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Marquine MJ, Kamalyan L, Zlatar ZZ, Yassai-Gonzalez D, Perez-Tejada A, Umlauf A, Al-Rousan T, González V, Breton J, Guareña LA, Brody L, Cherner M, Ellis RJ, Zúñiga ML, Mungas DM, Moore RC, Moore DJ, Wojna V, Hall RK, Franklin DR, Heaton RK. Disparities in Metabolic Syndrome and Neurocognitive Function Among Older Hispanics/Latinos with Human Immunodeficiency Virus. AIDS Patient Care STDS 2024; 38:195-205. [PMID: 38662469 DOI: 10.1089/apc.2024.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M = 57.9, standard deviation (SD) = 5.7; education (years): M = 13, SD = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d = 0.56, p < 0.05) and had higher rates of MetS (38% vs. 56%, p < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition (B = -3.82, SE = 1.27, p < 0.01). A model also including MetS showed that both Hispanic ethnicity (B = -3.39, SE = 1.31, p = 0.01) and MetS (B = -2.73, SE = 1.31, p = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.
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Affiliation(s)
- María J Marquine
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Zvinka Z Zlatar
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - David Yassai-Gonzalez
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Alán Perez-Tejada
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Verónica González
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Jordana Breton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Lesley A Guareña
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Lilla Brody
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Maria Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Dan M Mungas
- Department of Neurology, University of California Davis, Davis, California, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Valerie Wojna
- Neurology Division, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Donald R Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
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2
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Breton J, Watson CWM, Kamalyan L, Franklin D, Fazeli P, Umlauf A, Moore RC, Ellis R, Grant I, Heaton RK, Cherner M, Moore DJ, Marquine MJ. Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV. Clin Neuropsychol 2024:1-20. [PMID: 38588669 DOI: 10.1080/13854046.2024.2319900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024]
Abstract
Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.
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Affiliation(s)
- Jordana Breton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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3
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D'Costa ZU, Neibart SS, Jones LE, Shah MK, Page K, Jacob S. Delayed Diagnosis of Human Immunodeficiency Virus in the Latino Population at a Federally Qualified Community Health Center in New Jersey. J Immigr Minor Health 2024; 26:294-303. [PMID: 38147283 DOI: 10.1007/s10903-023-01544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 12/27/2023]
Abstract
Late diagnosis of human immunodeficiency virus (HIV) is associated with early progression to acquired immunodeficiency syndrome (AIDS). We examined racial/ethnic differences in presentation with advanced HIV/AIDS at a community health center in New Jersey. Records of patients diagnosed with HIV between 1990 and 2018 were reviewed. Odds ratios (OR) of presenting with AIDS at HIV diagnosis were computed in unadjusted and adjusted models. There were 182 (48.3%) Latino, 48 (12.7%) non-Latino White (NLW), 130 (34.5%) non-Latino Black, and 17 (4.5%) non-Latino of other race/ethnicity included in the analysis. Over 75% of the Latinos were foreign-born. Latino patients had higher odds of presentation with AIDS at time of HIV diagnosis than NLW in unadjusted (OR = 4.85, 95% confidence interval (95% CI): 2.28-10.31) and adjusted models (OR = 3.71, 95%CI: 1.60-8.59). Latino patients, particularly foreign-born and bisexual, had higher odds of being diagnosed with AIDS at presentation with HIV in this cohort.
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Affiliation(s)
- Zoee U D'Costa
- Robert Wood Johnson Medical School, Rutgers University, 277 George St, Piscataway, NJ, 08901, USA
| | - Shane S Neibart
- Robert Wood Johnson Medical School, Rutgers University, 277 George St, Piscataway, NJ, 08901, USA
| | - Laura E Jones
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Mansi K Shah
- School of Arts and Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Kathleen Page
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sneha Jacob
- Robert Wood Johnson Medical School, Rutgers University, 277 George St, Piscataway, NJ, 08901, USA.
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Mahlalela NB, Manne-Goehler J, Ohene-Kwofie D, B Adams L, Montana L, Kahn K, Rohr JK, Bärnighausen T, Gómez-Olivé FX. The Association Between HIV-Related Stigma and the Uptake of HIV Testing and ART Among Older Adults in Rural South Africa: Findings from the HAALSI Cohort Study. AIDS Behav 2024; 28:1104-1121. [PMID: 38286975 PMCID: PMC10896802 DOI: 10.1007/s10461-023-04222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 01/31/2024]
Abstract
HIV testing and antiretroviral therapy (ART) remain critical for curbing the spread of HIV/AIDS, but stigma can impede access to these services. Using data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we used a multivariable logistic regression to examine the correlation between HIV-related stigma, HIV testing and ART uptake in older adults. We used four questions to measure stigma, with three assessing social stigma (reflecting social distancing preferences) and one assessing anticipated stigma (disclosure concern). We combined the three social stigma questions to generate a social stigma score ranging from 0 to 3, with higher scores indicating higher stigma. Anticipated stigma was prevalent 85% (95% CI 0.84-0.86), and social stigma was also frequent 25% (95% CI 0.24-0.27). Higher social stigma scores correlated with decreased HIV testing for all participants with social stigma. Compared to those with a score of 0, odds of testing decreased with higher stigma scores (OR = 0.66, 95% CI 0.53-0.81, p = 0.000) for a score of 1 and (OR = 0.56, 95% CI 0.38-0.83, p = 0.004) for a score of 3. ART uptake also decreased with higher social stigma scores among people living with HIV (PLWH), although it was significant for those with a score of 2 (OR = 0.41, 95% CI 0.19-0.87, p = 0.020). These findings emphasize that HIV-related stigma hampers testing and ART uptake among older adults in rural South Africa. Addressing stigma is crucial for improving testing rates, early diagnosis, and treatment initiation among the older population and achieving UNAIDS 95-95-95 targets.
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Affiliation(s)
- Nomsa B Mahlalela
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jennifer Manne-Goehler
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Ohene-Kwofie
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Leslie B Adams
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Livia Montana
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
- The DHS Program, ICF, Rockville MD, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia K Rohr
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Till Bärnighausen
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute (AHRI), Mtubatuba, South Africa
| | - Francesc X Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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5
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Chan MPS, Liu S, White B, Zhang A, Zhou Y, Leung M, Dai W, Liu X, Durantini M, Ye Q, Palmese L, O’Keefe D, Albarracín D. The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics. J Consult Clin Psychol 2023; 91:574-595. [PMID: 37410398 PMCID: PMC10527151 DOI: 10.1037/ccp0000827] [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: 07/07/2023]
Abstract
OBJECTIVE Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population). METHOD This meta-analysis of 331 reports (clusters; number of effect sizes [k] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups. RESULTS Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index. CONCLUSIONS Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Man-pui Sally Chan
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Sicong Liu
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | | | - Angela Zhang
- Department of Psychology and Annenberg Public Policy Center, University of Pennsylvania
| | - Yubo Zhou
- Department of Psychology and Annenberg Public Policy Center, University of Pennsylvania
| | - Melody Leung
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Wenhao Dai
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Xi Liu
- Department of Psychology, University of Illinois
| | - Marta Durantini
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Qijia Ye
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Lidia Palmese
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Devlin O’Keefe
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Dolores Albarracín
- Annenberg School of Communication, Department of Family and Community Health, and Department of Psychology, University of Pennsylvania
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6
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Escarfuller SG, Mitchell JW, Sanchez M. HIV Prevention Intervention-related Research with Adult, Sexual Minority Hispanic Men in the United States: A Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01659-6. [PMID: 37340124 DOI: 10.1007/s40615-023-01659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
The systematic review describes aims to synthesize the HIV prevention intervention-related research conducted among adult, US sexual minority Hispanic men since 2012. Following PRISMA guidelines, 15 articles representing 14 studies were included in the review: 4 randomized controlled trials, 5 pilots, and 5 formative projects. Two interventions had PrEP-related outcomes whereas 7 focused on behavioral (e.g., condoms, testing) and/or educational outcomes. Few studies used digital health. All but one study was theoretically guided. Community engagement was a common and important thread in the included studies, with community-based participatory research being the most prevalent framework. The inclusion of cultural factors varied widely, as did the availability of Spanish language or bilingual study materials. Future research opportunities are discussed and recommendations to bolster HIV prevention interventions (e.g., tailoring) are presented. These include the need for greater integration of cultural factors (e.g., nuances related to the heterogeneity of Hispanic subgroups) and mitigating critical barriers to help improve uptake of evidence-based strategies in this population.
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Affiliation(s)
- Sebastian G Escarfuller
- Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, 33199, USA.
| | - Jason W Mitchell
- Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, 33199, USA
| | - Mariana Sanchez
- Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, 33199, USA
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7
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Brody LA, Kamalyan L, Karcher K, Guarena LA, Bender AA, McKenna BS, Umlauf A, Franklin D, Marquine MJ, Heaton RK. NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations. Patient Relat Outcome Meas 2023; 14:15-30. [PMID: 36814680 PMCID: PMC9939807 DOI: 10.2147/prom.s391113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH. Patients and Methods Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH. Results PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence. Conclusion The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.
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Affiliation(s)
- Lilla A Brody
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Kayle Karcher
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lesley A Guarena
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Benjamin S McKenna
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Donald Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maria J Marquine
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert K Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
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8
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Marium A, Ogunsola AS, Mercy UC, Anikpo I, Sa'id MA, Karaye RM, Yusuf A, Olatunji EA, Yunusa I, Karaye IM. HIV mortality trends among older adults in the United States, 1999-2020. Arch Gerontol Geriatr 2023; 109:104950. [PMID: 36739679 DOI: 10.1016/j.archger.2023.104950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite the progress made in managing HIV, the mortality trends among older adults in the US remains understudied. The lack of evidence in this demographic hampers the ability to implement evidence-based interventions. Our aim is to analyze the trends in HIV-related mortality among US citizens aged 65 years and above by demographic characteristics such as age, gender, race/ethnicity, and census region. METHODS We abstracted national mortality data from the underlying cause of death files in the CDC WONDER database. The ICD-10 Codes- B20-B24 were used to identify HIV deaths among US older adults from 1999 to 2020. Trends in age-adjusted mortality rate (AAMR) were assessed using a five-year simple moving average and Joinpoint analysis. Results were expressed as annual percentage changes (APC), average annual percentage changes, and 95% confidence intervals (CI). RESULTS Between 1999 and 2020, a total of 15,694 older adults died from HIV in the US (AAMR= 1.7 per 100,000; 95% CI: 1.6 - 1.7). Overall mortality trends increased at an annual rate of 1.5% (95% CI: 1.2, 1.8) from 1999 through 2020. The trends increased among Non-Hispanic Whites, stabilized among Non-Hispanic Blacks, and decreased among Hispanics from 1999 to 2020. Further, the trends increased consistently across categories of age (65 to 74 years; 75 to 84 years), sex, and census region. CONCLUSIONS HIV mortality among older adults in the US has risen overall from 1999 to 2020, but with varying trends by race and ethnicity. This highlights the need for enhanced public health surveillance to better understand the scope of HIV mortality among older adults and identify high-risk demographic and regional subgroups for targeted interventions. Improving timely diagnosis, managing comorbidities, and stigma surrounding HIV among older adults are crucial to reducing HIV mortality in this population.
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Affiliation(s)
- Amatul Marium
- Department of Population H, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States.
| | - Ayobami S Ogunsola
- Department of Epidemiology and Biostatistics, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States.
| | - Udeh C Mercy
- Department of Epidemiology and Biostatistics, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States.
| | - Ifedioranma Anikpo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, FL, United States.
| | - Maryam A Sa'id
- Bayero University/Aminu Kano Teaching Hospital, Kano State, Nigeria
| | | | - Aishatu Yusuf
- Department of Epidemiology and Biostatistics, Texas AandM University, TX, United States.
| | - Eniola A Olatunji
- Department of Health Policy and Management, Texas AandM University, 212 Adriance Lab Rd., College Station, TX 77843-1266, United States.
| | - Ismaeel Yunusa
- Clinical Pharmacy and Outcomes Sciences, University of South Carolina, 715 Sumter Street - CLS 311 L, Columbia, SC 29208, United States.
| | - Ibraheem M Karaye
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY 11549, United States.
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9
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Grieb SMD, Velez M, Corty EW, Saxton RE, Flores-Miller A, Shah HS, Page KR. HIV-related stigma among Spanish-speaking Latinos in an emerging immigrant city following the Solo Se Vive Una Vez social marketing campaign. PLoS One 2022; 17:e0274888. [PMID: 36201494 PMCID: PMC9536543 DOI: 10.1371/journal.pone.0274888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
HIV-related stigma exacerbates Latino immigrants' risk of HIV infection and delayed care. Following the implementation of the social marketing campaign Sólo Se Vive Una Vez (You Only Live Once) to increase HIV testing that addressed stigmatizing beliefs, we conducted a survey among Latinos in Baltimore, Maryland (N = 357). The aims of this paper are to 1) characterize the sociodemographic characteristics, HIV-related stigma beliefs, and testing behaviors of the survey respondents by campaign exposure, and 2) model the effects of Vive exposure on stigma beliefs and testing behaviors. Comparing post-campaign survey respondents exposed and unexposed to the campaign to survey findings previously obtained and reported before the campaign implementation, respondents to the post-Vive survey continued to hold high levels of stigma beliefs, and compared to the pre-Vive survey sample, were more likely to hold four or more stigmatizing beliefs (from the six survey items). Among the post-Vive survey respondents, those for whom religion was important or very important had an increased odds of 1.6 of holding four or more stigmatizing beliefs. Survey respondents who were exposed to the campaign, however, had an increased odds of 2.25 of reporting ever having been tested for HIV. Our findings demonstrate the importance of the changing social context in addressing stigma within emerging immigrant communities and highlight the critical role of religious leaders in efforts to address HIV-related stigma.
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Affiliation(s)
- Suzanne M. Dolwick Grieb
- Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Matthew Velez
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Edward W. Corty
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ronald E. Saxton
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Alejandra Flores-Miller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Harita S. Shah
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Kathleen R. Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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10
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Watson CWM, Kamalyan L, Tang B, Hussain MA, Cherner M, Mindt MR, Byrd DA, Franklin DR, Collier AC, Clifford DB, Gelman B, Morgello S, McCutchan JA, Ellis RJ, Grant I, Heaton RK, Marquine MJ. Ethnic/Racial Disparities in Longitudinal Neurocognitive Decline in People With HIV. J Acquir Immune Defic Syndr 2022; 90:97-105. [PMID: 35081558 PMCID: PMC8986565 DOI: 10.1097/qai.0000000000002922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To examine longitudinal neurocognitive decline among Latino, non-Latino Black, and non-Latino White people with HIV (PWH) and factors that may explain ethnic/racial disparities in neurocognitive decline. METHODS Four hundred ninety nine PWH (13.8% Latino, 42.7% Black, 43.5% White; baseline age: M = 43.5) from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study completed neurocognitive, neuromedical, and laboratory assessments every 6-12 months with up to 5 years of follow-up. Longitudinal neurocognitive change was determined via published regression-based norms. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and baseline and time-dependent variables that may explain ethnic/racial disparities in neurocognitive decline, including socio-demographic, HIV-disease, medical, psychiatric, and substance use characteristics. RESULTS In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latino compared with White PWH (HR = 2.25, 95% CI = 1.35 to 3.73, P = 0.002), and Latino compared with Black PWH (HR = 1.86, 95% CI = 1.14 to 3.04, P = 0.013), with no significant differences between Black and White PWH (P = 0.40). Comorbidities, including cardiometabolic factors and more severe neurocognitive comorbidity classification, accounted for 33.6% of the excess hazard for Latino compared with White PWH, decreasing the hazard ratio associated with Latino ethnicity (HR = 1.83, 95% CI = 1.06 to 3.16, P = 0.03), but did not fully account for elevated risk of decline. CONCLUSIONS Latino PWH may be at higher risk of early neurocognitive decline compared with Black and White PWH. Comorbidities accounted for some, but not all, of this increased risk among Latino PWH. Future research examining institutional, sociocultural, and biomedical factors, including structural discrimination and age-related biomarkers, may further explain the observed disparities.
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Affiliation(s)
| | | | - Bin Tang
- University of California, San Diego, San Diego, CA
| | | | | | | | | | | | - Ann C. Collier
- University of Washington School of Medicine, Seattle, WA
| | | | | | | | | | | | - Igor Grant
- University of California, San Diego, San Diego, CA
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11
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Naveed Z, Fox HS, Wichman CS, May P, Arcari CM, Meza J, Totusek S, Baccaglini L. Development of a Nomogram-Based Tool to Predict Neurocognitive Impairment Among HIV-positive Charter Participants. Open AIDS J 2021. [DOI: 10.2174/1874613602115010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH). Studies have generated inconsistent results regarding etiological factors for NCI in PLWH. Furthermore, a user-friendly and readily available predictive tool is desirable in clinical practice to screen PLWH for NCI.
Objective:
This study aimed to identify factors associated with NCI using a large and diverse sample of PLWH and build a nomogram based on demographic, clinical, and behavioral variables.
Methods:
We performed Bayesian network analysis using a supervised learning technique with the Markov Blanket (MB) algorithm. Logistic regression was also conducted to obtain the adjusted regression coefficients to construct the nomogram.
Results:
Among 1,307 participants, 21.6% were neurocognitively impaired. During the MB analysis, age provided the highest amount of mutual information (0.0333). Logistic regression also showed that old age (>50 vs. ≤50 years) had the strongest association (OR=2.77, 95% CI=1.99-3.85) with NCI. The highest possible points on the nomogram were 626, translated to a nomogram-predicted probability of NCI to be approximately 0.95. The receiver operating characteristic (ROC) curve's concordance index was 0.75, and the nomogram's calibration plot exhibited an excellent agreement between observed and predicted probabilities.
Conclusion:
The nomogram used variables that can be easily measured in clinical settings and, thus, easy to implement within a clinic or web-interface platform. The nomogram may help clinicians screen for patients with a high probability of having NCI and thus needing a comprehensive neurocognitive assessment for early diagnosis and appropriate management.
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12
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Naveed Z, Fox HS, Wichman CS, May P, Arcari CM, Meza J, Baccaglini L. An assessment of factors associated with neurocognitive decline in people living with HIV. Int J STD AIDS 2021; 33:38-47. [PMID: 34565257 DOI: 10.1177/09564624211043351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) remains a health concern. However, limited research has been done to identify factors associated with neurocognitive decline. We assessed risk factors associated with neurocognitive decline in people living with HIV using a definition of decline that is statistically easy to adopt, is based on a commonly used neuropsychological cut-off and may be clinically relevant. Cox proportional hazards modeling was performed using the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study database. 581 participants were followed for up to 12 years. Neurocognitive decline was defined as the first observed drop in global T-scores of at least 2.67. Lifetime methamphetamine use had the strongest association with neurocognitive decline (adjusted Hazard Ratio; aHR = 1.48; 95% CI = 0.92-2.39) followed by no current antiretroviral medication use (aHR = 1.32; 95% CI = 0.91-1.92). Other risk factors included Hispanic ethnicity, lifetime history of major depressive disorder, lifetime cannabis use, hepatitis-C infection, and difficulty eating, dressing, bathing, or using the toilet. Results indicate that consistent use of ART may be of high significance to preserving neurocognition. Furthermore, Hispanic patients, those with a history of depression and substance use, and those having difficulty in essential activities of daily living may require vigilant follow-up.
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Affiliation(s)
- Zaeema Naveed
- Department of Epidemiology, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Howard S Fox
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher S Wichman
- Department of Biostatistics, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Pamela May
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Christine M Arcari
- Department of Epidemiology, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Jane Meza
- Department of Biostatistics, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorena Baccaglini
- Department of Epidemiology, 12284University of Nebraska Medical Center, Omaha, NE, USA
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13
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Ramírez-Ortiz D, Forney DJ, Sheehan DM, Cano MÁ, Romano E, Sánchez M. Pre- and Post-immigration HIV Testing Behaviors among Young Adult Recent Latino Immigrants in Miami-Dade County, Florida. AIDS Behav 2021; 25:2841-2851. [PMID: 33751312 DOI: 10.1007/s10461-021-03233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
HIV testing early in the immigration process can facilitate timely linkage to HIV prevention and treatment services for immigrants. This study aims to determine the prevalence of self-report HIV testing pre- and post-immigration and the associations between pre-immigration HIV sexual risk behaviors, access to healthcare post-immigration, and HIV testing post-immigration among young adult recent Latino immigrants. Cross-sectional data from 504 recent Latino immigrants aged 18 to 34 who immigrated to Miami-Dade County, Florida during the 12 months before assessment were analyzed using robust Poisson regression models. We found that 23.8% of participants reported HIV testing post-immigration and 56.7% reported HIV testing pre-immigration. The prevalence ratio for post-immigration HIV testing was higher for participants that had health insurance (adjusted prevalence ratio [aPR]: 1.70, 95% confidence interval [CI]: 1.21-2.38) and a regular doctor or healthcare provider after immigration (aPR: 1.43, 95% CI 1.03-2.00), and post-immigration HIV testing was higher for participants that had ever been tested for HIV before immigration (aPR: 2.41, 95% CI 1.68-3.45). Also, the prevalence ratio was lower for those who engaged in condomless sex in the three months prior to immigration (aPR: 0.65, 95% 0.47-0.90). These findings suggest that addressing barriers to healthcare and prevention services for young adult recent Latino immigrants is needed to scale-up HIV testing in this population early in the immigration process.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Derrick J Forney
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research On U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | - Mariana Sánchez
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA.
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5 411, Miami, FL, 33199, USA.
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14
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Shah HS, Grieb SMD, Flores-Miller A, Yenokyan K, Castellanos-Aguirre J, Greenbaum A, Page KR. Sólo Se Vive Una Vez: Evaluation of a Social Marketing Campaign Promoting HIV Screening and Prevention for Immigrant Latinxs. AIDS Behav 2021; 25:3024-3033. [PMID: 33566213 PMCID: PMC8373748 DOI: 10.1007/s10461-021-03165-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/04/2022]
Abstract
Latinxs in the U.S. are disproportionately affected by HIV and more likely to have delayed diagnosis than their non-Latinx peers. We developed and implemented Sólo Se Vive Una Vez (You Only Live Once), the first Spanish-language campaign aimed at improving HIV testing and prevention among Latinx immigrants in Baltimore, Maryland. Sólo Se Vive Una Vez featured a website (www.solovive.org) and social marketing campaign promoting free HIV testing through the Baltimore City Health Department (BCHD) clinic and Latinx outreach team. The campaign was not associated with a change in the overall number of Latinxs obtaining HIV testing. However, Latinx HIV testers who reported being exposed to the campaign had significantly higher rates of high-risk sexual behaviors, mean number of sexual partners, and substance use. The campaign was also associated with increased PrEP referrals through the BCHD Latinx outreach team.
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Affiliation(s)
- Harita S Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | | | - Alejandra Flores-Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Baltimore, MD, USA
| | - Karine Yenokyan
- Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | | | | | - Kathleen R Page
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Baltimore, MD, USA
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15
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Bogart LM, Barreras JL, Gonzalez A, Klein DJ, Marsh T, Agniel D, Pantalone DW. Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men. AIDS Behav 2021; 25:1647-1660. [PMID: 33231847 PMCID: PMC8084890 DOI: 10.1007/s10461-020-03081-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.
| | - Joanna L Barreras
- Bienestar Human Services Inc, Los Angeles, CA, USA
- California State University Long Beach, Long Beach, CA, USA
| | - Ana Gonzalez
- Bienestar Human Services Inc, Los Angeles, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Terry Marsh
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Denis Agniel
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - David W Pantalone
- University of Massachusetts Boston, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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16
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Menon A, Patel PK, Karmakar M, Tipirneni R. The Impact of the Affordable Care Act Medicaid Expansion on Racial/Ethnic and Sex Disparities in HIV Testing: National Findings from the Behavioral Risk Factor Surveillance System. J Gen Intern Med 2021; 36:1605-1612. [PMID: 33501535 PMCID: PMC8175492 DOI: 10.1007/s11606-021-06590-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Over half of Americans have not been tested for HIV in their lifetime, and over a third of all HIV diagnoses are made less than a year before progression to AIDS. The Affordable Care Act (ACA) Medicaid expansion of 2014 had potential to improve HIV and other health screenings. We assessed the differential impacts of Medicaid expansion on racial/ethnic and racial/ethnic-sex disparities in HIV testing. METHODS Using Behavioral Risk Factor Surveillance System data from all 50 states and D.C., we sampled low-income (≤ 138% of the federal poverty level) adults ages 19-64 who were non-pregnant and non-disabled. Using a difference-in-differences (DD) and triple difference-in-differences (DDD) study design, we assessed differential impacts by race/ethnicity (White, Black, Hispanic, and other) and race/ethnicity-sex between 2011 and 2013 and 2014-2018. Outcomes were (1) ever having received an HIV test and (2) having received an HIV test in the last year. RESULTS Overall, Medicaid expansion was associated with a significant increase in HIV testing (p = 0.003). White females and Black males appeared most likely to benefit from this increase (DD 4.5 and 4.8 percentage points; p = 0.001 and 0.130 respectively). However, despite having baseline higher rates of HIV diagnosis, Black and Hispanic females did not have increased rates of ever having HIV testing following Medicaid expansion (DD - 1.9 and 0.9 percentage points; p = 0.391 and 0.703, respectively), including when compared to a White male reference subgroup and across other race/ethnicity-sex subgroups. CONCLUSIONS Medicaid expansion was associated with an increased overall probability of HIV testing among low-income, nonelderly adults, but certain groups including Black females were not more likely to benefit from this increase, despite being disproportionately affected by HIV at baseline. Targeted and culturally informed interventions to increase Medicaid enrollment and access to primary care may be needed to expand HIV testing in vulnerable groups.
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Affiliation(s)
- Anitha Menon
- University of Michigan Medical School, Ann Arbor, MI, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Payal K Patel
- University of Michigan Medical School, Ann Arbor, MI, USA
- Division of Infectious Diseases, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Monita Karmakar
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Renuka Tipirneni
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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17
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Tureson K, Byrd DA, Guzman V, Summers AC, Morris EP, Mindt MR. The impact of sociocultural factors on prospective memory performance in HIV+ Latinx adults. Neuropsychology 2021; 35:411-422. [PMID: 34043391 PMCID: PMC10284210 DOI: 10.1037/neu0000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Prospective memory (PM), a salient component of neurocognitive functioning for people living with HIV (PLH), is necessary for planning and coordinating health-related behaviors and instrumental tasks of daily living. However, little is known regarding the impact of sociocultural factors on PM in diverse populations, particularly Latinx PLH. The aim of this study was to examine ethnic group differences and sociocultural factors related to PM. METHOD The sample of 127 PLH (91 Latinx and 36 non-Latinx white) completed measures of quality of education, socioeconomic status (SES), and a validated PM measure, the Memory for Intentions Screening Test (MIST). The Latinx group also completed a bicultural acculturation measure. RESULTS Results revealed the Latinx and the non-Latinx white groups did not significantly differ in overall MIST performance (all p > .05). In the entire sample, better quality of education was associated with better MIST performance (all p < .05). Within the Latinx group, higher Latinx acculturation was associated with worse MIST performance (p = .02), whereas higher U.S. acculturation was associated with better MIST performance at a trend level (p = .07). Multivariate regressions revealed quality of education and Latinx acculturation significantly predicted MIST performance and PM errors (all p < .05). SES was not related to the MIST (all p > .10). CONCLUSIONS In sum, clinicians must take sociocultural factors into consideration when working with Latinx PLH, as these factors influence cognitive functions (i.e., PM) vital to health-related behaviors. Integrating culturally-informed psychoeducation into care plans is an imperative first step. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Desiree A. Byrd
- Department of Psychology, Queens College, Queens, NY
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vanessa Guzman
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Angela C. Summers
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Emily P. Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Monica Rivera Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
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18
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Jain MK, Vigil KJ, Parisot P, Go G, Vu T, Li X, Hansen L, Taylor BS. Incidence and Predictors of Hepatitis B Surface Antigen Clearance in HIV Patients: A Retrospective Multisite Study. Open Forum Infect Dis 2021; 8:ofab116. [PMID: 34337091 PMCID: PMC8320286 DOI: 10.1093/ofid/ofab116] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background New therapies to achieve hepatitis B surface antigen (HBsAg) clearance are under development. However, gaps in knowledge exist in understanding the incidence and predictors of HBsAg clearance in a racially diverse HIV population. Methods We examined the incidence and risk of HBsAg clearance in a retrospective cohort of people with HIV/hepatitis B virus (HBV). Included patients had sufficient data to establish chronic infection based on Centers for Disease Control and Prevention guidelines. We examined the incident rate for HBsAg loss and hazard rate ratios to evaluate predictors for HBsAg clearance in a multivariable model. Results Among 571 HIV/HBV patients, 87% were male, 61% were Black, 45% had AIDS, 48% were HBeAg positive, and the median follow-up was 88 months. Incident HBsAg clearance was 1.5 per 100 person-years. In the multivariate model, those with AIDS at baseline (adjusted hazard ratio [aHR], 2.43; 95% CI, 1.37–4.32), Hispanics (aHR, 3.57; 95% CI, 1.33–9.58), and those with injection drug use as an HIV risk factor (aHR, 3.35; 95% CI, 1.26–8.89) were more likely to lose HBsAg, whereas those who were HBeAg positive (aHR, 0.34; 95% CI, 0.19–0.63) were less likely to lose HBsAg. The median change in CD4 cell count during the observation period was 231 cells/mm3 in those with HBsAg loss vs 112 cells/mm3 in those with HBsAg persistence (P = .004). Conclusions HBsAg loss occurs in about 10% of those with chronic HBV infection. Being Hispanic, having AIDS at baseline, having an injection drug use history, and having HBeAg-negative status at baseline predicted the likelihood of HBsAg loss. Immune restoration may be a mechanism through which HBsAg loss occurs in HIV patients.
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Affiliation(s)
- Mamta K Jain
- UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA.,Parkland Health and Hospital System, Dallas, Texas, USA
| | - Karen J Vigil
- UT Southwestern Medical Center, Population and Data Science, Dallas, Texas, USA.,University of Texas Health Science Center, Department of Internal Medicine, Houston, Texas,USA
| | - Paul Parisot
- UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
| | - Gabriella Go
- UT Southwestern Medical Center, Population and Data Science, Dallas, Texas, USA.,University of Texas Health Science Center, Department of Internal Medicine, Houston, Texas,USA
| | - Trung Vu
- University of Texas Health Science Center, Department of Internal Medicine, San Antonio, Texas, USA
| | - Xilong Li
- UT Southwestern Medical Center, Population and Data Science, Dallas, Texas, USA
| | - Laura Hansen
- UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
| | - Barbara S Taylor
- University of Texas Health Science Center, Department of Internal Medicine, San Antonio, Texas, USA
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19
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Gant Z, Johnson Lyons S, Jin C, Dailey A, Nwangwu-Ike N, Satcher Johnson A. Geographic Differences in Social Determinants of Health Among US-Born and Non-US-Born Hispanic/Latino Adults With Diagnosed HIV Infection, United States and Puerto Rico, 2017. Public Health Rep 2021; 136:685-698. [PMID: 33563091 DOI: 10.1177/0033354920970539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE HIV disproportionately affects Hispanic/Latino people in the United States, and factors other than individual attributes may be contributing to these differences. We examined differences in the distribution of HIV diagnosis and social determinants of health (SDH) among US-born and non-US-born Hispanic/Latino adults in the United States and Puerto Rico. METHODS We used data reported to the Centers for Disease Control and Prevention's National HIV Surveillance System (NHSS) to determine US census tract-level HIV diagnosis rates and percentages among US-born and non-US-born Hispanic/Latino adults aged ≥18 for 2017. We merged data from the US Census Bureau's American Community Survey with NHSS data to examine regional differences in federal poverty level, education, median household income, employment, and health insurance coverage among 8648 US-born (n = 3328) and non-US-born (n = 5320) Hispanic/Latino adults. RESULTS A comparison of US-born and non-US-born men by region showed similar distributions of HIV diagnoses. The largest percentages occurred in census tracts where ≥19% of residents lived below the federal poverty level, ≥18% did not finish high school, the median household income was <$40 000 per year, ≥6% were unemployed, and ≥16% did not have health insurance. A comparison of US-born and non-US-born women by region showed similar distributions. CONCLUSION The findings of higher numbers of HIV diagnoses among non-US-born Hispanic/Latino adults than among US-born Hispanic/Latino adults, regional similarities in patterns of SDH and HIV percentages and rates, and Hispanic/Latino adults faring poorly in each SDH category are important for understanding SDH barriers that may be affecting Hispanic/Latino adults with HIV in the United States.
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Affiliation(s)
- Zanetta Gant
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shacara Johnson Lyons
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - André Dailey
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ndidi Nwangwu-Ike
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Satcher Johnson
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Kamalyan L, Hussain MA, Diaz MM, Umlauf A, Franklin DR, Cherner M, Mindt MR, Fortuny LAI, Grant I, Heaton RK, Marquine MJ. Neurocognitive impairment in Spanish-speaking Latinos living with HIV in the US: Application of the neuropsychological norms for the US-Mexico border region in Spanish (NP-NUMBRS). Clin Neuropsychol 2021; 35:433-452. [PMID: 31847711 PMCID: PMC7453430 DOI: 10.1080/13854046.2019.1701084] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Objective Latinos in the US are at increased risk for HIV-associated neurocognitive impairment (NCI). Most studies of US Latinos living with HIV have included primarily English-speakers only. We investigated the rate, pattern, and correlates of HIV-associated NCI in native Spanish-speaking Latinos living in the US near the Mexican border. Methods Participants included 407 native Spanish-speaking Latinos (Age: M = 37.65, SD = 10.0; Education: M = 10.75, SD = 4.1; 53% male): 153 persons living with HIV (PLWH; 56% AIDS) and 254 healthy controls. All participants completed comprehensive neuropsychological assessments in Spanish. Raw neuropsychological test scores from seven domains were converted to demographically-adjusted T-scores using norms developed with healthy controls. Global and domain NCI were defined per established criteria. Among PLWH we applied norms developed for non-Hispanic (NH) Whites and Blacks, and investigated correlates of global NCI, including HIV disease characteristics and psychiatric comorbidities. Results Utilizing population specific norms, rates of global NCI were significantly higher among PLWH (39%) than healthy controls (17%), comparable to previously published rates. In contrast, rates of global NCI in the same group of PLWH were significantly different when NH White norms (63%, p < 0.0001) and NH Black norms were used (18%, p < 0.0001). Among PLWH without a history of lifetime substance use disorder, more years of antiretroviral exposure were significantly associated with decreased rates of global NCI. Conclusions Present findings lend support to the validity of newly developed norms for native Spanish-speakers living near the US-Mexico border, and underscore the importance of utilizing appropriate norms to accurately identify HIV-associated NCI.
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Affiliation(s)
- Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Mariam A. Hussain
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Monica M. Diaz
- Department of Neurosciences, University of California, San Diego
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Donald R. Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Monica Rivera Mindt
- Department of Psychology & Latin American Latino Studies Institute, Fordham University and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Igor Grant
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Robert K. Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - María J. Marquine
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
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21
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Nkulu-Kalengayi FK, Jonzon R, Deogan C, Hurtig AK. Evidence and gaps in the literature on HIV/STI prevention interventions targeting migrants in receiving countries: a scoping review. Glob Health Action 2021; 14:1962039. [PMID: 34404337 PMCID: PMC8381899 DOI: 10.1080/16549716.2021.1962039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Evidence suggests that migration increases vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STI). However, there is limited knowledge about what has been done or needs to be done to address migrants' vulnerability in receiving countries. OBJECTIVES A scoping review was carried out to map the existing literature in this field, describe its characteristics, identify gaps in knowledge and determine whether a Sexual and Reproductive Health and Rights (SRHR)-perspective was applied. METHODS We used the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines for scoping reviews and subsequent enhancements proposed by other authors. We searched three databases and grey literature to identify relevant publications. RESULTS A total of 1,147 records were found across the three electronic databases and compiled. Of these, only 29 papers that met the inclusion criteria were included. The review shows that research in this field is dominated by studies from the USA that mostly include behavioural interventions for HIV and HBV prevention among migrants from Latin America and Asian countries, respectively. None of the interventions integrated an SRHR perspective. The intervention effects varied across studies and measured outcomes. The observed effects on knowledge, attitudes, perceptions, behavioural intentions and skills were largely positive, but reported effects on testing and sexual risk behaviours were inconsistent. CONCLUSIONS There is a need for good quality research, particularly in parts of the world other than the USA that will address all STIs and specifically target the most vulnerable subgroups of migrants. Further research requires greater scope and depth, including the need to apply an SRHR perspective and incorporate biomedical and structural interventions to address the interacting causes of migrants' vulnerability to HIV/STIs.
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Affiliation(s)
| | - Robert Jonzon
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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22
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Nduaguba SO, Ford KH, Wilson JP, Lawson KA, Cook RL. Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state. Int J STD AIDS 2020; 32:162-169. [PMID: 33327899 PMCID: PMC7879228 DOI: 10.1177/0956462420947567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.
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Affiliation(s)
- Sabina O Nduaguba
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Kentya H Ford
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - James P Wilson
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Kenneth A Lawson
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida College of Medicine, Gainesville, FL, USA
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23
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Chavez-Yenter D, Chou WYS, Kaphingst KA. State of recent literature on communication about cancer genetic testing among Latinx populations. J Genet Couns 2020; 30:911-918. [PMID: 33142015 DOI: 10.1002/jgc4.1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
Cancer-related genetic testing (hereafter CGT) has transformed cancer prevention, treatment, and care. Researchers debate whether diffusion and use of genetic testing will reduce or widen cancer health disparities through effects on improving or worsening cancer-related mortality, morbidity, and outcomes that disproportionately affect racial and ethnic minority populations. Cancer disparities by race and ethnicity have been associated with social determinants of health and healthcare access and experience. However, little research has explored how communication about CGT may contribute to these disparities. As such, the goal of this study was to characterize the literature published between 2010 and 2017 on communication about CGT among Latinx populations through a secondary analysis of papers identified in a larger scoping review. We found thirteen (2.5%) of 513 papers in the parent scoping review had over 50% Latinx representation; only nine of these (69%) had fully Latinx comprised study cohorts. The majority of the 13 identified studies (n = 9) were conducted to assess knowledge and attitudes regarding CGT. Most studies included services or materials in both Spanish and English. Few studies assessed language preference or acculturation or compared outcomes across sub-ethnicities. We identified opportunities for researchers to explore differences in outcomes by language preference and acculturation, and between sub-ethnicities in future studies. Leveraging a greater understanding of the heterogeneity within the Latinx population will allow genetics researchers and providers to improve utilization of CGT and therein health outcomes to advance health equity.
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Affiliation(s)
- Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, MD, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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24
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Wu Y, Yan X, Zhao S, Wang J, Ran J, Dong D, Wang M, Fung H, Yeoh EK, Chung RYN. Association of time to diagnosis with socioeconomic position and geographical accessibility to healthcare among symptomatic COVID-19 patients: A retrospective study in Hong Kong. Health Place 2020; 66:102465. [PMID: 33130449 PMCID: PMC7568172 DOI: 10.1016/j.healthplace.2020.102465] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
Early diagnosis is important to control COVID-19 outbreaks. This study aimed to assess how individual and area socioeconomic position and geographical accessibility to healthcare services were associated with the time to diagnosis among symptomatic COVID-19 patients in Hong Kong. Multivariable generalized linear regression was used to estimate the associations while adjusting for sociodemographic characteristics and case classification. This study found living in public rental housing and living in an area with low education were associated with longer time to diagnosis in the first wave of infections. Specifically, the risk of delayed diagnosis for public rental housing residents was mitigated by the higher density of public clinics/hospitals but was slightly increased by the higher density of private medical practitioners nearby. No such relations were found in the second wave of infections when the surveillance measures were enhanced. Given the grave impact of pandemics around the world, our findings call on taking inequalities into account when public health policies are being devised.
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Affiliation(s)
- Yushan Wu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China
| | - Xiang Yan
- Department of Urban Planning and Design, The Social Infrastructure for Equity and Wellbeing (SIEW) Lab, The University of Hong Kong, Pokfulam Road, Hong Kong, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; CUHK Shenzhen Research Institute, Shenzhen, China
| | - Jingxuan Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinjun Ran
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China
| | - Maggie Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; CUHK Shenzhen Research Institute, Shenzhen, China
| | - Hong Fung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; CUHK Medical Centure, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China; CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Roger Yat-Nork Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China; CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China.
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25
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Witkowski K, Valerio R, Samad A, Matiz-Reyes A, Padilla M. Aging and thriving with HIV: a photovoice project with long-term HIV survivors in Miami, Florida. Arts Health 2020; 13:329-346. [PMID: 32951532 DOI: 10.1080/17533015.2020.1821386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Long-term survivors of HIV in Miami, Florida are facing critical health and social issues as they age with this disease. METHODS Using PhotoVoice methodology, nine Latino/a activist-artists were recruited to take pictures depicting their everyday life-challenges to be used in several photography exhibits aimed at informing local policy direction. RESULTS The group identified a positive approach to aging with HIV as a priority at the individual, community and policy level, emphasizing policy alternatives to the negative and disease-ridden stereotypes that embed current discussions on living and aging with HIV. The activists highlight specific community and policy solutions that respond to the growing needs of long-term survivors of HIV/AIDS among Latino communities in South Florida. CONCLUSIONS The findings suggest that Miami (and areas with a large HIV-positive population) may benefit from community and policy solutions that take a successful aging approach and build upon the resiliency of this population.
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Affiliation(s)
- Kaila Witkowski
- Department of Public Policy & Administration, School of International & Public Affairs, Florida International University, Miami, FL, USA
| | - Reyni Valerio
- Global and Sociocultural Studies, School of International & Public Affairs, Florida International University, Miami, FL, USA
| | - Abdul Samad
- Department of Public Policy & Administration, School of International & Public Affairs, Florida International University, Miami, FL, USA
| | - Armando Matiz-Reyes
- Global and Sociocultural Studies, School of International & Public Affairs, Florida International University, Miami, FL, USA
| | - Mark Padilla
- Global and Sociocultural Studies, School of International & Public Affairs, Florida International University, Miami, FL, USA
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26
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Shah HS, Dolwick Grieb SM, Flores-Miller A, Greenbaum A, Castellanos-Aguirre J, Page KR. Sólo Se Vive Una Vez: The Implementation and Reach of an HIV Screening Campaign for Latinx Immigrants. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:229-242. [PMID: 32749875 DOI: 10.1521/aeap.2020.32.3.229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.
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Affiliation(s)
- Harita S Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alejandra Flores-Miller
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Baltimore City Health Department, Baltimore, Maryland
| | | | | | - Kathleen R Page
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Baltimore City Health Department, Baltimore, Maryland
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27
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Demeke HB, Luo Q, Beer L, Weiser J. Antiretroviral prescription, retention in care and viral suppression by place of birth among adults with diagnosed HIV in the United States-2015-2017, medical monitoring project. AIDS Care 2020; 33:86-91. [PMID: 32156156 DOI: 10.1080/09540121.2020.1738007] [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: 10/24/2022]
Abstract
HIV clinical outcomes have not been fully assessed by place of birth at the national level. We analyzed the Medical Monitoring Project data, an annual cross-sectional survey designed to produce nationally representative estimates on adults with diagnosed HIV in the United States, collected during 2015-2017 (n = 7617). We compared sociodemographic, behavioral, and clinical outcomes by place of birth using Rao-Scott chi-square tests (P < .05). Overall, 13.6% of adults with diagnosed HIV were non-US-born. During the past 12 months, a higher percentage of non-US-born than US-born adults, respectively, were prescribed ART (89.4% vs. 84.1%), retained in care (87.1% vs. 80.0%), virally suppressed at the last test (77.2% vs. 70.9%), and had sustained viral suppression (70.9% vs. 63.3%). A lower percentage of non-US-born adults reported binge drinking (13.0% vs. 16.1%), using non-injection drugs (15.3% vs. 31.7%), and suffering from depression (15.9% vs. 23.3%) or anxiety (10.0% vs. 20.2%). A significantly higher percentage of non-US-born adults had Ryan White HIV/AIDS Program (RWHAP) coverage (54.4% vs. 43.1%) and attended a RWHAP-funded health care facility (73.9% vs. 66.6%). Factors contributing to better HIV clinical outcomes among non-US-born persons may include access to RWHAP coverage, lower levels of substance use, and better mental health.
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Affiliation(s)
- Hanna B Demeke
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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28
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Arrington-Sanders R, Hailey-Fair K, Wirtz AL, Morgan A, Brooks D, Castillo M, Trexler C, Kwait J, Dowshen N, Galai N, Beyrer C, Celentano D. Role of Structural Marginalization, HIV Stigma, and Mistrust on HIV Prevention and Treatment Among Young Black Latinx Men Who Have Sex with Men and Transgender Women: Perspectives from Youth Service Providers. AIDS Patient Care STDS 2020; 34:7-15. [PMID: 31944853 DOI: 10.1089/apc.2019.0165] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Young black and Latinx men who have sex with men (YBLMSM) and transgender women (YBLTW) are disproportionately impacted by HIV. Structural and social marginalization, the social barriers, and structures that unevenly distribute benefits and burdens to different groups, may contribute to inability for youth to access prevention and treatment care services. Yet, few reports have examined the community and health care experiences of social marginalization among youth service providers who have multiple roles in the community (i.e., serve as a service provider and are a member or prior member of the YBLMSM and YBLTW population). Eighteen key informants (KIs), defined as youth, young adults, or adults who were members of or connected to the YBLMSM and young black and Latinx transgender (YBLTG) community, participated in a one-time, face-to-face, or telephone key informant interview (KII) lasting ∼45 min. KIs were defined as youth service providers because they described working with the target population and either being a member of or closely connected to the target population. KIs described key themes related to marginalization: lack of competent care among health care providers and both clinical and community spaces that left out key populations. HIV stigma and medical mistrust continues to create a barrier to care in this population and for interventions to be effective interventions will need to use an intersectional approach that simultaneously address all identities, and the social and structural needs of youth.
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Affiliation(s)
- Renata Arrington-Sanders
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kimberly Hailey-Fair
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anthony Morgan
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Durryle Brooks
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marne Castillo
- The Adolescent Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Connie Trexler
- Adolescent Clinical Research, Burgess Clinic, Children's National Medical Center, Washington, District of Columbia
| | | | - Nadia Dowshen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Bogart LM, Galvan FH, Leija J, MacCarthy S, Klein DJ, Pantalone DW. A Pilot Cognitive Behavior Therapy Group Intervention to Address Coping with Discrimination Among HIV-Positive Latino Immigrant Sexual Minority Men. ACTA ACUST UNITED AC 2020; 1:6-26. [PMID: 34355213 DOI: 10.1891/lgbtq.2019-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Discrimination is thought to be a key driver of health disparities that affect people with multiple intersecting devalued identities, such as HIV-positive Latino sexual minority men (SMM). Ineffective coping with the stress of discrimination (e.g., rumination, substance use) may lead to worse long-term mental and physical health. Within the context of a community partnership, we developed a nine-session, community-based, cognitive behavior therapy group intervention to address coping with discrimination among HIV-positive Latino immigrant SMM. In Study 1, we assessed anticipated intervention acceptability via semi-structured interviews with 28 HIV-positive Latino SMM and ten social service providers and administrators; we used interview data to develop the manualized intervention. In Study 2, we assessed acceptability, feasibility, and preliminary effects in a pre-post, non-randomized intervention evaluation with two intervention groups of HIV-positive Latino SMM (n = 30, average age = 48.5, SD = 10.3). In semi-structured interviews, key stakeholders were enthusiastic about the proposed intervention. In the non-randomized evaluation, feasibility was evidenced by moderate levels of intervention attendance (five sessions on average); reasons for missed sessions (e.g., illness, scheduling conflict with work) were unrelated to the intervention. Linear regressions showed preliminary effects for decreased negative emotional coping responses to discrimination pre-to-post intervention (i.e., feeling less anger, sadness, powerlessness, helplessness, and shame on two subscales; b (SE) = -0.23 (0.10), p = .03; b (SE) = -0.25 (0.11), p = .03). Our intervention holds promise for reducing disparities by empowering Latino SMM to leverage innate resilience resources to improve their health in the face of discrimination.
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Affiliation(s)
| | | | - Jesus Leija
- Bienestar Human Services, Inc., Los Angeles, CA
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Demeke HB, Luo Q, Luna-Gierke RE, Padilla M, Girona-Lozada G, Miranda-De León S, Weiser J, Beer L. HIV Care Outcomes among Hispanics/Latinos with Diagnosed HIV in the United States by Place of Birth-2015-2018, Medical Monitoring Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010171. [PMID: 31881732 PMCID: PMC6981500 DOI: 10.3390/ijerph17010171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
Relocation from one’s birthplace may affect human immunodeficiency virus (HIV) outcomes, but national estimates of HIV outcomes among Hispanics/Latinos by place of birth are limited. We analyzed Medical Monitoring Project data collected in 2015–2018 from 2564 HIV-positive Hispanic/Latino adults and compared clinical outcomes between mainland US-born (referent group), Puerto Rican (PR-born), and those born outside the United States (non-US-born). We reported weighted percentages of characteristics and used logistic regression with predicted marginal means to examine differences between groups (p < 0.05). PR-born Hispanics/Latinos were more likely to be prescribed antiretroviral therapy (ART) (94%) and retained in care (94%) than mainland-US-born (79% and 77%, respectively) and non-US-born (91% and 87%, respectively) Hispanics/Latinos. PR-born Hispanics/Latinos were more likely to have sustained viral suppression (75%) than mainland-US-born Hispanics/Latinos (57%). Non-US-born Hispanics/Latinos were more likely to be prescribed ART (91% vs. 79%), retained in care (87% vs. 77%), and have sustained viral suppression (74% vs. 57%) than mainland-US-born Hispanics/Latinos. Greater Ryan White HIV/AIDS-funded facility usage among PR-born, better mental health among non-US-born, and less drug use among PR-born and non-US-born Hispanics/Latinos may have contributed to better HIV outcomes. Expanding programs with comprehensive HIV/AIDS services, including for mental health and substance use, may reduce HIV outcome disparities among Hispanics/Latinos.
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Affiliation(s)
- Hanna B. Demeke
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-6230
| | - Qingwei Luo
- ICF Assigned to DHAP, NCHHSTP, CDC, Atlanta, GA 30329, USA
| | - Ruth E. Luna-Gierke
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mabel Padilla
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | | | | | - John Weiser
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Linda Beer
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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Barokar J, McCutchan A, Deutsch R, Tang B, Cherner M, Bharti AR. Neurocognitive impairment is worse in HIV/HCV-coinfected individuals with liver dysfunction. J Neurovirol 2019; 25:792-799. [PMID: 31281947 PMCID: PMC6923581 DOI: 10.1007/s13365-019-00767-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 01/09/2023]
Abstract
Infections with HIV and hepatitis C virus (HCV) can individually and jointly contribute to neurocognitive impairment (NCI). Rates of NCI in HIV/HCV-coinfected persons range from 40 to 63% but its correlates have not been described. In this study, we examined HIV/HCV-coinfected adults on antiretroviral therapy (ART) with undetectable HIV RNA in blood (n = 412) who were assessed using a comprehensive neuropsychological test battery. Demographics, host and viral biomarkers, and markers of liver dysfunction were compared between impaired (n = 198) and unimpaired (n = 214) participants using logistic regression. The cohort was predominantly middle-aged men, half of whom (48%) had NCI. The odds of NCI increased by almost two-fold when serum albumin was < 4 g/dL, 1.7-fold when alanine aminotransferase (ALT) levels were > 50 IU/L, and 2.2-fold with every unit increase in log10 AST to Platelet Ratio Index (APRI). These readily available clinical biomarkers of NCI measure hepatic injury and/or dysfunction, suggesting a mechanism for the effects of HCV infection on NCI. They may identify patients at increased risk of NCI who could be prioritized for early initiation of HCV treatment to protect or improve cognition.
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Affiliation(s)
- Jyoti Barokar
- Department of Psychiatry, University of California, San Diego, USA
| | - Allen McCutchan
- Department of Medicine, University of California, San Diego, USA
| | - Reena Deutsch
- Department of Psychiatry, University of California, San Diego, USA
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, USA
| | - Ajay R. Bharti
- Department of Medicine, University of California, San Diego, USA
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Using a Social Network Strategy to Distribute HIV Self-Test Kits to African American and Latino MSM. J Acquir Immune Defic Syndr 2019; 79:38-45. [PMID: 29771792 DOI: 10.1097/qai.0000000000001726] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) continue to be disproportionately impacted globally by the HIV epidemic. Studies suggest that HIV self-testing (HIVST) is highly acceptable among MSM. Social network strategies to increase testing are effective in reaching MSM, particularly MSM of color, who may not otherwise test. We tested a social network-based strategy to distribute HIVST kits to African American MSM (AAMSM) and Latino MSM (LMSM). SETTING This study was conducted in Alameda County, California, a large, urban/suburban county with an HIV epidemic mirroring the national HIV epidemic. METHODS From January 2016 to March 2017, 30 AAMSM, LMSM, and transgender women were trained as peer recruiters and asked to distribute 5 self-test kits to MSM social network members and support those who test positive in linking to care. Testers completed an online survey after their test. We compared peer-distributed HIVST testing outcomes to outcomes from Alameda County's targeted, community-based HIV testing programs using χ tests. RESULTS Peer-distributed HIVST to 143 social and sexual network members, of whom 110 completed the online survey. Compared with MSM who used the County's sponsored testing programs, individuals reached through the peer-based self-testing strategy were significantly more likely to have never tested for HIV (3.51% vs. 0.41%, P < 0.01) and to report a positive test result (6.14% vs. 1.49%, P < 0.01). CONCLUSION Findings suggest that a network-based strategy for self-test distribution is a promising intervention to increase testing uptake and reduce undiagnosed infections among AAMSM and LMSM.
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Desir FA, Lesko CR, Moore RD, Horberg MA, Wong C, Crane HM, Silverberg M, Thorne JE, Rachlis B, Rabkin C, Mayor AM, Mathews WC, Althoff KN. One Size Fits (n)One: The Influence of Sex, Age, and Sexual Human Immunodeficiency Virus (HIV) Acquisition Risk on Racial/Ethnic Disparities in the HIV Care Continuum in the United States. Clin Infect Dis 2019; 68:795-802. [PMID: 30169624 PMCID: PMC6376102 DOI: 10.1093/cid/ciy556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood. METHODS We estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014. RESULTS Among women aged 18-29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%-20.2%), 9.2% (95% CI, .4%-20.4%), and 13.5% (95% CI, 2.7%-22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged ≥50 years spent 6.3% (95% CI, 1.3%-11.7%), 11.0% (95% CI, 4.6%-18.1%), and 9.7% (95% CI, 3.6%-16.8%) less person-time in these stages, respectively, than white MSM ≥50 years of age. Among MSM aged 40-49 years, blacks spent 9.8% (95% CI, 2.4%-16.5%) and 11.9% (95% CI, 3.8%-19.3%) less person-time on ART and virally suppressed, respectively, than whites. CONCLUSIONS Racial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.
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Affiliation(s)
- Fidel A Desir
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore
| | - Michael A Horberg
- Division of Research, Kaiser Permanente Mid-Atlantic Research Group, Rockville, Maryland
| | - Cherise Wong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | | | - Jennifer E Thorne
- Division of Ocular Immunology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | - Beth Rachlis
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Charles Rabkin
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Angel M Mayor
- Department of Internal Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico
| | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
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Galletly CL, Lechuga J, Glasman LR, DiFranceisco W, Broaddus MR, Dickson-Gomez JB, McAuliffe TL, Vega M, LeGrand S, Mena CA, Barlow ML, Montenegro JI. HIV Testing and Mistaken Beliefs about Immigration Laws. J Racial Ethn Health Disparities 2019; 6:668-675. [PMID: 30725380 DOI: 10.1007/s40615-019-00565-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 01/24/2023]
Abstract
Evidence suggests that migrants may underutilize USA health care because of misconceptions about immigration-related consequences of health care use. This study aimed to explore whether common misconceptions about the immigration consequences of seeking health care, receiving an HIV test, and being diagnosed with HIV were associated with participant self-report of never having received an HIV test. The study sample comprised 297 adult, sexually active, documented and undocumented Spanish-speaking Latino migrants. Participants completed a cross-sectional survey via ACASI. In multiple logistic regression analyses controlling for sociodemographic variables and HIV stigma, misconceptions about laws emerged as a strong predictor of never having received an HIV test (p < .001). Associations between participants' endorsement of misconceptions and their HIV testing history suggest that incorrect perceptions of laws do deter some subgroups of USA Latino migrants from HIV testing. Identifying misconceptions about negative immigration consequences of engaging in important health behaviors should be a community health research priority.
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Affiliation(s)
- Carol L Galletly
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA.
| | - Julia Lechuga
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA, 18015, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Wayne DiFranceisco
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Michelle R Broaddus
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Julia B Dickson-Gomez
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, The Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI, 53202, USA
| | - Miriam Vega
- UMMA Community Clinic, 5849 Crocker St, Unit K, Los Angeles, CA, 90003, USA
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive Campus Mailbox 90392, Durham, NC, 27710, USA
| | - Carla A Mena
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive Campus Mailbox 90392, Durham, NC, 27710, USA
| | - Morgan L Barlow
- Duke University, 206 Academic Advising and Resource Center Building Box 90694, Durham, NC, 27708, USA
| | - Judith I Montenegro
- The Latino Commission on AIDS, 24 West, 25th Street, 9th Floor, New York, NY, 10010, USA
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HIV Testing, Risk Behaviors, and Fear: A Comparison of Documented and Undocumented Latino Immigrants. AIDS Behav 2019; 23:336-346. [PMID: 30109457 DOI: 10.1007/s10461-018-2251-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Latino immigrants in the United States are at elevated risk for HIV infection and delayed HIV diagnosis. Immigration documentation status and its contribution to fears are important barriers to accessing health services including HIV testing. A currently changing political climate within the United States may have increased the complexity of the intersection of documentation status and health care access. This study used an anonymous survey conducted in March and April 2017 in New York City to compare: sociodemographic characteristics, HIV testing behaviors, HIV risk behaviors, and perceptions of fear around HIV testing among documented and undocumented Latino immigrants (N = 301). We found that undocumented immigrants reported lower levels of education, income, and health insurance than did documented immigrants. However, groups did not differ in having tested for HIV in the last 12 months, in future intentions to test for HIV, or in emotional/cognitive perceptions of fear around HIV testing. Undocumented immigrants reported lower rates of having ever tested for HIV in their lifetime (68.6%) than documented immigrants (80.5%) (p = 0.027). In conclusion, we found that despite sociodemographic challenges, undocumented immigrants had similar HIV testing behaviors as their documented counterparts in our study community. Further understanding of the mitigating factors that resulted in seemingly equal access to HIV testing in this community for undocumented immigrants is warranted.
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36
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Pérez A, Santamaria EK, Operario D. A Systematic Review of Behavioral Interventions to Reduce Condomless Sex and Increase HIV Testing for Latino MSM. J Immigr Minor Health 2019; 20:1261-1276. [PMID: 29247266 DOI: 10.1007/s10903-017-0682-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV, and there have been calls to improve availability of culturally sensitive HIV prevention programs for this population. This article provides a systematic review of intervention programs to reduce condomless sex and/or increase HIV testing among Latino MSM. We searched four electronic databases using a systematic review protocol, screened 1777 unique records, and identified ten interventions analyzing data from 2871 Latino MSM. Four studies reported reductions in condomless anal intercourse, and one reported reductions in number of sexual partners. All studies incorporated surface structure cultural features such as bilingual study recruitment, but the incorporation of deep structure cultural features, such as machismo and sexual silence, was lacking. There is a need for rigorously designed interventions that incorporate deep structure cultural features in order to reduce HIV among Latino MSM.
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Affiliation(s)
- Ashley Pérez
- Department of Social and Behavioral Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - E Karina Santamaria
- Department of Social and Behavioral Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA
| | - Don Operario
- Department of Social and Behavioral Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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Lechuga J, Galletly CL, Broaddus MR, Dickson-Gomez JB, Glasman LR, McAuliffe TL, Vega MY, LeGrand S, Mena CA, Barlow ML, Valera E, Montenegro JI. The Development and Psychometric Properties of the Immigration Law Concerns Scale (ILCS) for HIV Testing. J Immigr Minor Health 2019; 20:1109-1117. [PMID: 29119305 DOI: 10.1007/s10903-017-0665-6] [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: 11/24/2022]
Abstract
To develop, pilot test, and conduct psychometric analyses of an innovative scale measuring the influence of perceived immigration laws on Latino migrants' HIV-testing behavior. The Immigration Law Concerns Scale (ILCS) was developed in three phases: Phase 1 involved a review of law and literature, generation of scale items, consultation with project advisors, and subsequent revision of the scale. Phase 2 involved systematic translation- back translation and consensus-based editorial processes conducted by members of a bilingual and multi-national study team. In Phase 3, 339 sexually active, HIV-negative Spanish-speaking, non-citizen Latino migrant adults (both documented and undocumented) completed the scale via audio computer-assisted self-interview. The psychometric properties of the scale were tested with exploratory factor analysis and estimates of reliability coefficients were generated. Bivariate correlations were conducted to test the discriminant and predictive validity of identified factors. Exploratory factor analysis revealed a three-factor, 17-item scale. subscale reliability ranged from 0.72 to 0.79. There were significant associations between the ILCS and the HIV-testing behaviors of participants. Results of the pilot test and psychometric analysis of the ILCS are promising. The scale is reliable and significantly associated with the HIV-testing behaviors of participants. Subscales related to unwanted government attention and concerns about meeting moral character requirements should be refined.
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Affiliation(s)
- Julia Lechuga
- Department of Education and Human Services, Lehigh University, 111 Research Drive, Bethlehem, PA, 18015, USA.
| | - Carol L Galletly
- Center for AIDS Intervention Research, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michelle R Broaddus
- Center for AIDS Intervention Research, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julia B Dickson-Gomez
- Center for AIDS Intervention Research, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, The Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Sarah LeGrand
- Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, Raleigh, NC, USA
| | - Carla A Mena
- Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, Raleigh, NC, USA
| | - Morgan L Barlow
- Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, Raleigh, NC, USA
| | - Erik Valera
- The Latino Commission on AIDS, New York, NY, USA
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Fiori KP, Schechter J, Gbeleou SC, Braganza S, Rhatigan J, Houndenou S, Lopez A, Bensen E, Hirschhorn L. Closing the delivery gap. Int J Health Care Qual Assur 2018; 31:327-336. [PMID: 29790442 DOI: 10.1108/ijhcqa-02-2017-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to describe the authors' experience operationalizing the care delivery value chain (CDVC) as a management and continuous quality improvement (QI) approach to strengthen HIV/AIDS services provided in Northern Togo through addressing gaps across a care continuum. Design/methodology/approach The authors led a series of discussions to develop a CDVC specific to existing HIV/AIDS services in Northern Togo. Using the CDVC framework, 28 specific gaps in service delivery were identified and integrated into a strategic QI plan. Findings At 12 months, 92 percent of delivery gaps had demonstrated improvement. The CDVC framework proved to be valuable in the following ways. First, it facilitated the first comprehensive mapping of HIV/AIDS services in the Kara region of Togo. Second, it enabled the identification of gaps or insufficiencies in the currently available services across the full continuum of care. Third, it catalyzed the creation of a strategic QI plan based on identified gaps. Research limitations/implications This case description is the authors' experience in one setting and should not be considered comparative in nature. Furthermore, the approach described may not be applicable to all initiatives and/or organizations. As described, the lack of sophisticated and comprehensive data collection systems limited the authors' ability to collect reliable data on some of the QI initiatives planned. Practical implications The operationalization of the CDVC framework is an effective approach to drive continuous QI. Originality/value Through the operationalization of the CDVC, the authors developed a new approach for assessing existing services, identifying gaps in service delivery and directing continuous QI initiatives in a strategic manner.
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Affiliation(s)
- Kevin Peter Fiori
- Hope Through Health, Medway, Massachusetts, USA.,Montefiore Medical Center, Bronx, New York, USA
| | | | | | | | | | - Spero Houndenou
- Hope Through Health/Association Espoir pour Demain, Kara, Togo
| | - Andrew Lopez
- Hope Through Health/Association Espoir pour Demain, Kara, Togo
| | | | - Lisa Hirschhorn
- Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
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Fields JA, Spencer B, Swinton M, Qvale EM, Marquine MJ, Alexeeva A, Gough S, Soontornniyomkij B, Valera E, Masliah E, Achim CL, Desplats P. Alterations in brain TREM2 and Amyloid-β levels are associated with neurocognitive impairment in HIV-infected persons on antiretroviral therapy. J Neurochem 2018; 147:784-802. [PMID: 30152135 PMCID: PMC6310632 DOI: 10.1111/jnc.14582] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
Neuroinflammation is a common pathological correlate of HIV-associated neurocognitive disorders (HAND) in individuals on antiretroviral therapy (ART). Triggering receptor expressed on myeloid cells 2 (TREM2) regulates neuroinflammation, clears extracellular Amyloid (A)-β, surveys for damaged neurons, and orchestrates microglial differentiation. TREM2 has not been studied in HIV+ brain tissues. In this retrospective study, we investigated TREM2 expression levels and localization to microglia, Aβ protein levels, and tumor necrosis factor (TNF)-α transcript levels in the frontal cortices of 52 HIV+ decedents. All donors had been on ART; 14 were cognitively normal (CN), 17 had an asymptomatic neurocognitive impairment (ANI), and 21 had a minor neurocognitive disorder (MND). Total TREM2 protein levels were increased in the soluble and decreased in the membrane-enriched fractions of MND brain tissues compared to CN; however, brains from MND Hispanics showed the most robust alterations in TREM2 as well as significantly increased TNF-α mRNA and Aβ levels when compared to CN Hispanics. Significant alterations in the expression of total TREM2 protein and transcripts for TNF-α were not observed in non-Hispanics, despite higher levels of Aβ in the non-Hispanic CN group compared to the non-Hispanic MND groups. These findings show that decreased and increased TREM2 in membrane-bound fractions and in soluble-enriched fractions, respectively, is associated with increased Aβ and neuroinflammation in this cohort of HIV+ brains, particularly those identifying as Hispanics. These findings suggest a role for TREM2 in the brain of HIV+ individuals may deserve more investigation as a biomarker for HAND and as a possible therapeutic target. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/.
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Affiliation(s)
- Jerel Adam Fields
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Brian Spencer
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Mary Swinton
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Emma Martine Qvale
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - María J. Marquine
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Arina Alexeeva
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Sarah Gough
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Benchawanna Soontornniyomkij
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Elvira Valera
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Eliezer Masliah
- Department of Pathology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Cristian L. Achim
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
- Department of Pathology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Paula Desplats
- Department of Pathology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
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Page KR, Grieb SD, Nieves-Lugo K, Yamanis T, Taylor H, Martinez O, Yamasaki Y, Limaye R, Davis W, Beyrer C, Zea MC. Enhanced immigration enforcement in the USA and the transnational continuity of HIV care for Latin American immigrants in deportation proceedings. Lancet HIV 2018; 5:e597-e604. [PMID: 29997050 PMCID: PMC6211169 DOI: 10.1016/s2352-3018(18)30074-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
In our work as clinicians, researchers, and immigrant rights advocates, we have noted increased anxiety about the possibility of deportation and disruptions in care among immigrants with HIV. Before the 2016 US elections, patients rarely asked about HIV treatment in their home countries. However, since the increase in anti-immigrant rhetoric and arrests by US Immigration and Customs Enforcement, patients have voiced concerns about the availability of HIV treatment in their home countries much more frequently. Although antiretroviral therapy is available throughout Latin America, access depends on economic, social, and political circumstances. Maintaining uninterrupted continuity of care among immigrants held in detention or deported to their home countries is challenging. In this Viewpoint, we identify periods of particular vulnerability for immigrants during deportation proceedings, from initial detention to deposition in their country of origin. We discuss the effect of enhanced immigration enforcement on the health and wellbeing of HIV-infected immigrants, and on public health. Finally, we also discuss recommendations for clinicians, immigration authorities, and public health institutions in the USA and in receiving countries.
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Affiliation(s)
- Kathleen R Page
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Suzanne Dolwick Grieb
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Holly Taylor
- Bloomberg Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Rupali Limaye
- Bloomberg Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Chris Beyrer
- Bloomberg Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Levison JH, Levinson JK, Alegría M. A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care. AIDS Behav 2018; 22:2500-2512. [PMID: 29948334 DOI: 10.1007/s10461-018-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
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Taveras J, Trepka MJ, Madhivanan P, Gollub EL, Devieux J, Ibrahimou B. HIV Testing Behaviors Among Latina Women Tested for HIV in Florida, 2012. HISPANIC HEALTH CARE INTERNATIONAL 2018; 15:27-34. [PMID: 28558511 DOI: 10.1177/1540415317696196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection but also underuse HIV prevention services, such as HIV testing. METHOD HIV testing events were examined to describe the HIV testing behaviors and test results among Latinas tested in 2012 at publicly funded sites in Florida, United States. Multivariable logistic regression was used to assess the demographic characteristics associated with reports of previous testing and positive HIV test results. RESULTS Of the 184,037 testing events, 87,569 (45.6%) were among non-Hispanic Blacks (NHBs), 47,926 (26.0%) non-Hispanic Whites (NHWs), 41,117 (22.3%) Latinas, 5,672 (3.1%) those with unknown race/ethnicity, and 1,753 (1.0%) other racial/ethnic groups. Compared to NHW and NHB women, Latinas testing for HIV were older (mean age = 32.1, NHW = mean age 30.3, NHB = mean age 30.0; p < .0001). Results indicated that women who reported previous HIV testing had decreased odds of being Latina (adjusted odds ratio = 0.90; 95% confidence interval [0.87, 0.94]). CONCLUSION These findings indicate that Latinas are underusing HIV testing, and efforts are needed to increase the proportion of Latinas, especially younger Latinas, tested for HIV in Florida.
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Marquine MJ, Heaton A, Johnson N, Rivera-Mindt M, Cherner M, Bloss C, Hulgan T, Umlauf A, Moore DJ, Fazeli P, Morgello S, Franklin D, Letendre S, Ellis R, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor N, Simpson D, McCutchan JA, Grant I, Heaton RK. Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States. J Int Neuropsychol Soc 2018; 24:163-175. [PMID: 28874213 PMCID: PMC5777885 DOI: 10.1017/s1355617717000832] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. METHODS Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. RESULTS Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13-2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11-5.29; p=.03). CONCLUSIONS HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163-175).
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Affiliation(s)
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego
| | - Neco Johnson
- Advancing Diversity through Aging Research (ADAR) Program, San Diego State University
| | | | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego
| | - C. Bloss
- Department of Psychiatry, University of California, San Diego
| | - T. Hulgan
- Department of Medicine, Vanderbilt University
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego
| | - Pariya Fazeli
- Department of Psychology, University of Alabama Birmingham
| | | | - Donald Franklin
- Department of Psychiatry, University of California, San Diego
| | - Scott Letendre
- Department of Medicine, University of California, San Diego
| | - Ron Ellis
- Department of Neurosciences, University of California, San Diego
| | | | | | - David. B. Clifford
- Department of Neurology, University of Washington
- Department of Medicine, University of Washington
| | | | - Ned Sacktor
- Department of Neurology, Johns Hopkins University
| | | | | | - Igor Grant
- Department of Psychiatry, University of California, San Diego
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Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities. J Acquir Immune Defic Syndr 2017; 75:290-298. [PMID: 28368951 DOI: 10.1097/qai.0000000000001385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS), and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes. METHODS We used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N = 1181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures were ART pharmacy fill and HIV viral load laboratory data extracted from the medical records over 3 years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved 3-stage, multivariable logistic regression with generalized estimating equations. RESULTS Overall, the intervention predicted greater odds of ART use (odds ratio [OR] = 2.50; 95% confidence interval: 2.29 to 2.73; P < 0.001) and VS (OR = 1.12; 95% confidence interval: 1.04 to 1.21; P < 0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Before the intervention, there were significant black/white disparities in ART use OR = 0.75 (0.58-0.98; P = 0.04) and VS OR = 0.75 (0.61-0.92; P = 0.001). After the intervention, the black/white disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than whites of ART use and VS, adjusting for covariates. CONCLUSIONS The intervention improved overall ART treatment and VS, and reduced black/white disparities. LHIE interventions may hold promise if implemented among similar patients.
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Chen Z, Klimentidis YC, Bea JW, Ernst KC, Hu C, Jackson R, Thomson CA. Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative. J Am Geriatr Soc 2017; 65:1907-1915. [PMID: 28229456 PMCID: PMC5569001 DOI: 10.1111/jgs.14790] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women. DESIGN Prospective cohort study of multiethnic postmenopausal women. SETTING Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics. PARTICIPANTS Postmenopausal women aged 50-79 participating in WHI (N = 161,808). MEASUREMENTS Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years. RESULTS Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups. CONCLUSION Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.
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Affiliation(s)
- Zhao Chen
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Epidemiology & Biostatistics Tucson, AZ, USA
| | - Yann C. Klimentidis
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Epidemiology & Biostatistics Tucson, AZ, USA
| | | | - Kacey C. Ernst
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Epidemiology & Biostatistics Tucson, AZ, USA
| | - Chengcheng Hu
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Epidemiology & Biostatistics Tucson, AZ, USA
| | - Rebecca Jackson
- Ohio State University, The Center for Clinical and Translational Science Columbus, OH, USA
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Rowell-Cunsolo TL, Cortes YI, Long Y, Castro-Rivas E, Liu J. Acceptability of Rapid HIV Testing Among Latinos in Washington Heights, New York City, New York, USA. J Immigr Minor Health 2017; 19:861-867. [PMID: 27815664 PMCID: PMC5418111 DOI: 10.1007/s10903-016-0525-9] [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: 12/01/2022]
Abstract
In the United States, human immunodeficiency virus (HIV) has a disproportionately large impact on Latino Americans. This study assessed the acceptability of rapid HIV testing among a sample of Latinos from New York City. A cross-sectional study was conducted with 192 participants from The Washington Heights/Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research (WICER) study. Participants were interviewed and offered rapid HIV testing and post-test counseling. Seventy-five percent (n = 143) accepted rapid HIV testing when offered. More religious participants were less likely than less religious participants to undergo testing (RR = 0.73; 95% CI 0.54-0.99). Participants tested for HIV within the past year were less likely than those who had not been tested within the past year to agree to undergo testing (RR = 0.27; 95% CI 0.11-0.66). Community-based rapid HIV testing is feasible among Latinos in urban environments. Outreach efforts to engage religious individuals and encouraging routine testing should be reinforced.
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Affiliation(s)
| | - Yamnia I Cortes
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yue Long
- Graduate School of Arts and Science, Columbia University, New York, NY, USA
| | - Erida Castro-Rivas
- School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA
| | - Jianfang Liu
- School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA
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Grieb SD, Flores-Miller A, Gulledge N, Clifford R, Page K. ¡Vive!: Designing an Intervention to Improve Timely HIV Diagnosis Among Latino Immigrant Men. Prog Community Health Partnersh 2017; 10:365-372. [PMID: 28230544 DOI: 10.1353/cpr.2016.0043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Latinos, particularly immigrant men, are more likely to present late to care for human immunodeficiency virus (HIV) infection. OBJECTIVES This manuscript describes the development of ¡Sólo Se Vive Una Vez! (¡Vive!) (You Only Live Once), a multilevel (individual and community) intervention aimed at increasing HIV testing. METHODS A partnership was established between the Baltimore Latino outreach team, a community coalition, designers, and academics. Intervention priorities were identified through a nominal group technique process. Design students then developed intervention material through an iterative process including feedback from the partners and 75 Latino immigrant men who participated in focus group discussions. RESULTS ¡Vive! is composed of nine motion graphic modules that can be individually tailored and delivered through a tablet or cell phone, and a complementary social marketing campaign to address HIV stigma in the community. CONCLUSIONS An iterative process with ongoing feedback resulted in intervention components that were engaging and appealing, and reflected the community's experience.
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¡Sólo Se Vive Una Vez! (You Only Live Once): A Pilot Evaluation of Individually Tailored Video Modules Aiming to Increase HIV Testing Among Foreign-Born Latino Men. J Acquir Immune Defic Syndr 2017; 74 Suppl 2:S104-S112. [PMID: 28079720 DOI: 10.1097/qai.0000000000001239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although Latinos living in the United States are disproportionately affected by HIV, the development, implementation, and evaluation of HIV prevention, testing, and linkage to care interventions lag behind efforts occurring in other communities. To address sociocultural barriers to testing, we developed a multilevel intervention. This study is a pilot evaluation of the individual-level component of the intervention-animated video modules that address specific barriers to HIV testing common among foreign-born Latino men. METHODS We conducted a survey assessing HIV risk and barriers to testing with a convenience sample of 104 foreign-born Latino men in Baltimore, MD, who had not tested for HIV within the past year. Intention to test in the next 3 months was measured before and after viewing an intervention module selected based on survey responses. RESULTS Fifty-two (50.0%) participants had never tested for HIV. Of the participants who had previously tested for HIV, the mean time since their last test was 3.48 years (SD = 3.55). Participants' intention to test for HIV significantly increased after watching the module (t = -8.28, P < 0.001). Increased intention to test was not associated with any socio-demographic characteristics (ie, age, country of origin) or reported sexual behaviors (ie, number of sex partners in the past year). DISCUSSION These results suggest that our culturally sensitive, individually tailored intervention can be an additional tool to encourage HIV testing among previously untested foreign-born Latino men, one of the demographic groups at highest risk for delayed HIV diagnosis in the United States.
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Sepúlveda-Torres LDC, Rishishwar L, Rogers ML, Ríos-Olivares E, Boukli N, Jordan IK, Cubano LA. A decade of viral mutations and associated drug resistance in a population of HIV-1+ Puerto Ricans: 2002-2011. PLoS One 2017; 12:e0177452. [PMID: 28493944 PMCID: PMC5426751 DOI: 10.1371/journal.pone.0177452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/27/2017] [Indexed: 12/14/2022] Open
Abstract
Puerto Rico has one of the highest rates of HIV/AIDS seen for any US state or territory, and antiretroviral therapy has been a mainstay of efforts to mitigate the HIV/AIDS public health burden on the island. We studied the evolutionary dynamics of HIV-1 mutation and antiretroviral drug resistance in Puerto Rico by monitoring the population frequency of resistance-associated mutations from 2002 to 2011. Whole blood samples from 4,475 patients were analyzed using the TRUGENE HIV-1 Genotyping Kit and OpenGene DNA Sequencing System in the Immunoretrovirus Research Laboratory at Universidad Central del Caribe. Results show that 64.0% of female and 62.9% of male patients had HIV-1 mutations that confer resistance to at least one antiretroviral medication. L63P and M184V were the dominant mutations observed for the protease (PRO) and reverse transcriptase (RT) encoding genes, respectively. Specific resistance mutations, along with their associated drug resistance profiles, can be seen to form temporal clusters that reveal a steadily changing landscape of resistance trends over time. Both women and men showed resistance mutations for an average of 4.8 drugs over the 10-year period, further underscoring the strong selective pressure exerted by antiretrovirals along with the rapid adaptive response of HIV. Nevertheless, both female and male patients showed a precipitous decrease for overall drug resistance, and for PRO mutations in particular, over the entire course of the study, with the most rapid decrease in frequency seen after 2006. The reduced HIV-1 mutation and drug resistance trends that we observed are consistent with previous reports from multi-year studies conducted around the world. Reduced resistance can be attributed to the use of more efficacious antiretroviral drug therapy, including the introduction of multi-drug combination therapies, which limited the ability of the virus to mount rapid adaptive responses to antiretroviral selection pressure.
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Affiliation(s)
- Lycely del C. Sepúlveda-Torres
- Department of Microbiology and Immunology, Universidad Central del Caribe, Bayamón, Puerto Rico, United States of America
| | - Lavanya Rishishwar
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- PanAmerican Bioinformatics Institute, Cali, Valle del Cauca, Colombia
- Applied Bioinformatics Laboratory, Atlanta, Georgia, United States of America
| | - Maria Luisa Rogers
- Natural Sciences Department, Sacred Heart University, San Juan, Puerto Rico, United States of America
| | - Eddy Ríos-Olivares
- Department of Microbiology and Immunology, Universidad Central del Caribe, Bayamón, Puerto Rico, United States of America
| | - Nawal Boukli
- Department of Microbiology and Immunology, Universidad Central del Caribe, Bayamón, Puerto Rico, United States of America
| | - I. King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- PanAmerican Bioinformatics Institute, Cali, Valle del Cauca, Colombia
- Applied Bioinformatics Laboratory, Atlanta, Georgia, United States of America
| | - Luis A. Cubano
- Department of Microbiology and Immunology, Universidad Central del Caribe, Bayamón, Puerto Rico, United States of America
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Chapin-Bardales J, Rosenberg ES, Sullivan PS. Trends in racial/ethnic disparities of new AIDS diagnoses in the United States, 1984-2013. Ann Epidemiol 2017; 27:329-334.e2. [PMID: 28506566 DOI: 10.1016/j.annepidem.2017.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE In the United States, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) disproportionately impacts racial/ethnic minorities. We describe and evaluate trends in the Black-White and Hispanic-White disparities of new AIDS diagnoses from 1984 to 2013 in the United States. METHODS AIDS diagnosis rates by race/ethnicity for people ≥13 years were calculated using national HIV surveillance and Census data. Black-White and Hispanic-White disparities were measured as rate ratios. Joinpoint Regression was used to identify time periods across which to estimate rate-ratio trends. We calculated the estimated annual percent change in disparities for each time period using log-normal linear regression modeling. RESULTS Black-White disparity increased from 1984 to 1990, followed by a large increase from 1991 to 1996, and a smaller increase from 1997 to 2001. Black-White disparity moderated from 2002 to 2005 and rose again from 2006 to 2013. Hispanic-White disparity increased from 1984 to 1997 but declined after 1998. Black-White and Hispanic-White disparities increased for men who have sex with men during 2008 to 2013. CONCLUSIONS Recent increases in racial/ethnic disparities of AIDS diagnoses were observed and may be due in part to care continuum inequalities. We suggest assessing disparities in AIDS diagnoses as a high-level measure to capture changes at multiple stages of the care continuum collectively. Future research should examine determinants of racial/ethnic differences at each step of the continuum to better identify characteristics driving disparities.
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Affiliation(s)
| | - Eli Samuel Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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