA
| | - Danika Duffalo
- School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10001, USA
| | - Amanda Cox
- Culverhouse College of Business, University of Alabama, Tuscaloosa, AL, USA
| | - Wanda M Burton
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, 35401, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Tejossy John
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA
| | - Benjamin Grin
- Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, MO, 64106, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, 07102, USA
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Gutner CA, Hocqueloux L, Jonsson‐Oldenbüttel C, Vandekerckhove L, van Welzen BJ, Slama L, Crusells‐Canales M, Sierra JO, DeMoor R, Scherzer J, Ait‐Khaled M, Bontempo G, Gill M, Patel N, D'Amico R, Hove K, Baugh B, Barnes N, Hadi M, Low EL, Anand SB, Hamilton A, Garges HP, Czarnogorski M. Implementation of long-acting cabotegravir and rilpivirine: primary results from the perspective of staff study participants in the Cabotegravir And Rilpivirine Implementation Study in European Locations. J Int AIDS Soc 2024; 27:e26243. [PMID: 38978405 PMCID: PMC11231444 DOI: 10.1002/jia2.26243] [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: 08/31/2023] [Accepted: 04/03/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Cabotegravir plus rilpivirine (CAB + RPV) is the first complete long-acting (LA) regimen recommended for maintaining HIV-1 virological suppression. Cabotegravir And Rilpivirine Implementation Study in European Locations (CARISEL) is an implementation-effectiveness study examining the implementation of CAB+RPV LA administered every 2 months (Q2M) in European HIV centres. We present staff study participant (SSP) perspectives on the administration of CAB+RPV LA over 12 months. METHODS Eighteen clinics were randomized to one of two implementation support packages: standard arm (Arm-S) or enhanced arm (Arm-E). Arm-S included video injection training and provider/patient toolkits. Additionally, Arm-E included skilled wrap-around team meetings, face-to-face injection training and continuous quality improvement (CQI) calls. SSPs completed surveys on the acceptability, appropriateness and feasibility of CAB+RPV LA as an intervention and its implementation into their clinics, as well as barriers and facilitators to implementation. All surveys were completed at Month (M)1 (baseline), M5 and M12; data collection was completed by February 2022. Qualitative data were obtained from semi-structured interviews at M1, M5 and M12. The primary objective was assessed via formal statistical comparisons between study arms of the Acceptability of Implementation Measure, Implementation Appropriateness Measure and Feasibility of Implementation Measure surveys (1-5 Likert scale ranging from 1 = "completely disagree" to 5 = "completely agree"). Equivalent measures anchored to CAB+RPV LA as a therapy were also assessed. RESULTS Seventy SSPs completed surveys and interviews at M1, 68 at M5 and 62 at M12. Mean acceptability/appropriateness/feasibility scores were ≥3.8 (out of 5) at M12 for implementation- and intervention-based measures. An analysis of covariance showed no significant differences between study arms for these outcomes. Although barriers were noted, most SSPs were not overly concerned that these would impact implementation; concern about these anticipated barriers also decreased over time. At M12, 90.3% (n = 56/62) of SSPs held a positive opinion about CAB+RPV LA implementation. Qualitative interviews and CQI calls highlighted three top practices that supported implementation: implementation planning; education about CAB+RPV LA clinical efficacy; and education around administering injections and managing pain/discomfort after injections. CONCLUSIONS CARISEL demonstrated that CAB+RPV LA dosed Q2M was successfully implemented across a range of European locations, with SSPs finding implementation highly acceptable, appropriate and feasible. CLINICALTRIALS GOV NUMBER NCT04399551.
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Affiliation(s)
| | | | | | | | | | - Laurence Slama
- Department of Infectious DiseasesHôtel‐Dieu Hospital, University Paris CitéParisFrance
- Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS)ParisFrance
| | | | | | | | | | | | | | | | | | | | | | - Bryan Baugh
- Janssen Research & DevelopmentTitusvilleNew JerseyUSA
| | | | | | | | | | - Alison Hamilton
- University of CaliforniaLos AngelesCaliforniaUSA
- Center for the Study of Healthcare InnovationImplementation and PolicyVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
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Belay YA, Yitayal M, Atnafu A, Taye FA. Barriers and Facilitators for Implementing Shared Decision Making in Differentiated Antiretroviral Therapy Service in Northwest Ethiopia: Implications for Policy and Practice. MDM Policy Pract 2024; 9:23814683241281385. [PMID: 39301043 PMCID: PMC11412211 DOI: 10.1177/23814683241281385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/18/2024] [Indexed: 09/22/2024] Open
Abstract
Background. Shared decision making (SDM) for patients enrolling in differentiated antiretroviral therapy (DART) is crucial. Empirical evidence is lacking regarding factors promoting or hindering SDM implementation in DART provision in Ethiopia. Hence, this study aimed to explore the barriers and facilitators to implementing SDM for patients enrolled in DART in Northwest Ethiopia. Methods. A qualitative descriptive study using semi-structured interviews among 17 patients and 15 providers at health facilities providing DART service was conducted. The MAXQDA version 20 software was used for inductive coding. Interviews were analyzed using thematic analysis. Results. Ten themes emerged at 4 levels related to SDM in the provision of DART: patient, provider, organizational, and health system. At the patient level, 1) trust in providers (facilitator) and 2) patient's level of education (barrier) emerged as themes. At the provider level, 3) lack of familiarity with DART models (barrier) and 4) patient-provider relationship (barrier and facilitator) were emerged themes. At the organizational level, 5) workload (barrier) and 6) resources (barrier and facilitator) emerged as themes. At the health system level, 7) availability of DART models (facilitator), 8) not involving providers while initiating DART models (barrier), 9) other providers' involvement (facilitator), and 10) presence of other implementing partners (barrier) emerged as themes. Conclusions. Numerous barriers and facilitators influence the implementation of SDM in the provision of DART. Based on these findings, the following steps are recommended. Providing access to patient decision aids shall be in place to assist patients in making decisions about their preferred DART models. Health care workers shall be trained, and patients shall be given education to enhance the SDM process. Policy makers and program managers shall consider the resource context (training and size of human resources and convenience of rooms) for the delivery of ART service to have an appropriate implementation of SDM in clinical practice. Highlights Shared decision making in DART is influenced by various barriers and facilitators present at the patient, provider, organizational, and health system levels.Patients need education, and health care staff need regular training to improve SDM in DART service provision.Patient access to decision support tools that aid in the selection of the preferred DART model in health facilities is critical.Policy makers and program managers shall consider the availability of adequate and trained human resources as well as provide adequate space and private rooms for SDM in the implementation of DART.
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Affiliation(s)
- Yihalem Abebe Belay
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fitalew Agimass Taye
- Department of Accounting, Finance, and Economics, Griffith University, Brisbane, Australia
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Ishihara M, Hikasa S, Tsukiji M, Kunimoto Y, Nobori K, Kimura T, Onishi K, Yamamoto Y, Haruta K, Kashiwabara Y, Fujii K, Shimabukuro S, Watanabe D, Tsurumi H, Suzuki A. Assessment of satisfaction with antiretroviral drugs and the need for long-acting injectable medicines among people living with HIV in Japan and its associated factors: a prospective multicenter cross-sectional observational study. AIDS Res Ther 2023; 20:62. [PMID: 37641099 PMCID: PMC10463659 DOI: 10.1186/s12981-023-00557-5] [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] [Received: 04/07/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Long-acting injectable formulations for HIV infection have been approved and are now available in Japan. Although not currently recommended as first-line drugs in Japanese or overseas guidelines, use of such formulations may increase, in accordance with patient conditions and preference. We determine the level of satisfaction with current anti-HIV drugs and analyzed the preferences of patients who favor long-acting injectable drugs based on their satisfaction level with the present anti-HIV drugs. METHODS People living with HIV (PLWH) who had received antiretroviral therapy (ART) for at least one month and consented to the study between 1 April and 31 December 2021 were included in a survey conducted using a self-administered questionnaire. The content of the survey included satisfaction with seven items (tablet size, ease and feeling when taking the medicine, color, taste, portability, daily oral therapy, and co-payment) related to the anti-HIV drugs they were taking and their need for future drugs (dosage form, frequency of dosing, long-acting injectable, etc.). In addition, factors related to the need for long-acting injectable medications were analyzed with regard to the relationship with satisfaction with anti-HIV drugs. RESULTS Overall, 667 patients available for analysis were included in this study. Satisfaction with anti-HIV drugs was highest with regard to "co-payment" and lowest with "daily oral therapy". Regarding the need for long-acting injectable medications, logistic regression analysis indicated that tablet size and daily oral therapy were significant predictors of patient preference for a once-every-eight-weeks intramuscular formulation in terms of their requirement for long-acting injectable medications (tablet size, OR = 2.14, 95%CI 1.030-4.430, p = 0.042; and daily oral therapy, OR = 1.75, 95%CI 1.010-3.030, p = 0.044). CONCLUSIONS Patients currently receiving anti-HIV drugs who express dissatisfaction with tablet size and daily oral therapy may prefer a long-acting injectable formulation, taking into consideration patient age, employment status, ART history, frequency of daily dosage and concomitant medications other than ART.
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Affiliation(s)
- Masashi Ishihara
- Department of Pharmacy, Gifu University Hospital, 1-1, Yanagido, Gifu, 501-1194, Japan.
| | - Shinichi Hikasa
- Department of Pharmacy, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Mariko Tsukiji
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba, Japan
| | - Yusuke Kunimoto
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Kazuko Nobori
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Kobe University Hospital, Kobe, Japan
| | - Kenta Onishi
- Division of Pharmacy, Wakayama Medical University Hospital, Wakayama, Wakayama, Japan
| | - Yuki Yamamoto
- Division of Pharmacy, Himeji Medical Center, Himeji, Hyogo, Japan
| | - Kyohei Haruta
- Department of Pharmacy, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Yohei Kashiwabara
- Division of Pharmacy, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Kenji Fujii
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Shota Shimabukuro
- Department of Pharmacy, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Daichi Watanabe
- Department of Pharmacy, Gifu University Hospital, 1-1, Yanagido, Gifu, 501-1194, Japan
| | - Hisashi Tsurumi
- Department of Haematology and Infectious Disease, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1, Yanagido, Gifu, 501-1194, Japan
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Daigakunishi, Gifu, Japan
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Sikombe K, Pry JM, Mody A, Rice B, Bukankala C, Eshun-Wilson I, Mutale J, Simbeza S, Beres LK, Mukamba N, Mukumbwa-Mwenechanya M, Mwamba D, Sharma A, Wringe A, Hargreaves J, Bolton-Moore C, Holmes C, Sikazwe IT, Geng E. Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial. BMJ Open 2023; 13:e069086. [PMID: 37407057 PMCID: PMC10335575 DOI: 10.1136/bmjopen-2022-069086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To compare unannounced standardised patient approach (eg, mystery clients) with typical exit interviews for assessing patient experiences in HIV care (eg, unfriendly providers, long waiting times). We hypothesise standardised patients would report more negative experiences than typical exit interviews affected by social desirability bias. SETTING Cross-sectional surveys in 16 government-operated HIV primary care clinics in Lusaka, Zambia providing antiretroviral therapy (ART). PARTICIPANTS 3526 participants aged ≥18 years receiving ART participated in the exit surveys between August 2019 and November 2021. INTERVENTION Systematic sample (every nth file) of patients in clinic waiting area willing to be trained received pre-visit training and post-visit interviews. Providers were unaware of trained patients. OUTCOME MEASURES We compared patient experience among patients who received brief training prior to their care visit (explaining each patient experience construct in the exit survey, being anonymous, without manipulating behaviour) with those who did not undergo training on the survey prior to their visit. RESULTS Among 3526 participants who participated in exit surveys, 2415 were untrained (56% female, median age 40 (IQR: 32-47)) and 1111 were trained (50% female, median age 37 (IQR: 31-45)). Compared with untrained, trained patients were more likely to report a negative care experience overall (adjusted prevalence ratio (aPR) for aggregate sum score: 1.64 (95% CI: 1.39 to 1.94)), with a greater proportion reporting feeling unwelcome by providers (aPR: 1.71 (95% CI: 1.20 to 2.44)) and witnessing providers behaving rude (aPR: 2.28 (95% CI: 1.63 to 3.19)). CONCLUSION Trained patients were more likely to identify suboptimal care. They may have understood the items solicited better or felt empowered to be more critical. We trained existing patients, unlike studies that use 'standardised patients' drawn from outside the patient population. This low-cost strategy could improve patient-centred service delivery elsewhere. TRIAL REGISTRATION NUMBER Assessment was nested within a parent study; www.pactr.org registered the parent study (PACTR202101847907585).
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Affiliation(s)
- Kombatende Sikombe
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Jake M Pry
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Aaloke Mody
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Brian Rice
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Chama Bukankala
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jacob Mutale
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Njekwa Mukamba
- Social and Behavioural Science Research Group, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Daniel Mwamba
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Social and Behavioural Science Research Group, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - James Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Carolyn Bolton-Moore
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Holmes
- Center for Innovation in Global Health, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Izukanji T Sikazwe
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Antunes A, Racha-Pacheco R, Esteves C, Tavares A, Mendez J, Pacheco P, Short D. PRO-Act: a healthcare provider workshop outlining the added value of implementing PROs in routine HIV practice. J Patient Rep Outcomes 2023; 7:50. [PMID: 37261556 DOI: 10.1186/s41687-023-00584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Patient Reported Outcomes (PROs) are an evidenced way of adding value to routine clinical care. As a source of unique information on the effect of a medical condition and its treatment from the patients' perspective (Mercieca-Bebber et al. in Patient Relat Outcome Meas 9: 353-367, https://doi.org/10.2147/PROM.S156279 , 2018), PROs allow for an improved assessment in routine clinical care of symptoms, side effects, functional outcomes (physical, sexual, social, emotional, cognitive functioning), and health-related quality of life (HRQoL). By helping to align healthcare providers' interventions with what matters most to the patient, PROs contribute to the individualized choice of Anti-Retroviral Therapy (Carfora et al. in PLoS ONE 17(4): e0267030, https://doi.org/10.1371/journal.pone.0267030 , 2022) as a paramount component of tailored and person-centred care management, in routine clinical practice. This article outlines a practical framework and process tested in Portugal to raise awareness of PROs' added value, and to help guide first steps in the implementation and seamless integration of PROs, in routine HIV care.
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Affiliation(s)
- António Antunes
- ViiV Healthcare Medical Department, Rua Dr. António Loureiro Borges, nº 3 - Arquiparque - Miraflores, 1495-131, Algés, Portugal
| | | | - Catarina Esteves
- Infectious Diseases Ward, Hospital de Cascais, Av. Brigadeiro Victor Novais Gonçalves, 2755-009, Alcabideche, Portugal
| | - Ana Tavares
- ViiV Healthcare Medical Department, Rua Dr. António Loureiro Borges, nº 3 - Arquiparque - Miraflores, 1495-131, Algés, Portugal
| | - Josefina Mendez
- Hospital Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | | | - Duncan Short
- ViiV Healthcare Implementation Science Department, 980 Great West Road, Brentford Middlesex, TW8 9GS, UK
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Yu F, Hsiao YH, Park S, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. The Influence of Anticipated HIV Stigma on Health-related Behaviors, Self-rated Health, and Treatment Preferences Among People Living with HIV in East Asia. AIDS Behav 2023; 27:1287-1303. [PMID: 36348191 PMCID: PMC10036452 DOI: 10.1007/s10461-022-03865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Long-acting injectable regimens for HIV treatment have been developed which are less frequent, more discreet, and more desirable for some people living with HIV (PLHIV) and may help reduce stigma-related barriers to HIV treatment. However, there is little information on the relationship between reported stigma and preference for these newer treatments. We characterized anticipated, experienced, and internalized HIV stigma and examined the associations with treatment preferences among an international sample of PLHIV. Data came from the international, web-based, cross-sectional study called "Positive Perspectives" conducted among PLHIV aged ≥ 18 years in 25 geographic locations during 2019 (n = 2389). Descriptive analyses were stratified among East Asian (n = 230) vs. non-Asian (n = 2159) participants. Results showed that prevalence of anticipated stigma was significantly higher among East Asian than non-Asian participants (72.2%[166/230] vs. 63.8%[1377/2159], p = 0.011). A significantly higher percentage of East Asian (68.7%[158/230]) than non-Asian participants (43.3%[935/2159] indicated that someone finding their HIV pills would cause them much "stress or anxiety" (p < 0.001). Actions taken by some PLHIV to prevent unwanted disclosure included restricting who they shared their HIV status with, hiding their HIV pills, or even skipping a dose altogether because of privacy concerns. Overall, 50.0%[115/230] East Asian participants believed HIV would reduce their lifespan and 43.0%[99/230] no longer planned for their old age because of HIV. Anticipated stigma was strongly associated with receptivity to non-daily regimens. Concerted efforts to reduce stigma and deliver flexible treatment options that address the unmet treatment needs of PLHIV, including confidentiality concerns, may improve their health-related quality of life.
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Affiliation(s)
- Fei Yu
- Danlan Beijing Media Limited, Beijing, China
| | | | | | - Keita Kambara
- Japanese Network of People living with HIV/AIDS, Tokyo, Japan
| | - Brent Allan
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
- International Council of AIDS Service Organizations (ICASO), Toronto, Canada
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Fernandez SB, Ward MK, Ramírez-Ortiz D, Flores A, Santander TG, Dawit R, Ibarra C, Garcia A, Ladner R, Brock P, Jean-Gilles M, Ibañez G, Dévieux J, Beach MC, Trepka MJ. Clients' Perspectives on Patient-Centeredness: a Qualitative Study with Low-Income Minority Women Receiving HIV Care in South Florida. J Racial Ethn Health Disparities 2023; 10:930-941. [PMID: 35426056 PMCID: PMC9562593 DOI: 10.1007/s40615-022-01281-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
Low-income, minority women living with HIV often experience multiple barriers in care that contribute to suboptimal care outcomes. Medical case managers (MCM) and medical providers are key players involved in care coordination and aid women along the HIV care continuum. The objective of this study was to identify current and potential patient-centered practices that facilitate adherence to medication and retention in care, from the perspective of racially and ethnically diverse women living with HIV. We implemented a qualitative study using semi-structured interviews with 75 African American, Hispanic/Latina, and Haitian women who were enrolled in the Ryan White HIV/AIDS Program in South Florida in 2019. We organized domains of exploration using a patient-centered care framework to identify practices in which providers acknowledged, respected, and responded to clients' preferences, needs, and values. Interviews were analyzed using consensual thematic analysis approach. Findings reflect women valued MCMs who were proactive and directive in care, provided motivation, and aided with navigation of shame, fear, and stigma. Women valued medical providers who upheld simple educational communication. Moreover, women reported that providers who reviewed medical results with clients, incorporated questions about families, and inquired about multiple physical and clinical needs beyond HIV created opportunities for women to feel respected, valued, and in turn, enhanced their involvement in their care. Findings identify specific interpersonal practices that can enhance the ability to better meet the needs of diverse groups of women, specifically those from racial/ethnic minority groups who face multiple sociocultural barriers while in care.
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Affiliation(s)
- Sofia B Fernandez
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA.
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA.
| | - Melissa K Ward
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Daisy Ramírez-Ortiz
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Annette Flores
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Taidiana Gonzalez Santander
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Rahel Dawit
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Ashley Garcia
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Robert Ladner
- Behavioral Science Research Corp, 2121 Ponce de Leon Boulevard, Suite 240, Coral Gables, FL, 33134, USA
| | - Petra Brock
- Deft Research, 333 South 7th St, Suite 1370, Minneapolis, MN, 55402, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Gladys Ibañez
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Jessy Dévieux
- Department of Health Promotion and Disease Prevention, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, 2024 East Monument Street, Room 2-511, Baltimore, MD, 21287, USA
| | - Mary Jo Trepka
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
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9
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Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care. Lancet HIV 2023; 10:e126-e133. [PMID: 36427522 PMCID: PMC7614396 DOI: 10.1016/s2352-3018(22)00295-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
With more than 38 million people living with HIV worldwide, the scale-up of antiretroviral therapy ensures nearly 28 million of them receive regular treatment. However, a substantial number of deaths still occur every year from AIDS-related complications, with approximately 680 000 deaths in 2021. Of the estimated 56·8 million people globally in need of palliative care in 2020, only 7 million can access services. Providing palliative care services can help alleviate health-related suffering, such as pain and disease-related symptoms, and improve wellbeing. This Viewpoint discusses the unrealised potential of palliative care in individuals with advanced HIV disease. Key areas of training for health-care workers include appropriate sensitisation, training in palliative care, and effective communication. Advance care planning supports both the individual and their family and is therefore of crucial importance. Integration of palliative care in HIV programmes is needed to address health-related suffering, particularly for advanced HIV disease.
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10
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O’Shea JG, Fanfair RN, Dasgupta S, Tie Y, Yuan X, Beer L, Weiser J. Cisgender women with HIV in the United States: how have HIV care continuum outcomes changed over time? 2015-2020. AIDS 2023; 37:347-353. [PMID: 36541646 PMCID: PMC10928949 DOI: 10.1097/qad.0000000000003431] [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: 12/24/2022]
Abstract
OBJECTIVE To evaluate HIV care continuum trends over time among women with HIV (WWH). DESIGN The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States. METHODS We used 2015-2019 MMP data collected from 5139 adults with diagnosed HIV infection who identified as cisgender women. We calculated weighted percentages with 95% confidence intervals (CIs) for all characteristics and estimated annual percentage change (EAPC) and the associated 95% CI to assess trends. EAPCs were considered meaningful from a public health perspective if at least 1% with P values less than 0.05. RESULTS Among cisgender women with diagnosed HIV infection during 2015-2019, 58.8% were Black or African American (95% CI 54.4-63.3), 19% were Hispanic/Latina (95% CI 14.7-23.2), and 16% were Non-Hispanic White (95% CI 14.1-17.9) persons. There was a meaningful increase in the percentage who ever had stage 3 HIV disease from 55.8% (95% CI 51.0-60.5) in 2015 to 61.5% (95% CI 58.1-64.8) in 2019 (EAPC 1.7%; CI 1.5-1.9; P < 0.001). There were no meaningful changes over time among women, overall, in retention in care, antiretroviral therapy (ART) prescription, ART adherence, missed appointments, or recent or sustained viral suppression. CONCLUSION The HIV care continuum outcomes among WWH did not meaningfully improve from 2015 to 2019, raising a concern that Ending the HIV Epidemic in the US (EHE) initiative goals will not be met. To improve health and reduce transmission of HIV among WWH, multifaceted interventions to retain women in care, increase ART adherence, and address social determinants of health are urgently needed.
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Affiliation(s)
- Jesse Garrett O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robyn Neblett Fanfair
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Carcone AI, Coyle K, Butame S, Harper GW, Aarons GA, Naar S. Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence-based practices into adolescent HIV settings. AIDS Behav 2022; 26:4093-4106. [PMID: 36066763 PMCID: PMC9643628 DOI: 10.1007/s10461-022-03735-0] [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] [Accepted: 05/26/2022] [Indexed: 11/01/2022]
Abstract
Despite advances in evidence-based practices (EBP) to support HIV prevention and treatment, youth ages 13-24 experience significant disparities in HIV risk and outcomes. An important factor in this disparity is poor EBP implementation, yet implementation research is limited, particularly in youth-serving settings. This study used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide the implementation of four Motivational Interviewing (MI) and MI-framed interventions into youth-serving HIV prevention and treatment settings. Key stakeholders (n = 153) across 13 sites completed pre-implementation interviews. Stakeholders' comments identified two critical factors for effective implementation: fit with the patient population and provider receptivity, including concerns about scope of practice, buy-in, and time. Stakeholders recommended strategies for structuring training, fidelity monitoring, and facilitating implementation including engaging informal leaders, collaboratively developing the implementation strategy, and site-wide implementation. Results highlight the importance of pre-implementation contextual assessment and strategic planning for identifying provider concerns and developing responsive implementation strategies.
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Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, United States
| | - Karin Coyle
- Education, Training, and Research (ETR), Scotts Valley, California, United States
| | - Seyram Butame
- Center for Translational Behavioral Science, Florida State University, Tallahassee, Florida, United States
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, United States
| | - Gregory A Aarons
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, La Jolla, California, United States
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, Florida, United States
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12
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van Dyk R, Lammertink B, Appiah A, Plieger H, de los Rios P, Okoli C. Preference for non-daily ART is associated with perceived
extent of ART-related emotional, psychosocial, physical, and
adherence challenges among people living with HIV in the
Netherlands and other European countries. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/156768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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13
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Hunt JA, Randell KA, Mermelstein S, Miller MK, Masonbrink AR. Understanding the Sexual and Reproductive Health Needs of Hospitalized Adolescent Males. Hosp Pediatr 2022; 12:e387-e392. [PMID: 36300339 PMCID: PMC9647630 DOI: 10.1542/hpeds.2021-006489] [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] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males. METHODS We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included reported healthcare utilization, sexual health behaviors (eg, sexual activity), contraception use, and acceptability of SRH discussions during a hospitalization. RESULTS Among 145 participants, 42% reported a history of vaginal sex, 27% current sexual activity, 12% early sexual debut, and 22% 4 or more prior sexual partners. At last sex, condom use was reported by 63% and use of reversible contraception by 36%. Nearly half (45%) agreed that hospital-based SRH discussions were acceptable, particularly among those with history of sexual activity (P < .01). Some (12%) reported they had not accessed care in the past year when they felt they should. CONCLUSIONS Hospitalized males in our study had similar rates of sexual activity as compared with the general population but had higher rates of early sexual debut and number of prior partners, which are independently linked with negative sexual health outcomes (eg, sexually transmitted infections). Our participants found SRH discussions to be generally acceptable. These findings reveal opportunities to screen for unmet SRH needs and provide SRH education and services for adolescent males in the hospital.
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Affiliation(s)
- Jane Alyce Hunt
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Kimberly A Randell
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Sarah Mermelstein
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Melissa K Miller
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Abbey R Masonbrink
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
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14
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Kuznetsov S, Eremin A, Zaytseva E, Young B, Basova A, Paice A, Marin O, de Los Rios P, Okoli C. Treatment challenges and health conditions among people living with HIV with or without substance use disorder in the Russian Federation. AIDS Care 2022; 34:1276-1281. [PMID: 34369217 DOI: 10.1080/09540121.2021.1960945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We quantified treatment challenges faced by people living with HIV (PLHIV) in Russia. Cross-sectional data of 150 PLHIV in Russia were from the 2019 Positive Perspectives Survey. Mean age was 38.3 y. Two-thirds (68.0%[102/150]) had ever disguised their HIV pills, and 43.3%[65/150] said they would be stressed if someone saw their HIV pills. Overall, 14.7%[22/150] reported being ever diagnosed with substance use disorder (SUD). Self-rated optimal health was significantly lower among those with vs without a report of SUD on multiple health domains: sexual (40.9%[9/22] vs. 70.3%[90/128], p = 0.007), physical (22.7%[5/22] vs. 68.0%[87/128], p < 0.001), and overall health (27.3%[6/22] vs. 68.8%[88/128], p < 0.001). Those reporting SUD were more likely to miss HIV medication ≥ 1 time in the past month because they used recreational drugs (age and gender-adjusted prevalence ratio [APR] = 8.23, 95%CI = 6.99-9.68), could not afford their medication (APR = 3.28, 95%CI = 2.90-3.72), had to work (APR = 3.27, 95%CI = 2.97-3.60), or to avoid side effects (APR = 2.62, 95%CI = 2.37-2.89). Furthermore, self-reported SUD was strongly associated with numerous poor health conditions, including self-reported diagnosis of cancer (APR = 6.67, 95%CI = 5.24-8.48), mental illness (APR = 5.01, 95%CI = 4.53-5.55), and liver disease (APR = 4.29, 95%CI = 3.98-4.61). The distinct patterns of poorer health-related outcomes among PLHIV with SUD underscore the need to address behavioral and psychosocial challenges as part of holistic HIV care.
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15
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Okoli C, Finkielsztejn L, Appiah A, Pugliese P, Fructuoso C, de los Rios P. Comorbidities, comedications and polypharmacy among people living with HIV and associated challenges with HIV antiretroviral therapy: Findings from people living with HIV in four countries in Western Europe. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/151521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Tan JY, Greene M, Blat C, Albers A, Grochowski J, Oskarsson J, Shiels M, Hsue P, Havlir D, Gandhi M, Myers J. Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study. AIDS Behav 2022; 26:1562-1571. [PMID: 34705153 PMCID: PMC8548856 DOI: 10.1007/s10461-021-03509-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 02/01/2023]
Abstract
The combined burden of geriatric conditions, comorbidities, and HIV requires a model of HIV care that offers a comprehensive clinical approach with people 50 years or older with HIV. Golden Compass is an outpatient, multidisciplinary HIV-geriatrics program with an onsite HIV geriatrician, cardiologist, pharmacist, and social worker, offering specialist referrals, care navigation, and classes on improving functional status and cognition. Participants (13 patients and 11 primary care providers) were recruited using a non-probability sampling method to participate in semi-structured interviews on the perceived impact of Golden Compass on care delivered to older people with HIV. Interviews were transcribed verbatim and framework analysis used to analyze the transcripts. The perceived impacts of Golden Compass by patients and providers were organized by the Compass points (Northern: Heart and Mind, Eastern: Bones and Strength, Southern: Navigation and Network, Western: Dental, Hearing, and Vision). Overall, patients valued the focus on functional health and whole-person care, leading to greater trust in the ability of providers. Providers gained new skills through the geriatrics, cardiology and/or pharmacist consultations. The HIV-geriatrics specialty approach of Golden Compass improved functional ability and quality of life for older adults with HIV. Few integrated care programs for older people with HIV have been evaluated. This study adds to the limited literature demonstrating high patient and provider satisfaction with a HIV-care model that incorporated principles of geriatric medicine emphasizing a comprehensive approach to sustaining functional ability and improving quality of life.
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Affiliation(s)
- Judy Y. Tan
- Division of Prevention Science, Department of Medicine, University of California San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143 USA
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Cinthia Blat
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA USA
| | - Autumn Albers
- Facente Consulting, 5601 VAN FLEET AVE, 94804 Richmond, CA USA
| | - Janet Grochowski
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Jon Oskarsson
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Mary Shiels
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Priscilla Hsue
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA USA
| | - Janet Myers
- Division of Prevention Science, Department of Medicine, University of California San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143 USA
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17
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Budhwani H, Gakumo CA, Yigit I, Rice WS, Fletcher FE, Whitfield S, Ross S, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Sosanya O, Goparaju L, Gange S, Kempf MC, Turan B, Turan JM. Patient Health Literacy and Communication with Providers Among Women Living with HIV: A Mixed Methods Study. AIDS Behav 2022; 26:1422-1430. [PMID: 34642834 PMCID: PMC9001740 DOI: 10.1007/s10461-021-03496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA.
| | - C Ann Gakumo
- University of Massachusetts Boston (UMB), Boston, MA, 02125, USA
| | | | | | | | | | - Shericia Ross
- University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | | | - Mardge H Cohen
- Stroger Hospital of Cook County, Chicago, IL, 60612, USA
| | | | | | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Tonya N Taylor
- State University of New York, Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Tracey E Wilson
- State University of New York, Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Sheri D Weiser
- University of California, San Francisco, San Francisco, CA, 94143, USA
| | | | | | | | | | | | - Janet M Turan
- University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
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18
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Koga I, Wakatabe R, Okamoto N, Sasai A, Kambara K, Maldonado A, de Los Rios P, Okoli C. Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics. AIDS Behav 2022; 26:1633-1651. [PMID: 34870772 PMCID: PMC8647062 DOI: 10.1007/s10461-021-03515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
We examined satisfaction and perceived challenges with antiretroviral therapy (ART) among people living with HIV (PLHIV) in Japan vs three other Asian countries (China, Taiwan, South Korea), and 21 non-Asian countries, using data from the 2019 Positive Perspectives Study (pooled sample size from all 25 countries = 2389). Participants in other Asian countries were more likely than those in Japan to report they missed ART ≥ 1 time in the past month because they were depressed/overwhelmed (57.4%[89/155] vs 32.0%[24/75]), had privacy concerns (56.8%[88/155] vs 30.7%[23/75]), were concerned about the potential long-term negative impacts of ART (46.5%[72/155] vs 26.7%[20/75]), or just wanted to forget about HIV (45.8%[71/155] vs 22.7%[17/75]). ART satisfaction however did not differ significantly between surveyed PLHIV in Japan (54.7%[41/75]) vs those in other Asian countries (47.7%[74/155]). The percentage who felt that daily ART dosing limited their lives was 36.0%[27/75] among participants from Japan, 48.4%[75/155] among participants from other Asian countries, and 27.3%[589/2159] among those from non-Asian countries. Within a structural equation model using pooled data from all 25 countries, positive correlations were seen between ART satisfaction and "provider engagement" (β = 0.35), high perceived control over ART dosing schedule (β = 0.28), and the belief that ART prevents HIV transmission (β = 0.16). Conversely, negative correlations were seen between ART satisfaction and experience of ART side-effects (β = - 0.24), high "ART anxiety" (β = - 0.20); and being on multi-tablet regimens (β = - 0.13). Those ART-satisfied reported higher self-rated health and greater ART adherence. These findings underscore the need for patient-centered care to enhance treatment satisfaction and improve ART adherence.
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Affiliation(s)
| | | | | | | | - Keita Kambara
- Japanese Network of People Living With HIV/AIDS (JANP Plus), Tokyo, Japan
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19
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Park S, Hsiao YH, Yu F, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. Drug-drug interactions with antiretroviral therapy among people living with HIV in Asia and other regions: risk factors and impact on indicators of health-related quality of life. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/149454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Waryold JM, Shihabuddin C, Masciola R. Barriers to Culturally Competent Human Immunodeficiency Virus Care Among the Black, Indigenous, and People of Color Community. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Cao W, You X, Li J, Peng L, Gu J, Hao C, Hou F, Wei D, Deng Y, Hao Y, Mo PKH. Same-sex behavior disclosure to health care providers associated with greater awareness of pre-exposure prophylaxis. BMC Public Health 2021; 21:2243. [PMID: 34893061 PMCID: PMC8665488 DOI: 10.1186/s12889-021-12317-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aimed to determine whether the disclosure of same-sex behavior to health care providers (HCPs) is associated with higher rates of prior human immunodeficiency virus (HIV) testing experience and greater awareness of immediate antiretroviral therapy (ART), Undetectable = Untransmittable (U=U), and pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM). METHODS We conducted a cross-sectional survey among 689 adult males in Chengdu, China who self-reported having had anal intercourse with at least one man in the past 6 months. We measured same-sex behavior disclosure to three types of HCPs (hospital clinicians, community-based organization peer educators, and Center for Disease Control and Prevention public health specialists), and the awareness of immediate ART, U=U, and PrEP. RESULTS Of the 689 enrolled participants, 31.4% had disclosed their same-sex behavior to some or all of the clinicians, 83.9% had done so to the peer educators, and 56.8% had done so to the public health specialists. Approximately four in five (82.1%) of the participants had ever been tested for HIV. The awareness rate was 84.8% for immediate ART, 20.2% for U=U, and 50.7% for PrEP. After controlling for significant background variables, same-sex behavior disclosure to clinicians was associated with greater awareness of PrEP (adjusted odds ratio [AOR] = 1.64; 95% confidence interval [CI]: 1.08-2.48), but similar findings were not reported regarding disclosure to peer educators or public health specialist. Same-sex behavior disclosure to any types of HCPs was not associated with HIV testing experience, and awareness of immediate ART or U=U. CONCLUSIONS The rates of same-sex behavior disclosure varied with different types of HCPs. Disclosure to clinicians was associated with greater awareness of PrEP, but not awareness of immediate ART or U=U.
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Affiliation(s)
- Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinyi You
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Liping Peng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Fengsu Hou
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.,Department of Public Mental Health, Kangning Hospital, Shenzhen, Guangdong, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yang Deng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Phoenix Kit-Han Mo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Shatin, Hong Kong.
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22
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Allan B, Drummond F, Maccarrone A, Young B, Okoli C. Quantifying unmet treatment needs among people living with HIV in Australia and other countries. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/143160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fuster-RuizdeApodaca MJ, Safreed-Harmon K, Pastor de la Cal M, Laguia A, Naniche D, Lazarus JV. Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain. Front Psychol 2021; 12:681058. [PMID: 34177734 PMCID: PMC8219862 DOI: 10.3389/fpsyg.2021.681058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). We developed a clinic screening tool (CST-HIV) for the purpose of identifying these issues in routine specialist clinical care in Spain. METHODS We used the following established instrument development procedures: (1) a literature review; (2) four focus group discussions (FGDs), two that convened 16 expert HIV care providers, and two that convened 15 PLHIV; (3) prioritisation, selection and definition of constructs (health-related issues) to include in the CST-HIV and drafting of initial item pool; and (4) a pilot study to analyse psychometric properties and validity of items and to determine which to retain in the final CST-HIV. The FGD interview scripts incorporated an exercise to prioritise the health-related issues perceived to have the greatest negative effect on HRQoL. The online questionnaire used for the pilot study included the pool of CST-HIV items and validated measures of each construct. RESULTS We identified 68 articles that reported on factors associated with the HRQoL of PLHIV. The most burdensome health-related issues identified in the FGDs related to stigma, socioeconomic vulnerability, sleep/fatigue, pain, body changes, emotional distress, and sexuality. Based on the literature review and FGD findings, we selected and defined the following constructs to include in the initial CST-HIV: anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Two researchers wrote six to eight items for each construct. Next, 18 experts rated 47 items based on their clarity, relevance, and representativeness. Pilot testing was carried out with 226 PLHIV in Spain. We retained 24 items based on empirical criteria that showed adequate psychometric properties. Confirmatory factor analysis confirmed the eight-factor structure with a good fit to the data (RMSEA = 0.035, AGFI = 0.97, CFI = 0.99). We found strong positive correlations between the instrument's eight dimensions and validated measures of the same constructs. Likewise, we found negative associations between the dimensions of the CST-HIV and HRQoL. CONCLUSION The CST-HIV is a promising tool for use in routine clinical care to efficiently identify and address health-related issues undermining the HRQoL of PLHIV.
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Affiliation(s)
- Maria José Fuster-RuizdeApodaca
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marta Pastor de la Cal
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
- Bizkaisida, Bilbao, Spain
| | - Ana Laguia
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study. AIDS Behav 2021; 25:961-972. [PMID: 33026574 PMCID: PMC7936969 DOI: 10.1007/s10461-020-03055-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
To assess challenges with daily oral antiretroviral therapy (ART), we analyzed data for 2389 participants in the 2019 Positive Perspectives survey of people living with HIV in 25 countries. ART-related challenges reported included difficulty swallowing pills (33.1% [790/2389]); stress from daily dosing routine (33.3% [795/2389]); bad memories from daily intake of HIV medication (35.1%[839/2389]), and concern “that having to take pills every day means a greater chance of revealing my HIV status to others” (37.9% [906/2389]). Individuals who felt empowered by daily oral dosing [“taking my pill(s) every day reassures me that my HIV is being kept under control”] had 69% higher odds of optimal overall health (AOR 1.69, 95% CI 1.40–2.04). Conversely, odds of optimal overall health were lower among those who felt daily pill intake “limits my day-to-day life” (AOR 0.53, 95% CI 0.44–0.64). These findings show that there is need for increased flexibility of ART delivery to meet diverse patient needs.
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Okoli C, Van de Velde N, Brough G, Hardy WD, Corbelli G, Allan B, Muchenje M, Castellanos E, Young B, Eremin A, Ramothwala P, de los Rios P. Differences in HIV treatment experiences, perceptions, and behaviors by gender and sexual orientation in 25 middle-income and high-income countries: Findings from the 2019 Positive Perspectives Survey. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/128600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ahmad A, Neelamegam M, Rajasuriar R. Ageing with HIV: health implications and evolving care needs. J Int AIDS Soc 2020; 23:e25621. [PMID: 32996718 PMCID: PMC7526224 DOI: 10.1002/jia2.25621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ahsan Ahmad
- Department of MedicineSection of Infectious DiseasesAIDS ProgramYale School of MedicineNew HavenConnecticutUSA
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
| | - Malinee Neelamegam
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Department of Epidemiology of Microbial DiseasesYale School of Public HealthNew HavenConnecticutUSA
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
- Faculty of MedicineDepartment of MedicineUniversity of MalayaKuala LumpurMalaysia
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