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Van Sluytman LG, Nesbitt JM, Rhodes DJ, Allen-Milton S. No Man Is an Island: Resiliency Among Older African American Men Living with HIV. SOCIAL WORK IN PUBLIC HEALTH 2024:1-15. [PMID: 38934701 DOI: 10.1080/19371918.2024.2371966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
African American men face chronic illness earlier in life and earlier death due to higher severity of illness and poor control of chronic diseases than their white male counterparts. Preexposure and post-exposure prophylaxis PrEP and PREP have improved the odds of survival among those living with HIV. However, the anti-retroviral treatments, though effective, are only as effective as early prevention and detection and in cases where patients can adhere to treatment regimens. The mean age of participants (N = 11) was 56.44 (SD = 5.175, range = 47-63). The current study employs qualitative methodology to propose an ecosystems-driven intersectional model to identify resilience and the influence of personal, social, and societal forces shaping the lives of older African American men living with HIV. Findings determine stigma, community violence, and structural barriers to care as crucial stress areas. Participants discussed self-advocacy and family as constituent elements of resilience. Several implications for practice and research emerged. Practice must design and deploy assessment instruments to include exposure to racism and violence, including emotional and structural violence. Practice must include advocacy at the micro, meso, and macro levels. Assessment must also be self-reflexive. Organizational assessment should involve internal and structural reviews of barriers to meeting client preferences.
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Affiliation(s)
| | - Jade Marie Nesbitt
- School of Social Work, Morgan State University, Baltimore, Maryland, USA
| | - Dasha J Rhodes
- School of Social Work, University of South Florida, Tampa, Florida, USA
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2
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Tobin K, Heidari O, Volpi C, Sodder S, Duncan D. Use of geofencing interventions in population health research: a scoping review. BMJ Open 2023; 13:e069374. [PMID: 37536963 PMCID: PMC10401224 DOI: 10.1136/bmjopen-2022-069374] [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: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES Technological advancements that use global positioning system (GPS), such as geofencing, provide the opportunity to examine place-based context in population health research. This review aimed to systematically identify, assess and synthesise the existing evidence on geofencing intervention design, acceptability, feasibility and/or impact. DESIGN Scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance for reporting. DATA SOURCES PubMed, CINAHL, EMBASE, Web of Science, Cochrane and PsycINFO for articles in English published up to 31 December 2021. ELIGIBILITY CRITERIA Articles were included if geofencing was used as a mechanism for intervention delivery. EXCLUSION CRITERIA (1) a component or combination of GPS, geographical information system or ecological momentary assessment was used without delivery of an intervention; (2) did not include a health or health-related outcome from the geofencing intervention; or (3) was not a peer-reviewed study. DATA EXTRACTION AND SYNTHESIS Several researchers independently reviewed all abstracts and full-text articles for final inclusion. RESULTS A total of 2171 articles were found; after exclusions, nine studies were included in the review. The majority were published in 5 years preceding the search (89%). Geofences in most studies (n=5) were fixed and programmed in the mobile application carried by participants without their input. Mechanisms of geofencing interventions were classified as direct or indirect, with five studies (56%) using direct interventions. There were several different health outcomes (from smoking to problematic alcohol use) across the five studies that used a direct geofencing intervention. CONCLUSIONS This scoping review found geofencing to be an emerging technology that is an acceptable and feasible intervention applied to several different populations and health outcomes. Future studies should specify the rationale for the locations that are geofenced and user input. Moreover, attention to mechanisms of actions will enable scientists to understand not only whether geofencing is an appropriate and effective intervention but why it works to achieve the outcomes observed.
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Affiliation(s)
- Karin Tobin
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Omeid Heidari
- Child, Family and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Connor Volpi
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shereen Sodder
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dustin Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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3
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Weinstein ER, Harkness A, Ironson G, Shrader CH, Duncan DT, Safren SA. Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV. Int J Behav Med 2023; 30:345-355. [PMID: 35499813 PMCID: PMC9626397 DOI: 10.1007/s12529-022-10095-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes-viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. METHODS Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. RESULTS Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = - 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = - 0.40, BSTP [- 0.87, - 0.09]). CONCLUSION This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.
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Affiliation(s)
- Elliott R Weinstein
- Department of Psychology, University of Miami, 1120 NW 14th StreetSuite 787, Miami, FL, 33136, USA.
| | - Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, 1120 NW 14th StreetSuite 787, Miami, FL, 33136, USA
| | - Cho-Hee Shrader
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 1120 NW 14th StreetSuite 787, Miami, FL, 33136, USA
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4
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Houston E, Mindry D, Alvarado E, Kim JJ, Evans J, Tarn DM. Hidden cues for approach and avoidance motivation: implicit cognitive associations among patients with Nonadherence to HIV treatment. AIDS Care 2022; 34:1257-1263. [PMID: 34851780 DOI: 10.1080/09540121.2021.2008296] [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: 01/26/2023]
Abstract
Although patient motivation related to HIV treatment is widely acknowledged as a key factor related to consistent adherence and engagement with medical care, research has predominantly focused on explicit rather than implicit cognitive processes that underlie motivation. This study identified and examined implicit cognitive processes that influence approach and avoidance treatment motivation in a sample of 30 HIV patients with suboptimal adherence and poor engagement with medical care. Study participants were predominantly African American (87%) and gay/bisexual (63%). We examined 173 thought statements about treatment collected from patients during two previous studies. Thematic analysis described how implicit cognitive associations influenced patients to approach or avoid treatment and medical care. Findings revealed three major contextual categories of treatment-related thoughts: links with routines and habits, connections to physical changes and reactions, and interpersonal associations. Within each category, implicit cognitive associations about treatment in terms of these daily life events and experiences cued approach and avoidance motivational tendencies without the patient's awareness. Findings from this study support the need for interventions that use implicit, less effortful approaches aimed at promoting adherence and improving the retention of patients with poor engagement.
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Affiliation(s)
- Eric Houston
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Deborah Mindry
- University of California Global Health Institute, Women's Health, Gender, and Empowerment Center of Expertise, Los Angeles, CA, USA
| | - Eric Alvarado
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Joshua J Kim
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Justine Evans
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Derjung M Tarn
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
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5
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Bleasdale J, Leone LA, Morse GD, Liu Y, Taylor S, Przybyla SM. Socio-Structural Factors and HIV Care Engagement among People Living with HIV during the COVID-19 Pandemic: A Qualitative Study in the United States. Trop Med Infect Dis 2022; 7:259. [PMID: 36288000 PMCID: PMC9607497 DOI: 10.3390/tropicalmed7100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 08/22/2023] Open
Abstract
Achieving HIV prevention goals will require successful engagement in each stage of the HIV continuum. The present study sought to understand the ways in which socio-structural factors influence HIV care engagement among people living with HIV (PLH) within the context of the ongoing COVID-19 pandemic. Twenty-five PLH were recruited from January to October 2021. Semi-structured interviews discussed various socio-contextual factors that influenced engagement in HIV-related care as a result of the pandemic. A thematic content analysis reported semantic level themes describing factors influencing HIV care following an integrated inductive-deductive approach. Qualitative analysis revealed three themes that either supported or hindered engagement in care within the context of the COVID-19 pandemic: (1) social determinants of health, (2) social support, and (3) modes of healthcare delivery. The results underscore the need to assess socio-structural factors of health as means to promote successful engagement in the HIV care continuum and shed new insights to guide future practice in the era of COVID-19.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Shelby Taylor
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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6
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Bondarchuk CP, Mlandu N, Adams T, de Vries E. Predictors of low antiretroviral adherence at an urban South African clinic: A mixed-methods study. South Afr J HIV Med 2022; 23:1343. [PMID: 35284095 PMCID: PMC8905451 DOI: 10.4102/sajhivmed.v23i1.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/01/2021] [Indexed: 11/01/2022] Open
Abstract
Background: Low adherence to antiretroviral treatment (ART) in people living with HIV (PLHIV) remains a critical issue, especially in vulnerable populations. Although ART is responsible for greatly reducing the mortality and morbidity associated with HIV, low treatment adherence continues to impact the effectiveness of ART. Considering that a high level of adherence to ART is required for the excellent clinical outcomes with which ART is often associated, understanding the complex contextual and personal factors that limit high levels of treatment adherence remains paramount. Poor adherence remains an issue in many South African communities many years after the introduction of ART.Objectives: Our study sought to understand the specific factors and the interactions among them that contribute to non-adherence in this patient population in order to devise successful and contextually appropriate interventions to support ART adherence in PLHIV.Methods: This mixed-methods study employed a study-specific questionnaire (N = 103) and semi-structured interviews (N = 8) to investigate the factors linked to non-adherence at the Heideveld Community Day Centre in Cape Town, South Africa.Results: Over half (57.3%) of participants were ART non-adherent. Non-adherence was correlated with younger age, negative self-image and a low belief in the necessity of ART (P 0.05). In patient interviews, alcohol use, treatment fatigue and stigmatisation emerged as contributors to suboptimal adherence.Conclusion: The results suggest that there remains a need for context-sensitive interventions to support PLHIV in South African communities. Future research needs to ensure that these targeted interventions take these factors into consideration.
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Affiliation(s)
- Connor P Bondarchuk
- Department of Medicine, Harvard University, Boston, Massachusetts, United States of America
| | - Nwabisa Mlandu
- Division of Neuropsychology, Faculty of Humanities, University of Cape Town, Cape Town, South Africa
| | - Tasneem Adams
- Cape Town Metro Health Service, Western Cape Department of Health, Cape Town, South Africa
| | - Elma de Vries
- Cape Town Metro Health Service, Western Cape Department of Health, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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7
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Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV. Community Ment Health J 2021; 57:1328-1339. [PMID: 33387180 DOI: 10.1007/s10597-020-00756-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.
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8
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Jones DL, Salazar AS, Rodriguez VJ, Balise RR, Starita CU, Morgan K, Raccamarich PD, Montgomerie E, Nogueira NF, Barreto Ojeda I, Maddalon M, Rodriguez NLY, Brophy T, Martinez T, Alcaide ML. Severe Acute Respiratory Syndrome Coronavirus 2: Vaccine Hesitancy Among Underrepresented Racial and Ethnic Groups With HIV in Miami, Florida. Open Forum Infect Dis 2021; 8:ofab154. [PMID: 34621912 PMCID: PMC8083672 DOI: 10.1093/ofid/ofab154] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) disproportionally affect underrepresented ethnoracial groups in the United States. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake. METHODS We conducted a cross-sectional study of adults ≥18 years of age with HIV residing in Miami, Florida. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April to August 2020 and followed by a coronavirus disease 2019 (COVID-19) vaccine hesitancy survey from August to November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group of Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of the Fisher exact test. RESULTS A total of 94 participants were enrolled; mean age was 54.4 years, 52% were female, 60% were Black non-Latinx, and 40% were non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, P = .009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, P = .029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, P = .002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, P = .049). CONCLUSIONS Medical mistrust, vaccine hesitancy, and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | | | - Raymond R Balise
- Division of Biostatistics, Department of Public Health
Sciences, University of Miami Miller School of Medicine,
Miami, Florida, USA
| | - Claudia Uribe Starita
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Kristiana Morgan
- Division of Biostatistics, Department of Public Health
Sciences, University of Miami Miller School of Medicine,
Miami, Florida, USA
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Patricia D Raccamarich
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Emily Montgomerie
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Irma Barreto Ojeda
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Marissa Maddalon
- University of Miami School of Nursing and Health
Studies, Miami, Florida, USA
| | - Nicolle L Yanes Rodriguez
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Theodora Brophy
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Thais Martinez
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
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9
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Wilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW, Portela M, Srivastava A, Li Y, McCarthy ML. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:1359-1370. [PMID: 33515188 PMCID: PMC8131473 DOI: 10.1007/s11606-020-06447-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA. METHODS We conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases: PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively. RESULTS A total of 3137 unduplicated abstracts were identified from our database searches. A total of 173 were selected for full text review after evaluating the abstract. A total of 29 articles were included for this systematic review. Economic-related SDH factors and MA were mostly commonly examined. The meta-analysis revealed a significant relationship between food insecurity (aOR = 0.56; 95% CI 0.42-0.7), housing instability (aOR = 0.64; 95% CI 0.44-0.93), and social determinants overall (aOR = 0.75; 95% CI 0.65-0.88) and medication adherence. DISCUSSION Food insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.
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Affiliation(s)
- Marcee E Wilder
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.
| | - Paige Kulie
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Caroline Jensen
- Anesthesiology Residency Program, Columbia University, New York, NY, USA
| | - Paul Levett
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC, USA
| | - Janice Blanchard
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Luis W Dominguez
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Maria Portela
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Aneil Srivastava
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Melissa L McCarthy
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.,Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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10
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Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021. [DOI: https://doi.org.10.1097/qai.0000000000002570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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11
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Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021; 86:200-207. [PMID: 33196555 PMCID: PMC7808278 DOI: 10.1097/qai.0000000000002570] [Citation(s) in RCA: 297] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. METHODS Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. RESULTS Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = -5.19 (2.08), P = 0.02]. DISCUSSION To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.
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Affiliation(s)
| | - Bisola O. Ojikutu
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
- Infectious Disease Division, Massachusetts General Hospital, Boston, MA
- Division of Global Health Equity, Harvard Medical School, Boston, MA
| | - Keshav Tyagi
- Community-Based Research, APLA Health & Wellness; and
| | | | - Matt G. Mutchler
- Community-Based Research, APLA Health & Wellness; and
- Department of Health Science, California State University, Dominguez Hills
| | | | | | | | - Sarah Kellman
- Community-Based Research, APLA Health & Wellness; and
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12
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Zhao C, Batio S, Lovett R, Pack AP, Wolf MS, Bailey SC. The Relationship Between COVID-19 Related Stress and Medication Adherence Among High-Risk Adults During the Acceleration Phase of the US Outbreak. Patient Prefer Adherence 2021; 15:1895-1902. [PMID: 34511885 PMCID: PMC8418366 DOI: 10.2147/ppa.s310613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To assess the relationship between stress regarding COVID-19 and medication adherence. PATIENTS AND METHODS Older adults with ≥1 chronic condition(s) were recruited from 4 active, federally funded studies in Chicago to participate in a longitudinal telephone survey. Participants self-reported stress regarding COVID-19 in the last week. Adherence was measured via the ASK-12 survey. RESULTS Most participants reported feeling stressed "some of the time" (54.0%), while 18.2% felt stressed "most" or "all of the time" and 27.8% "never" felt stressed. In bivariate analyses, participants who reported being stressed "most" or "all of the time" had worse medication adherence than participants who reported being stressed "some of the time" or "never" (p < 0.001). In multivariable analyses, participants who reported feeling stressed "most" or "all of the time" had worse adherence than those who "never" felt stressed (Adjusted Least Square Mean (Standard Error): 21.3 (0.6) vs 19.7 (0.6), p=0.01). CONCLUSION Stress due to COVID-19 has significantly impacted medication adherence, which has negative implications for the course of both COVID-19 and comorbid conditions. Healthcare providers should be aware of the potential impact of COVID-19 on patients' mental and physical well-being and consider ways to routinely assess patient experiences.
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Affiliation(s)
- Caroline Zhao
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Stephanie Batio
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rebecca Lovett
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Allison P Pack
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Stacy C Bailey
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
- Correspondence: Stacy C Bailey Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USATel +1 312-503-5595Fax +1 312-503-2777 Email
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13
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Momplaisir FM, Fortune K, Nkwihoreze H, Groves AK, Aaron E, Jemmott JB. Outcome expectancies toward adherence to antiretroviral therapy for pregnant and postpartum women with HIV. WOMEN'S HEALTH 2021; 17:17455065211061094. [PMID: 34812095 PMCID: PMC8640315 DOI: 10.1177/17455065211061094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: Adherence to antiretroviral therapy and retention in care significantly drop for women with HIV during the postpartum period. We have a limited understanding of how outcome expectancies influence maternal adherence and retention in care. Methods: Women with HIV from an urban academic clinic completed in-depth interviews in the third trimester and at 3 to 9 months postpartum to evaluate outcome expectancies, facilitators, and barriers to antiretroviral therapy adherence and retention in care. Interviews were audio-recorded and analyzed for content. A codebook was created using deductive (based on the theory of reasoned action approach) and inductive (based on emergent themes) codes. Results: We conducted 21 interviews with 12 women during pregnancy and 9 women during postpartum period. Participants had a mean age of 31 (standard deviation = 5.7) and most were African American (75%). Outcome expectancies centered mostly around pediatric health to prevent perinatal transmission of HIV and to be healthy to raise their children. Other outcome expectancies included preventing transmission of HIV to their partners. Social support from partners served as a strong facilitator as they helped routinize pill-taking behaviors, provided reminders, and decreased social isolation. Barriers to antiretroviral therapy adherence included depression, the disruption of scheduling routines, and the physical demands associated with the postpartum period. These barriers were accentuated for women with multiple children. Conclusion: Women’s commitment to pediatric health was the primary motive for antiretroviral therapy adherence. Partners also served an important role. These findings suggest that interventions linking pediatric and maternal health, and partner support can improve maternal HIV treatment in the postpartum period.
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Affiliation(s)
- Florence M Momplaisir
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Hervette Nkwihoreze
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Erika Aaron
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - John B Jemmott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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14
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Kalichman SC, Kalichman MO, Banas E, Hill M, Katner H. Drug Use and Life Chaos as Potential Factors Contributing to HIV Viral Load among People with Lower Health Literacy. Subst Use Misuse 2021; 56:606-614. [PMID: 33648415 DOI: 10.1080/10826084.2021.1884722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lower health literacy is associated with poorer health outcomes in people living with HIV (PLWH), but the explanatory mechanisms for these associations are not well understood. Factors such as drug use and life chaos may at least in part account for the relationship between lower health literacy and poor health outcomes. The current study tested the hypothesis that lower health literacy would predict drug use, which in turn would predict life chaos, and that all three factors would be related to poorer heath, defined by higher concentrations of HIV viremia. Methods: Patients receiving HIV care (N = 251) at an HIV clinic in the southeastern United States completed computerized interviews and permission to access their medical records. Process modeling tested direct and indirect effects of all variables in a serial mediation model. Results: The direct effects of lower health literacy and drug use were significantly related to HIV viremia. In addition, the indirect effect of health literacy on HIV viremia through drug use was significant. However, results did not demonstrate any effect, direct or indirect, of life chaos on HIV viremia. Conclusion: Findings from this study bolster previous research demonstrating lower health literacy and drug use as barriers to HIV care, and show that lower health literacy impacts HIV viremia, at least in part, through drug use. Interventions aimed to improve HIV treatment outcomes in lower health literacy populations may be enhanced by integrating evidence-based approaches to reducing drug use.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
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15
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Mitzel LD, Foley JD, Sweeney SM, Park A, Vanable PA. Medication Beliefs, HIV-Related Stigmatization, and Adherence to Antiretroviral Therapy: An Examination of Alternative Models. Behav Med 2021; 47:40-50. [PMID: 31290726 DOI: 10.1080/08964289.2019.1629386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV-related stigma and beliefs about medication necessity and concerns have separately demonstrated significant associations with antiretroviral adherence in people with HIV. However, no work has examined both of these associations in the same model. Based on the necessity-concerns framework, this study examined four alternative models of relationships among HIV-related stigma, medication beliefs, and adherence. Cross-sectional analyses were used to test the four alternative models to best depict associations among HIV-related stigma, medication beliefs, and medication adherence. Models tested included two indirect effects models, an interaction model, and a simple predictors model with no interaction or indirect effects. The outcome variable was HIV medication adherence, and model fit was determined by variance accounted for, Akaike information criterion (AIC), and Bayesian information criterion (BIC) values. An interaction model between internalized stigma and medication concerns accounted for the most variance in adherence. There was also a significant indirect effect of internalized stigma on adherence via medication concerns. Medication concerns are a promising target for interventions focusing on increasing adherence among people with HIV.
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Affiliation(s)
| | | | | | - Aesoon Park
- Department of Psychology, Syracuse University
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16
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Effectiveness of an Intervention for Improving Treatment Adherence, Service Utilization and Viral Load Among HIV-Positive Adult Alcohol Users. AIDS Behav 2020; 24:1495-1504. [PMID: 31637608 DOI: 10.1007/s10461-019-02702-6] [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: 10/25/2022]
Abstract
This study evaluates whether a group intervention that included cognitive remediation improved ART adherence, service utilization, and viral load among HIV-positive adults with a history of alcohol abuse. HIV-seropositive adults (n = 243), recruited from community-based organizations were randomized to the Holistic Health Recovery Program (HHRP-A) or a comparison condition. Both conditions included eight group sessions; outcomes (adherence, service utilization, and viral load) and processes (social support and stress) were measured. Data were collected at baseline, immediately post-intervention, 3 months, and 6 months follow-up. Participants were ≥ 18 and ≤ 60 ([Formula: see text] years old), 71% male, and 79.6% black. Participants randomized to HHRP-A were more likely to report adequate ART adherence and to report an undetectable viral load at 6 months post-intervention. Participants in the HHRP-A condition showed significantly greater improvement in social support than the comparison group. Providing comprehensive health promotion interventions that incorporate cognitive remediation strategies, could improve health outcomes for HIV-positive substance users.
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17
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Takada S, Ettner SL, Harawa NT, Garland WH, Shoptaw SJ, Cunningham WE. Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail. AIDS Behav 2020; 24:491-505. [PMID: 31396766 PMCID: PMC6994355 DOI: 10.1007/s10461-019-02570-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Veterans Affairs Health Services Research and Development Service, Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Nina T Harawa
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Charles R. Drew University, Los Angeles, CA, USA
| | - Wendy H Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA, USA
| | - Steve J Shoptaw
- Department of Family Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - William E Cunningham
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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O’Conor R, Benavente JY, Kwasny MJ, Eldeirawi K, Hasnain-Wynia R, Federman AD, Hebert-Beirne J, Wolf MS. Daily Routine: Associations With Health Status and Urgent Health Care Utilization Among Older Adults. THE GERONTOLOGIST 2019; 59:947-955. [PMID: 30247549 PMCID: PMC6857682 DOI: 10.1093/geront/gny117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronically ill older adults must integrate self-care behaviors into their daily routine to promote health and reduce urgent health care utilization. Individuals of lower socioeconomic position (SEP) experience a disproportionate burden of stressors that challenge the formation of regular routines. We examined associations between the presence of a daily routine and older adults' health status and urgent health care utilization, to determine whether higher levels of daily routine mediates associations between SEP and health outcomes. RESEARCH DESIGN AND METHODS We used data from a cohort of older adult primary care patients in Chicago. Daily routine was measured using a brief, validated scale. A single factor score of SEP was created with measures of education, income, homeownership, and insurance status. Health status was assessed by Patient Reported Outcomes Measurement Information Service physical function, depression, and anxiety. Urgent health care utilization was patient reported. Multivariable models were used to assess the effect of routine and SEP on health status and urgent health care utilization. RESULTS Individuals reporting low levels of daily routine reported worse physical function (β = -2.34; 95% CI -4.18, -0.50), more anxiety (β = 2.73; 95% CI 0.68, 4.78) and depressive symptoms (β = 2.83; 95% CI 0.94, 4.74) than those with greater daily routine. No differences in urgent health care utilization were observed by daily routine. Daily routine varied by SEP (p < .001); routine partially mediated the relationship between SEP and physical function and anxiety symptoms (ps < .05). DISCUSSION AND IMPLICATIONS A daily routine may be an under recognized modifiable factor that could promote health outcomes among older adults.
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Affiliation(s)
- Rachel O’Conor
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | | | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kamal Eldeirawi
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | | | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Jennifer Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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Factors Associated with Perceived Life Chaos among Post-Myocardial Infarction Survivors in a Malaysian Cardiac Care Facility. ACTA ACUST UNITED AC 2018; 54:medicina54050079. [PMID: 30400590 PMCID: PMC6262329 DOI: 10.3390/medicina54050079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 01/20/2023]
Abstract
Background and objectives: Survivors of chronic life-threatening conditions like myocardial infarction (MI) are often confronted with multiple physical and psychological stressors as a consequence of elevated demands of lifestyle adjustments and modifications. Such stressors, collectively known as “life chaos”, cause disruption to one’s lifestyle equilibrium of having organized, calm, and regular routines. The objective of the current study was to determine the level of life chaos and its associated correlates among post-myocardial infarction (post-MI) survivors in Malaysia. Materials and Methods: An analytical cross-sectional study was conducted among 242 post-MI survivors in a Malaysian cardiac health facility from July to September 2016. A self-administered questionnaire in Malay that consisted of items on socio-demographics, health attributes, validated OSLO-3 Social Support Scale (OSS-3), and the Modified Confusion, Hubbub, and Order Scale (CHAOS-6) was utilized in this study. Descriptive, bivariate, and multivariate analyses were conducted. Results: The sample constituted of 208 (86%) men and 34 (14%) women. The average age was 55 years (SD = 11), and the age ranged between 24 and 96 years. Overall, 128 (52.9%) of the total post-MI survivors had highly chaotic lives. In multivariate analysis, younger age, lower household income, perceived financial insecurity, poor health status, and multiple comorbidities were related to the high chaos score, and these associations were statistically significant (p < 0.05). Conclusions: Highly chaotic lifestyles were prevalent in post-MI survivors. Demographic, health attributes, and socio-economic factors were important correlates of life chaos.
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Howell EM, Kigozi NG, Heunis JC. Community-based directly observed treatment for TB patients to improve HIV services: a cross-sectional study in a South African province. BMC Health Serv Res 2018; 18:255. [PMID: 29625569 PMCID: PMC5889613 DOI: 10.1186/s12913-018-3074-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is uncertainty about how directly observed treatment (DOT) support for tuberculosis (TB) can be delivered most effectively and how DOT support can simultaneously be used to strengthen human immunodeficiency virus (HIV) prevention and control among TB patients. This study describes how DOT support by community health workers (CHWs) was used in four municipalities in the Free State province – a high TB/HIV burden, poorly-resourced setting – to provide HIV outreach, referrals, and health education for TB patients. Methods The study was part of a larger cross-sectional study of HIV counselling and testing (HCT) among 1101 randomly-selected TB patients registered at 40 primary health care (PHC) facilities (clinics and community health centres) across small town/rural and large town/urban settings. Univariate analysis of percentages, chi-square tests and t-tests for difference in means were used to describe differences between the types of TB treatment support and patient characteristics, as well as the types of – and patient satisfaction with – HIV information and referrals received from various types of treatment supporters including home-based DOT supporters, clinic-based DOT supporters or support from family/friends/employers. Multivariate logistic regression was used to predict the likelihood of not having receiving home-based DOT and of never having received HIV counselling. The independent variables include poverty-related health and socio-economic risk factors for poor outcomes. Statistical significance is shown using a 95% confidence interval and a 0.05 p-value. Results Despite the fact that DOT support for all TB patients was the goal of South African health policy at the time (2012), most TB patients were not receiving formal DOT support. Only 155 (14.1%) were receiving home-based DOT, while 114 (10.4%) received clinic-based DOT. TB patients receiving home-based DOT reported higher rates of HIV counselling than other patients. Conclusions Public health providers should train DOT supporters to provide HIV prevention and target DOT to those at greatest risk of HIV, particularly those at greatest socio-economic risk.
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Affiliation(s)
- Embry M Howell
- The Urban Institute, Health Policy Center, 2100 M St., N.W, Washington, D.C., 20037, USA
| | - N Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa
| | - J Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
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Filho AWDO, Brites C. Geolocalization of HIV-1 subtypes and resistance mutations of patients failing antiretroviral therapy in Salvador - Brazil. Braz J Infect Dis 2017; 21:234-239. [PMID: 28363087 PMCID: PMC9428007 DOI: 10.1016/j.bjid.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 12/05/2022] Open
Abstract
Background Geographical distribution of HIV variants is an important way to understand the circulation and spread of such viral strains. Objectives To evaluate the spatial distribution of HIV-1 variants in patients failing antiretroviral therapy, in Salvador, Brazil. Methods We performed a cross-sectional evaluation of HIV resistance test reports of patients who underwent genotyping tests in a referral center in Salvador, Brazil, for the years 2008–2014. The laboratory database contains around 2500 resistance reports of patients failing antiretroviral therapy. Genotypic tests were performed by sequencing of HIV-1 POL region (TrueGene, Siemens). We assessed HIV-1 resistance mutations and subtype, as well as residential address, age, and gender of patients. Results We evaluated 1300 reports, 772 (59.4%) of them from male patients. As expected, subtype B predominated (79%) followed by subtypes F1 (6.7%) and BF (6.5%). The most frequent mutations in HIV-1 reverse transcriptase were 184V (79.1%), 41L (33.5%), 67N (30.4%), 103N (42.4%), and 108I (11.1%). Most frequent mutations in HIV-1 protease were 63P (52.4%), 36I (47.9%), 15 V (33.0%), 62 V (28.1%) and 13 V (25.8%). Some mutations (41L, 215Y, 210W) were significantly more frequent among men. We detected a significantly higher accumulation of 103N mutation in specific areas of Salvador. We identified a more restricted circulation pattern for subtype FB (more frequent in some regions), and F1 (almost absent in a specific region). Conclusion Our results suggest that specific subtypes/resistance mutations present a distinct frequency rate in specific areas of Salvador, probably due to a restricted circulation pattern. This trend to clustering was observed in regions covered by AIDS referral centers, suggesting that pattern of care for such patients can interfere in virological outcomes.
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Affiliation(s)
| | - Carlos Brites
- LAPI - Laboratório de Pesquisa em Infectologia, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.
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