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Hatef E, Richards T, Topel K, Hail S, Kitchen C, Shaw K, Zhang T, Lasser EC, Weiner JP. Piloting a Clinical Decision Support Tool to Identify Patients With Social Needs and Provide Navigation Services and Referral to Community-Based Organizations: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57316. [PMID: 39042426 PMCID: PMC11303893 DOI: 10.2196/57316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Social needs and social determinants of health (SDOH) significantly outrank medical care when considering the impact on a person's length and quality of life, resulting in poor health outcomes and worsening life expectancy. Integrating social needs and SDOH data along with clinical risk information within operational clinical decision support (CDS) systems built into electronic health records (EHRs) is an effective approach to addressing health-related social needs. To achieve this goal, applied research is needed to develop EHR-integrated CDS tools and closed-loop referral systems and implement and test them in the digital and clinical workflows at health care systems and collaborating community-based organizations (CBOs). OBJECTIVE This study aims to describe the protocol for a mixed methods study including a randomized controlled trial and a qualitative phase assessing the feasibility, acceptability, and effectiveness of an EHR-integrated digital platform to identify patients with social needs and provide navigation services and closed-loop referrals to CBOs to address their social needs. METHODS The randomized controlled trial will enroll and randomize adult patients living in socioeconomically challenged neighborhoods in Baltimore City receiving care at a single academic health care institution in the 3-month intervention (using the digital platform) or the 3-month control (standard-of-care assessment and addressing of social needs) arms (n=295 per arm). To evaluate the feasibility and acceptability of the digital platform and its impact on the clinical and digital workflow and patient care, we will conduct focus groups with the care teams in the health care system (eg, clinical providers, social workers, and care managers) and collaborating CBOs. The outcomes will be the acceptability, feasibility, and effectiveness of the CDS tool and closed-loop referral system. RESULTS This clinical trial opened to enrollment in June 2023 and will be completed in March 2025. Initial results are expected to be published in spring 2025. We will report feasibility outcome measures as weekly use rates of the digital platform. The acceptability outcome measure will be the provider's and patient's responses to the truthfulness of a statement indicating a willingness to use the platform in the future. Effectiveness will be measured by tracking a 3-month change in identified social needs and provided navigation services as well as clinical outcomes such as hospitalization and emergency department visits. CONCLUSIONS The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of such interventions in digital and clinical workflows to enhance the health care system and CBO ability related to social needs assessment and intervention. These results may inform the construction of a future multi-institutional trial designed to test the effectiveness of this intervention across different health care systems and care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05574699; https://clinicaltrials.gov/study/NCT05574699. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57316.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Thomas Richards
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kristin Topel
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sofia Hail
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, United States
| | - Christopher Kitchen
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Shaw
- Johns Hopkins Community Physicians East Baltimore Medical Center, Baltimore, MD, United States
| | - Talan Zhang
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elyse C Lasser
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jonathan P Weiner
- Center for Population Health Information Technology, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Cook BL, Rastegar J, Patel N. Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders. Med Care Res Rev 2024; 81:209-222. [PMID: 38235576 PMCID: PMC11168608 DOI: 10.1177/10775587231222583] [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: 01/19/2024]
Abstract
The intersection of social risk and race and ethnicity on mental health care utilization is understudied. This study examined disparities in health care treatment, adjusting for clinical need, among 25,780 Medicare Advantage beneficiaries with a diagnosis of a psychiatric disorder. We assessed contributions to disparities from racial and ethnic differences in the composition and returns of social risk variables. Black and Hispanic beneficiaries had lower rates of mental health outpatient visits than Whites. Assessing composition, Black and Hispanic beneficiaries experienced greater financial, food, and housing insecurity than White beneficiaries, factors associated with greater mental health treatment. Assessing returns, food insecurity was associated with an exacerbation of Hispanic-White disparities. Health care systems need to address the financial, food and housing insecurity of racial and ethnic minority groups with psychiatric disorder. Accounting for racial and ethnic differences in social risk adjustment-based payment reforms has significant implications for provider reimbursement and outcomes.
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Affiliation(s)
- Benjamin Lê Cook
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Nikesh Patel
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
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Rein SM, Lampe FC, Ingle SM, Sterne JAC, Trickey A, Gill MJ, Papastamopoulos V, Wittkop L, van der Valk M, Kitchen M, Guest JL, Satre DD, Wandeler G, Galindo P, Castilho J, Crane HM, Smith CJ. All-cause hospitalisation among people living with HIV according to gender, mode of HIV acquisition, ethnicity, and geographical origin in Europe and North America: findings from the ART-CC cohort collaboration. Lancet Public Health 2023; 8:e776-e787. [PMID: 37777287 PMCID: PMC10851157 DOI: 10.1016/s2468-2667(23)00178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Understanding demographic disparities in hospitalisation is crucial for the identification of vulnerable populations, interventions, and resource planning. METHODS Data were from the Antiretroviral Therapy Cohort Collaboration (ART-CC) on people living with HIV in Europe and North America, followed up between January, 2007 and December, 2020. We investigated differences in all-cause hospitalisation according to gender and mode of HIV acquisition, ethnicity, and combined geographical origin and ethnicity, in people living with HIV on modern combination antiretroviral therapy (cART). Analyses were performed separately for European and North American cohorts. Hospitalisation rates were assessed using negative binomial multilevel regression, adjusted for age, time since cART intitiaion, and calendar year. FINDINGS Among 23 594 people living with HIV in Europe and 9612 in North America, hospitalisation rates per 100 person-years were 16·2 (95% CI 16·0-16·4) and 13·1 (12·8-13·5). Compared with gay, bisexual, and other men who have sex with men, rates were higher for heterosexual men and women, and much higher for men and women who acquired HIV through injection drug use (adjusted incidence rate ratios ranged from 1·2 to 2·5 in Europe and from 1·2 to 3·3 in North America). In both regions, individuals with geographical origin other than the region of study generally had lower hospitalisation rates compared with those with geographical origin of the study country. In North America, Indigenous people and Black or African American individuals had higher rates than White individuals (adjusted incidence rate ratios 1·9 and 1·2), whereas Asian and Hispanic people living with HIV had somewhat lower rates. In Europe there was a lower rate in Asian individuals compared with White individuals. INTERPRETATION Substantial disparities exist in all-cause hospitalisation between demographic groups of people living with HIV in the current cART era in high-income settings, highlighting the need for targeted support. FUNDING Royal Free Charity and the National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Sophia M Rein
- CAUSALab and Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute for Global Health, UCL, London, UK.
| | | | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; Health Data Research UK South-West, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vasileios Papastamopoulos
- Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Linda Wittkop
- University of Bordeaux, INSERM, Bordeaux Population Health-U1219, CIC1401-EC, Bordeaux, France; CHU de Bordeaux-Bordeaux University Hospital, Service d'information médicale, INSERM, CIC-EC 1401, Bordeaux, Franc; SISTM, INRIA, University of Bordeaux, Talence, France
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Maria Kitchen
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Pepa Galindo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi M Crane
- Department of Medicine and Department of Health Services, University of Washington, Seattle, WA, USA
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Palar K, Sheira LA, Frongillo EA, Kushel M, Wilson TE, Conroy AA, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Tien PC, Weiser SD. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV. AIDS Behav 2023; 27:3345-3355. [PMID: 37067613 PMCID: PMC10783960 DOI: 10.1007/s10461-023-04053-9] [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: 03/29/2023] [Indexed: 04/18/2023]
Abstract
Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.
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Affiliation(s)
- Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Margot Kushel
- Division of General Internal Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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Zeien J, Vieira J, Hanna J, Ramirez A, Miller C, Hartmark-Hill J, Rosales C. Utilization of street-based COVID-19 vaccination clinics in Phoenix's homeless population. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023:2752535X231196415. [PMID: 37635377 DOI: 10.1177/2752535x231196415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The novel Coronavirus (COVID-19) is a highly contagious viral illness that has caused the most significant global health crisis in recent human history. Individuals experiencing homelessness represent one of the more vulnerable populations for COVID-19 infection and morbidity. Amongst individuals experiencing homelessness in Phoenix, a student-led interprofessional organization called Street Medicine Phoenix (SMP) sought to both reduce the risk of COVID-19 transmission and morbidity/mortality related to infection. Through collaborations with the Maricopa County Department of Public Health and various community organizations, SMP developed a format for street-based vaccination clinics. SMP deployed these clinics on numerous occasions to the streets directly surrounding the community homeless shelter, allowing SMP to vaccinate individuals directly in their encampments. Through SMP's efforts starting in February 2021, 400 individuals experiencing homelessness have received at least one COVID-19 vaccine. Challenges encountered included low health literacy, lack of established rapport and trust, low vaccine confidence, difficulty verifying patients' vaccination status, difficulty obtaining sufficient information from patients to create a record in the Arizona State Immunization Information System (ASIIS), monitoring patients post-vaccination, transporting vaccine supplies from encampment to encampment, and lack of patient awareness of the mobile vaccine clinic services. Despite challenges, SMP's outreach efforts have demonstrated the feasibility and importance of mobile public health services to reach homeless encampments, particularly mobile vaccination clinics in response to disease outbreaks, and the necessity of strategic partnerships with community agencies to effectively meet the needs of underserved populations.
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Affiliation(s)
- Justin Zeien
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jaime Vieira
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Jeffery Hanna
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | - Alma Ramirez
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | - Catherine Miller
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | | | - Cecilia Rosales
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
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Bleasdale J, Liu Y, Leone LA, Morse GD, Przybyla SM. The impact of food insecurity on receipt of care, retention in care, and viral suppression among people living with HIV/AIDS in the United States: a causal mediation analysis. Front Public Health 2023; 11:1133328. [PMID: 37601182 PMCID: PMC10433761 DOI: 10.3389/fpubh.2023.1133328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Attaining The Joint United Nations Programme on HIV/AIDS 95-95-95 targets to end the HIV epidemic by 2030 will require a greater understanding of the underlying mechanisms influencing care engagement among people living with HIV/AIDS (PLWHA). One such mechanism is food insecurity, defined as limited or uncertain access to food. Food insecurity has been shown to significantly impact HIV outcomes. Yet, few studies have examined the mechanisms through which food insecurity may influence these outcomes. We aimed to examine the effects of nutritional, behavioral, and mental health mechanisms through which food insecurity may impact HIV care continuum outcomes: receipt of care, retention in care, and viral suppression. Methods We conducted a cross-sectional study of 200 PLWHA in New York State, United States from May-August 2022. Participants were recruited using convenience sampling methods. Multivariable logistic regression models were conducted to examine the associations between food insecurity and care continuum outcomes (receipt of care, retention in care, viral suppression), adjusting for age, race, ethnicity, education, income, and marital status. Individual causal mediation analyses were conducted to assess whether behavioral, mental health, and nutritional mechanisms mediated the hypothesized associations. Results The median age of participants was 30 years (IQR: 27-37 years). The majority self-identified as Black (54.0%), male (55.5%) and straight/heterosexual (63.0%). Increasing severity of food insecurity was associated with greater odds of non-retention in care (aOR: 1.35, 95% CI: 1.07, 1.70) and viral non-suppression (aOR: 1.29, 95% CI: 1.08, 1.54). For the impact of food insecurity on non-retention in care, there was an indirect relationship (natural indirect effect; NIE) mediated through Body Mass Index (BMI) (ORNIE: 1.08, 95% CI: 1.00, 1.18). For viral non-suppression, there was an indirect relationship mediated through BMI (ORNIE: 1.07, 95% CI: 1.00,1.16) and an indirect relationship mediated through depression (ORNIE: 1.27, 95% CI: 1.07, 1.47). Discussion Food insecurity was associated with greater odds of non-retention in care and viral non-suppression among PLWHA. Nutritional and mental health pathways are important mediators of these relationships. Results highlight the need for interventions to target these pathways to address food insecurity as an underlying mechanism influencing engagement in HIV care.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
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Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco. J Urban Health 2023; 100:303-313. [PMID: 36652157 PMCID: PMC9848030 DOI: 10.1007/s11524-022-00705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 01/19/2023]
Abstract
In this study, we consider the patient, provider, and public health repercussions of San Francisco's (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020-2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.
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Tanner AE, Palakshappa D, Morse CG, Mann-Jackson L, Alonzo J, Garcia M, Wright E, Dharod A, Isom S, Sucaldito AD, Aviles LR, Rhodes SD. Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure. Trials 2022; 23:998. [PMID: 36510319 PMCID: PMC9743787 DOI: 10.1186/s13063-022-06924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM). METHODS In Aim 1, we will recruit a longitudinal cohort of 1800 adult (≥18 years) PWH from our clinic-based population to determine the difference in the prevalence and incidence of cardiometabolic comorbidities between food-secure and food-insecure PWH. Food insecurity screening, indicators of cardiometabolic comorbidities, and other characteristics documented in the electronic health record (EHR) will be collected annually for up to 3 years from this cohort. In Aim 2, we will conduct a randomized controlled trial among a sample of food-insecure PWH who have prediabetes or T2DM to compare changes in insulin sensitivity over 6 months between participants in weCare/Secure and participants receiving usual care. In Aim 3, we will conduct semi-structured individual in-depth interviews to explore the effect of the intervention among intervention participants with varying insulin sensitivity outcomes. TRIAL STATUS Aim 1 (longitudinal cohort) recruitment began in May 2022 and is ongoing. Aim 2 (intervention) recruitment is planned for spring 2023 and is expected to be completed in spring 2024. Aim 3 (process evaluation) data collection will occur after sufficient completion of the 6-month assessment in Aim 2. Final results are anticipated in fall 2025. CONCLUSIONS This research seeks to advance our understanding of how food insecurity impacts the development of cardiometabolic comorbidities among PWH and how food insecurity interventions may alleviate relevant comorbidities. Given the growing interest among health systems in addressing food insecurity, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04943861 . Registered on June 29, 2021.
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Affiliation(s)
- Amanda E. Tanner
- grid.266860.c0000 0001 0671 255XDepartment of Public Health Education, University of North Carolina Greensboro, Coleman 437E, Greensboro, NC 27402 USA
| | - Deepak Palakshappa
- grid.241167.70000 0001 2185 3318Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Caryn G. Morse
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lilli Mann-Jackson
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jorge Alonzo
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Manuel Garcia
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Elena Wright
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ajay Dharod
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott Isom
- grid.241167.70000 0001 2185 3318Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ana D. Sucaldito
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lucero Refugio Aviles
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott D. Rhodes
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
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9
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Power J, Lea T, Melendez-Torres GJ, Lyons A, Norman T, Hill AO, Bourne A. Health literacy, financial insecurity and health outcomes among people living with HIV in Australia. Health Promot Int 2022; 37:6823574. [DOI: 10.1093/heapro/daac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Summary
It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant’s confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Toby Lea
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
- Centre for Social Research in Health, UNSW Sydney , John Goodsell Building, Sydney, NSW , Australia
| | | | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University , Building NR6, Bundoora, Melbourne , Australia
- Kirby Institute, UNSW , Wallace Wurth Building, Kensington, NSW , Australia
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10
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Mullady SSS, Castellanos S, Lopez L, Aguirre G, Weeks J, King S, Valle K, Goode C, Tsoy E, Possin K, Miller B, Kushel M, Lanata S. Neurocognitive health of older adults experiencing homelessness in Oakland, California. Front Neurol 2022; 13:905779. [PMID: 35937073 PMCID: PMC9353024 DOI: 10.3389/fneur.2022.905779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background and objectives The homeless population in the US is aging. Cognitive impairment is prevalent in this population, yet little is known about the neurologic etiologies of such impairment. Addressing this gap in knowledge is important because homeless older adults with cognitive impairment due to neurodegenerative disease may need lifelong tailored support to obtain and maintain housing. In this study, we characterized the neurocognitive health of a sample of adults who experienced homelessness for the first time after age 50 using gold standard behavioral neurology examination practices. Methods We conducted a descriptive cross-sectional study of older adults who first experienced homelessness after age 50. We recruited our sample purposively from an ongoing longitudinal cohort study of adults who were aged 50 and over and homeless when they entered the cohort. For this sub study, we enrolled a convenience sample from those who reported their first episode of homelessness after age 50. We did not exclude individuals based on history of substance use. Neurologists conducted a structured neurocognitive history intake, neurological examination, neuropsychological evaluation, and functional assessment between November 2020 and February 2021. We screened all participants for neurocognitive disorders using gold standard clinical research diagnostic criteria. Results We evaluated 25 participants, most were men (76%) and Black (84%), with a median age of 61 years. The most common neurocognitive complaints included deficits in recent episodic memory (n = 15, 60%), executive functions (n = 13, 52%), and behavior/mood, with apathy being the most common complaint (n = 20, 80%). Neuropsychological testing revealed a high prevalence of socioemotional deficits (n = 20, 80%). Common neurological examination deficits included difficulties with coordination, such as impaired Luria task (n = 16, 64%), signs of distal peripheral neuropathy (n = 8, 32%), anosmia/hyposmia (n = 4, 21%), and signs of mild Parkinsonism (n = 5, 20%). The most common diagnoses were MCI (n = 7, 28%), bvFTD (n = 4, 16%), AD (n = 4, 16%), and DLB (n = 2, 8%). Discussion Our findings suggest that neurocognitive concerns and examination deficits are common among older homeless adults. Specific neurocognitive disorders may be overrepresented in this population, particularly frontotemporal disorders. Longitudinal studies involving brain biomarkers are needed to characterize the neurocognitive health of this vulnerable population more precisely.
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Affiliation(s)
- Sandeepa Satya-Sriram Mullady
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Sandeepa Satya-Sriram Mullady
| | - Stacy Castellanos
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Gloria Aguirre
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - John Weeks
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen King
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Karen Valle
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Collette Goode
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Possin
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Kushel
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,Serggio Lanata
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11
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Assessing the Health Outcomes of the Food Access Pilot Project: An Evaluation of a Medically Supportive Food Support Program for People Living with HIV in Rural California Counties. AIDS Behav 2022; 26:2613-2622. [PMID: 35122577 PMCID: PMC9252945 DOI: 10.1007/s10461-022-03589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/08/2022]
Abstract
Food insecurity disproportionately affects rural communities and people living with HIV (PLHIV). The Food Access Pilot Project (FAPP) was a California state-funded program that provided home-delivered, medically supportive meals via online meal vendors to food-insecure PLHIV in three rural counties. We performed longitudinal, retrospective analyses of FAPP participant data (n = 158; 504 and 460 person-time observations for viral load and CD4 count, respectively) over 36 months from a Ryan White client management database. Pre-post analyses demonstrated increased prevalence of food security and CD4 ≥ 500 between baseline and 12 months. Population-averaged trends using generalized estimating equations adjusted for participant demographics demonstrated increased odds of viral suppression and CD4 ≥ 500, and increased CD4 count (cells/mm3) for every six months of program enrollment. Home-delivered, medically supportive meals may improve food security status, HIV viral suppression, and immune health for low-income PLHIV in rural settings.
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12
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Jolayemi O, Bogart LM, Storholm ED, Goodman-Meza D, Rosenberg-Carlson E, Cohen R, Kao U, Shoptaw S, Landovitz RJ. Perspectives on preparing for long-acting injectable treatment for HIV among consumer, clinical and nonclinical stakeholders: A qualitative study exploring the anticipated challenges and opportunities for implementation in Los Angeles County. PLoS One 2022; 17:e0262926. [PMID: 35113892 PMCID: PMC8812879 DOI: 10.1371/journal.pone.0262926] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/09/2022] [Indexed: 01/01/2023] Open
Abstract
Long-acting injectable (LAI) antiretroviral therapy (ART) is a novel HIV treatment option for people with HIV. The first LAI ART regimen for HIV treatment received regulatory approval in the United States in January 2021. In February 2020, we collected qualitative data from 18 consumers and 23 clinical and non-clinical stakeholders to catalog anticipated individual-consumer, healthcare system, and structural levels barriers and facilitators to LAI ART implementation in Los Angeles County, California. Thematic analysis was guided by the CFIR implementation science model. CFIR constructs of intervention characteristics, individual characteristics, outer and inner setting, intervention characteristics, and implementation process emerged in analysis. Under intervention characteristics, anticipated facilitators included the relative advantage of LAI ART over pills for adherence and reduced treatment management burden and related anxiety; anticipated barriers included non-adherence to injection appointments, concerns of developing HIV resistance, discomfort with injection and cost. Anticipated facilitators based on individual characteristics included overall acceptability based on knowledge and positive beliefs about LAI ART. Participant noted several characteristics of the outer setting that could negatively impact implementation, such as medical mistrust, external policies, and LAI ART eligibility (i.e., to be virally suppressed prior to initiation). Participants were optimistic about the potential to decrease stigma but expressed that provider willingness for adoption could be hindered by challenges in organizational inner setting related to payment authorizations, increased staffing needs, medication procurement and storage, and provider and healthcare system readiness. Results from this pre-implementation study may inform rollout and scale-up of LAI ART in Los Angeles County.
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Affiliation(s)
- Oluwadamilola Jolayemi
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA, United States of America
| | - Erik D. Storholm
- RAND Corporation, Santa Monica, CA, United States of America
- School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Elena Rosenberg-Carlson
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Rebecca Cohen
- Division of HIV and STD Programs, County of Los Angeles Department of Public Health, Los Angeles, CA, United States of America
| | - Uyen Kao
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Raphael J. Landovitz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Center for Clinical AIDS Research and Education, University of California, Los Angeles, CA, United States of America
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13
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Nagata JM, Ganson KT, Cattle CJ, Whittle HJ, Tsai AC, Weiser SD. Food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic. Public Health Nutr 2022; 25:76-81. [PMID: 34261566 PMCID: PMC8367866 DOI: 10.1017/s1368980021003001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the association between food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic. DESIGN Cross-sectional study. Multiple logistic regression models were used to estimate the associations between food insufficiency and mental health service utilisation. SETTING US Census Household Pulse Survey data collected in October 2020. PARTICIPANTS Nationally representative sample of 68 611 US adults. RESULTS After adjusting for sociodemographic factors, experiencing food insufficiency was associated with higher odds of unmet mental health need (adjusted OR (AOR) 2·90; 95 % CI 2·46, 3·43), receiving mental health counselling or therapy (AOR 1·51; 95 % CI 1·24, 1·83) and psychotropic medication use (AOR 1·56; 95 % CI 1·35, 1·80). Anxiety and depression symptoms mediated most of the association between food insufficiency and unmet mental health need but not the associations between food insufficiency and either receiving mental health counselling/therapy or psychotropic medication use. CONCLUSIONS Clinicians should regularly screen patients for food insufficiency, especially in the wake of the COVID-19 pandemic. Expanding access to supplemental food programmes may help to mitigate the need for higher mental health service utilisation during the COVID-19 pandemic.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA94158, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA94158, USA
| | - Henry J Whittle
- Division of Psychiatry, University College London, London, UK
| | - Alexander C Tsai
- Center for Global Health, Mongan Institute, Massachusetts General Hospital; Harvard Medical School, Boston, MA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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14
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Estrella A, Scheidell J, Khan M, Castelblanco D, Mijanovich T, Lee DC, Gelberg L, Doran KM. Cross-sectional Analysis of Food Insecurity and Frequent Emergency Department Use. West J Emerg Med 2021; 22:911-918. [PMID: 35354018 PMCID: PMC8328160 DOI: 10.5811/westjem.2021.3.50981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/08/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients. METHODS We completed survey questionnaires with randomly sampled adult patients from an urban public hospital ED (n = 2,312). We assessed food insecurity using four questions from the United States Department of Agriculture Household Food Security Survey. The primary independent variable was any food insecurity, defined as an affirmative response to any of the four items. Frequent ED use was defined as self-report of ≥4 ED visits in the past year. We examined the relationship between patient food insecurity and frequent ED use using bivariate and multivariable analyses and examined possible mediation by anxiety/depression and overall health status. RESULTS One-third (30.9%) of study participants reported frequent ED use, and half (50.8%) reported any food insecurity. Prevalence of food insecurity was higher among frequent vs. non-frequent ED users, 62.8% vs 45.4% (P <0.001). After controlling for potential confounders, food insecurity remained significantly associated with frequent ED use (adjusted odds ratio 1.48, 95% confidence interval, 1.20-1.83). This observed association was partially attenuated when anxiety/depression and overall health status were added to models. CONCLUSION The high observed prevalence of food insecurity suggests that efforts to improve care of ED patients should assess and address this need. Further research is needed to assess whether addressing food insecurity may play an important role in efforts to reduce frequent ED use for some patients.
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Affiliation(s)
- Alex Estrella
- UMMS-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Joy Scheidell
- New York University School of Medicine, NYU Langone Health, Department of Population Health, New York, New York
| | - Maria Khan
- New York University School of Medicine, NYU Langone Health, Department of Population Health, New York, New York
| | - Donna Castelblanco
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Tod Mijanovich
- New York University Steinhardt School of Culture, Education, and Human Development, Department of Applied Statistics, Social Science, and Humanities, New York, New York
| | - David C Lee
- New York University School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, Department of Family Medicine, Los Angeles, California.,UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Office of Healthcare Transformation and Innovation, Los Angeles, California
| | - Kelly M Doran
- New York University School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
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15
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Jia J, Fung V, Meigs JB, Thorndike AN. Food Insecurity, Dietary Quality, and Health Care Utilization in Lower-Income Adults: A Cross-Sectional Study. J Acad Nutr Diet 2021; 121:2177-2186.e3. [PMID: 34247978 DOI: 10.1016/j.jand.2021.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Food insecurity and poor nutrition are prevalent in the United States and associated with chronic diseases. Understanding relationships among food insecurity, diet, and health care utilization can inform strategies to reduce health disparities. OBJECTIVE Our aim was to determine associations between food security status and inpatient and outpatient health care utilization and whether they differed by dietary quality in lower-income adults. DESIGN This was a cross-sectional study of data from the 2009-2016 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Participants were 13,956 lower-income (<300% federal poverty level) adults 18 years and older in the United States. MAIN OUTCOME MEASURES Self-reported health care utilization in the past 12 months included no usual source of care, any outpatient visit, any mental health service use, and any hospitalization. STATISTICAL ANALYSES Multiple logistic regression was used to study the association between food insecurity and health care utilization. Analyses were stratified by diet-related comorbidities to account for potential confounding and mediation of health care utilization, and by dietary quality. RESULTS In a sample of lower-income adults <300% federal poverty level, 4,319 participants (27.4%) were food insecure, 2,208 (15.0%) were marginally food secure, and 7,429 (57.6%) were food secure. Food insecurity was associated with having no usual source of care (adjusted odds ratio [aOR] 1.30; 95% CI 1.11 to 1.52), any mental health service use (aOR 2.02; 95% CI 1.61 to 2.52), and any hospitalization (aOR 1.19; 95% CI 1.01 to 1.41). Food-insecure adults were more likely to report no outpatient visits if they had diet-related comorbidities (aOR 1.45; 95% CI 1.10 to 1.92) or the lowest dietary quality (aOR 1.53; 95% CI 1.06 to 2.23). Marginal food security was associated with having no usual source of care (aOR 1.22; 95% CI 1.04 to 1.44). CONCLUSIONS Adults with food insecurity were more likely to be hospitalized, use mental health services, and have no usual source of care. Food-insecure participants with diet-related comorbidities or poor diet were less likely to have outpatient visits. Hospitalizations and mental health visits represent underused opportunities to identify and address food insecurity and dietary intake in lower-income patients.
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Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - James B Meigs
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Harvard University, Boston, MA
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16
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Derose KP, Fulcar MA, Acevedo R, Armenta G, Jiménez-Paulino G, Bernard CL, del Rosario LEP, Then-Paulino A. An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:187-201. [PMID: 34014110 PMCID: PMC8274817 DOI: 10.1521/aeap.2021.33.3.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.
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Affiliation(s)
- Kathryn P. Derose
- RAND Corporation, Santa Monica, CA, USA
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Gipsy Jiménez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
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17
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Wiens K, Nisenbaum R, Sucha E, Aubry T, Farrell S, Palepu A, Duhoux A, Gadermann A, Hwang SW. Does Housing Improve Health Care Utilization and Costs? A Longitudinal Analysis of Health Administrative Data Linked to a Cohort of Individuals With a History of Homelessness. Med Care 2021; 59:S110-S116. [PMID: 33710082 DOI: 10.1097/mlr.0000000000001379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals who are homeless have complex health care needs, which contribute to the frequent use of health services. In this study, we investigated the relationship between housing and health care utilization among adults with a history of homelessness in Ontario. METHODS Survey data from a 4-year prospective cohort study were linked with administrative health records in Ontario. Annual rates of health encounters and mean costs were compared across housing categories (homeless, inconsistently housed, housed), which were based on the percentage of time an individual was housed. Generalized estimating equations were applied to estimate the average annual effect of housing status on health care utilization and costs. RESULTS Over the study period, the proportion of individuals who were housed increased from 37% to 69%. The unadjusted rates of ambulatory care visits, prescription medications, and laboratory tests were highest during person-years spent housed or inconsistently housed and the rate of emergency department visits was lowest during person-years spent housed. Following adjustment, the rate of prescription claims remained higher during person-years spent housed or inconsistently housed compared with the homeless. Rate ratios for other health care encounters were not significant (P>0.05). An interaction between time and housing status was observed for total health care costs; as the percentage of days housed increased, the average costs increased in year 1 and decreased in years 2-4. CONCLUSIONS These findings highlight the effects of housing on health care encounters and costs over a 4-year study period. The rate of prescription medications was higher during person-years spent housed or inconsistently housed compared with the homeless. The cost analysis suggests that housing may reduce health care costs over time; however, future work is needed to confirm the reason for the reduction in total costs observed in later years.
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Affiliation(s)
- Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Ewa Sucha
- Institute for Clinical Evaluative Sciences
| | - Tim Aubry
- School of Psychology
- Centre for Research on Educational and Community Services, University of Ottawa
| | | | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital
- Division of General Internal Medicine, University of British Colombia, Vancouver, BC
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, QC
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital
- School of Population and Public Health, University of British Colombia, Vancouver, BC
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
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18
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Stewart A, Antoniou T, Graves E, Plumptre L, Carusone SC. Health care utilization in medically complex people living with HIV before and after admission to an HIV-specific community facility: a pre-post comparison study. CMAJ Open 2021; 9:E460-E465. [PMID: 33958381 PMCID: PMC8157977 DOI: 10.9778/cmajo.20200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People living with HIV and multiple comorbidities have high rates of health service use. This study evaluates system usage before and after admission to a community facility focused on HIV care. METHODS We used Ontario administrative health databases to conduct a pre-post comparison of rates and costs of hospital admissions, emergency department visits, and family physician and home care visits among medically complex people with HIV in the year before and after admission to Casey House, an HIV-specific hospital in Toronto, for all individuals admitted between April 2009 and March 2015. Negative binomial regression was used to compare rates of health care utilization. We used Wilcoxon rank sum tests to compare associated health care costs, standardized to 2015 Canadian dollars. To contextualize our findings, we present rates and costs of health service use among Ontario residents living with HIV. RESULTS During the study period, 268 people living with HIV were admitted to Casey House. Emergency department use declined from 4.6 to 2.5 visits per person-year (p = 0.02) after discharge from Casey House, and hospitalization rates declined from 1.4 to 1.1 admissions per person-year (p = 0.05). Conversely, home care visits increased from 24.3 to 35.6 visits per person-year (p = 0.01) and family physician visits increased from 18.3 to 22.6 visits per person-year (p < 0.001) in the year after discharge. These changes were associated with reduced overall costs to the health care system. The reduction in overall costs was not significant (p = 0.2); however, costs of emergency department visits (p < 0.001) and physician visits (p < 0.001) were significantly less. INTERPRETATION Health care utilization by people with HIV was significantly different before and after admission to a community hospital focused on HIV care. This has implications for health care in other complex patient populations.
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Affiliation(s)
- Ann Stewart
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont.
| | - Tony Antoniou
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
| | - Erin Graves
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
| | - Lesley Plumptre
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
| | - Soo Chan Carusone
- Department of Family and Community Medicine (Stewart, Antoniou), St. Michael's Hospital, University of Toronto; Li Ka Shing Knowledge Institute (Antoniou), St. Michael's Hospital; ICES (Antoniou, Graves, Plumptre); Casey House (Chan Carusone), Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Chan Carusone), McMaster University, Hamilton, Ont
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19
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Rein SM, Lampe FC, Johnson MA, Bhagani S, Miller RF, Chaloner C, Phillips AN, Burns FM, Smith CJ. All-cause hospitalization according to demographic group in people living with HIV in the current antiretroviral therapy era. AIDS 2021; 35:245-255. [PMID: 33170817 PMCID: PMC7810421 DOI: 10.1097/qad.0000000000002750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We investigated differences in all-cause hospitalization between key demographic groups among people with HIV in the UK in the current antiretroviral therapy (ART) era. DESIGN/METHODS We used data from the Royal Free HIV Cohort study between 2007 and 2018. Individuals were classified into five groups: MSM, Black African men who have sex with women (MSW), MSW of other ethnicity, Black African women and women of other ethnicity. We studied hospitalizations during the first year after HIV diagnosis (Analysis-A) separately from those more than one year after diagnosis (Analysis-B). In Analysis-A, time to first hospitalization was assessed using Cox regression adjusted for age and diagnosis date. In Analysis-B, subsequent hospitalization rate was assessed using Poisson regression, accounting for repeated hospitalization within individuals, adjusted for age, calendar year, time since diagnosis. RESULTS The hospitalization rate was 30.7/100 person-years in the first year after diagnosis and 2.7/100 person-years subsequently; 52% and 13% hospitalizations, respectively, were AIDS-related. Compared with MSM, MSW and women were at much higher risk of hospitalization during the first year [aHR (95% confidence interval, 95% CI): 2.7 (1.7-4.3), 3.0 (2.0-4.4), 2.0 (1.3-2.9), 3.0 (2.0-4.5) for Black African MSW; other ethnicity MSW; Black African women; other ethnicity women respectively, Analysis-A] and remained at increased risk subsequently [corresponding aIRR (95% CI): 1.7 (1.2-2.4), 2.1 (1.5-2.8), 1.5 (1.1-1.9), 1.7 (1.2-2.3), Analysis-B]. CONCLUSION In this setting with universal healthcare, substantial variation exists in hospitalization risk across demographic groups, both in early and subsequent periods after HIV diagnosis, highlighting the need for targeted interventions.
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Affiliation(s)
| | | | | | | | - Robert F. Miller
- Institute for Global Health, UCL
- Royal Free Hampstead NHS Trust, London, UK
| | | | | | - Fiona M. Burns
- Institute for Global Health, UCL
- Royal Free Hampstead NHS Trust, London, UK
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20
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Rein SM, Smith CJ, Chaloner C, Stafford A, Rodger AJ, Johnson MA, McDonnell J, Burns F, Madge S, Miners A, Sherr L, Collins S, Speakman A, Phillips AN, Lampe FC. Prospective association of social circumstance, socioeconomic, lifestyle and mental health factors with subsequent hospitalisation over 6-7 year follow up in people living with HIV. EClinicalMedicine 2021; 31:100665. [PMID: 33554077 PMCID: PMC7846674 DOI: 10.1016/j.eclinm.2020.100665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Predictors of hospitalisation in people with HIV (PLHIV) in the contemporary treatment era are not well understood. METHODS This ASTRA sub-study used clinic data linkage and record review to determine occurrence of hospitalisations among 798 PLHIV from baseline questionnaire (February to December 2011) until 1 June 2018. Associations of baseline social circumstance, socioeconomic, lifestyle, mental health, demographic and clinical factors with repeated all-cause hospitalisation from longitudinal data were investigated using Prentice-Williams-Peterson models. Associations were also assessed in 461 individuals on antiretroviral therapy (ART) with viral load ≤50 copies/ml and CD4 count ≥500 cells/ µl. FINDINGS Rate of hospitalisation was 5.8/100 person-years (95% CI: 5.1-6.5). Adjusted for age, demographic group and time with diagnosed HIV, the following social circumstance, socioeconomic, lifestyle and mental health factors predicted hospitalisation: no stable partner (adjusted hazard ratio (aHR)=1.59; 95% CI=1.16-2.20 vs living with partner); having children (aHR=1.50; 1.08-2.10); non-employment (aHR=1.56; 1.07-2.27 for unemployment; aHR=2.39; 1.70-3.37 for sick/disabled vs employed); rented housing (aHR=1.72; 1.26-2.37 vs homeowner); not enough money for basic needs (aHR=1.82; 1.19-2.78 vs enough); current smoking (aHR=1.39; 1.02-1.91 vs never); recent injection-drug use (aHR=2.11; 1.30-3.43); anxiety symptoms (aHRs=1.39; 1.01-1.91, 2.06; 1.43-2.95 for mild and moderate vs none/minimal); depressive symptoms (aHRs=1.67; 1.17-2.38, 1.91; 1.30-2.78 for moderate and severe vs none/minimal); treated/untreated depression (aHRs=1.65; 1.03-2.64 for treated depression only, 1.87; 1.39-2.52 for depressive symptoms only; 1.53; 1.05-2.24; for treated depression and depressive symptoms, versus neither). Associations were broadly similar in those with controlled HIV and high CD4. INTERPRETATION Social circumstance, socioeconomic disadvantage, adverse lifestyle factors and poorer mental health are strong predictors of hospitalisation in PLHIV, highlighting the need for targeted interventions and care. FUNDING British HIV Association (BHIVA) Research Award (2017); SMR funded by a PhD fellowship from the Royal Free Charity.
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Affiliation(s)
- Sophia M. Rein
- Institute for Global Health, UCL, London, United Kingdom
| | | | | | - Adam Stafford
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Fiona Burns
- Institute for Global Health, UCL, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sara Madge
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alec Miners
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Lorraine Sherr
- Institute for Global Health, UCL, London, United Kingdom
| | | | | | | | - Fiona C. Lampe
- Institute for Global Health, UCL, London, United Kingdom
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21
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Improving Care Outcomes for PLWH Experiencing Homelessness and Unstable Housing: a Synthetic Review of Clinic-Based Strategies. Curr HIV/AIDS Rep 2020; 17:259-267. [PMID: 32382919 DOI: 10.1007/s11904-020-00488-0] [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: 12/11/2022]
Abstract
PURPOSE OF REVIEW Singular interventions targeting vulnerable populations of people living with HIV (PLWH) are necessary for reducing new infections and optimizing individual-level outcomes, but extant literature for PLWH who experience homelessness and unstable housing (HUH) has not been compiled. To inform implementation of clinic-based programs that improve care outcomes in this population, we present a synthetic review of key studies examining clinic-based interventions, specifically case management, patient navigation, financial incentives, and the use of mobile technology. RECENT FINDINGS Results from unimodal interventions are mixed or descriptive, are limited by inability to address related multi-modal barriers to care, and do not address major challenges to implementation. Multi-component interventions are needed, but gaps in our knowledge base may limit widespread uptake of such interventions before further data are compiled. Future research evaluating interventions for PLWH experiencing HUH should include implementation outcomes in order to facilitate adaptation across diverse clinical settings.
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22
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Weiser SD, Sheira LA, Palar K, Kushel M, Wilson TE, Adedimeji A, Merenstein D, Cohen M, Turan JM, Metsch L, Adimora AA, Ofotokun I, Wentz E, Tien PC, Frongillo EA. Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV. AIDS Patient Care STDS 2020; 34:425-435. [PMID: 32941054 DOI: 10.1089/apc.2020.0009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.
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Affiliation(s)
- Sheri D. Weiser
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Lila A. Sheira
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Margot Kushel
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dan Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University, Grady Healthcare System, Atlanta, Georgia, USA
| | - Eryka Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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23
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Tan JY, A Sheira L, Frongillo EA, A Adimora A, Tien PC, Konkle-Parker D, Golub ET, Merenstein D, Levin S, Cohen M, Ofotokun I, A Fischl M, Rubin LH, Weiser SD. Food insecurity and neurocognitive function among women living with or at risk for HIV in the United States. Am J Clin Nutr 2020; 112:1280-1286. [PMID: 32844175 PMCID: PMC7657325 DOI: 10.1093/ajcn/nqaa209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) persists among women living with HIV. Food insecurity is also common among women and may be an important modifiable contributor of NCI. OBJECTIVE The goal of this study was to determine the association of food insecurity with neurocognitive function among women living with or without HIV. METHODS From 2013 to 2015, we analyzed data from a cross-sectional sample from the Women's Interagency HIV Study (WIHS). Measures included food insecurity and a comprehensive neuropsychological test battery assessing executive function, processing speed, attention/working memory, learning, memory, fluency, and motor function. We conducted multivariable linear regressions to examine associations between food insecurity and domain-specific neurocognitive performance, adjusting for relevant sociodemographic, behavioral, and clinical factors. RESULTS Participants (n = 1,324) were predominantly HIV seropositive (68%), Black/African-American (68%) or Hispanic (16%), and low income (48% reported <$12,000/y), with a median age of 49.6 y (IQR = 43.1, 55.5). Approximately one-third (36%, n = 479) were food insecure. Food insecurity was associated with poorer executive function (b = -1.45, SE = 0.58, P ≤ 0.01) and processing speed (b = -1.30, SE = 0.59, P ≤ 0.05). HIV serostatus modified the association between food insecurity and learning, memory, and motor function (P values <0.05). Food insecurity was positively associated with learning among women living with HIV (b = 1.58, SE = 0.77, P ≤ 0.05) and negatively associated with motor function among HIV-negative women (b = -3.57, SE = 1.08, P ≤ 0.001). CONCLUSIONS Food insecurity was associated with domain-specific neurocognitive function in women, and HIV serostatus modified associations. Food security may be an important point of intervention for ethnically diverse women with low socioeconomic status. Longitudinal studies are warranted to determine potential pathways by which food insecurity is associated with neurocognitive function among women living with or at risk for HIV.
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Affiliation(s)
- Judy Y Tan
- Address correspondence to JYT (e-mail: )
| | - Lila A Sheira
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco CA, USA,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Susanna Levin
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Disease, Atlanta, GA, USA
| | - Margaret A Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheri D Weiser
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
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24
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McCree DH, Beer L, Fugerson AG, Tie Y, Bradley ELP. Social and Structural Factors Associated with Sustained Viral Suppression Among Heterosexual Black Men with Diagnosed HIV in the United States, 2015-2017. AIDS Behav 2020; 24:2451-2460. [PMID: 32020509 DOI: 10.1007/s10461-020-02805-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper describes sociodemographic, sexual risk behavior, and clinical care factors associated with sustained viral suppression (SVS) among heterosexual Black men with diagnosed HIV in the US. Sample was 968 men, 2015-2017 cycles of Medical Monitoring Project. We used prevalence ratios and a multivariable logistic regression model to identify independent predictors of SVS. About 9% of sexually active men had sex that carries a risk of HIV transmission. Nearly 2/3 lived at or below the poverty level, 13% were under or uninsured, 1/4 experienced food insecurity and 15% reported recent homelessness. About 26% were not engaged in HIV care, 8% not currently taking antiretroviral therapy (ART) and 59% had SVS. Among men taking ART, care engagement and adherence were the only significant independent predictors of SVS. Efforts to increase VS should focus on increasing ART use, care engagement, and ART adherence, and include strategies that address the social and structural factors that influence them.
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Affiliation(s)
- Donna Hubbard McCree
- 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.
| | - Linda Beer
- 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
| | | | - Yunfeng Tie
- 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
| | - Erin L P Bradley
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
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25
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Abstract
OBJECTIVE This review summarises and synthesises the existing literature on the relationship between food insecurity (FS) and mental health conditions among adult individuals experiencing homelessness. DESIGN Scoping review. Papers published between 1 January 2008 and 2 November 2018, searched in PubMed, Web of Science, Scopus, PsycINFO, Cochrane Library and CINAHL, using homelessness, food security and mental health keywords. SETTING Global evidence. PARTICIPANTS Homeless adults aged 18 years or more. RESULTS Nine articles (eight cross-sectional and one longitudinal) were included in the present review. FS was measured using the Household Food Insecurity Access Scale, the United States Department of Agriculture Household Food Security Survey Module, as well as single-item or constructed measures. Depression and depressive symptoms were the most common mental health conditions studied. Other mental health conditions assessed included alcohol and substance use, emotional disorders, mental health problems symptoms severity and psychiatric hospitalisations. Composite measures such as axis I and II categories and a cluster of severe mental conditions and mental health-related functioning status were also analysed. FS and mental health-related problems were considered as both exposure and outcome variables. The existing evidence suggests a potential association between FS and several mental health conditions, particularly depression, mental health symptoms severity and poor mental health status scores. CONCLUSIONS This review suggests the potential association between some mental health conditions and FS among homeless adults. However, there is a need for more longitudinal- and interventional-based studies, in order to understand the nature and directionality of the links between FS and mental health in this population group.
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26
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Hatef E, Ma X, Rouhizadeh M, Singh G, Weiner JP, Kharrazi H. Assessing the Impact of Social Needs and Social Determinants of Health on Health Care Utilization: Using Patient- and Community-Level Data. Popul Health Manag 2020; 24:222-230. [PMID: 32598228 DOI: 10.1089/pop.2020.0043] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As the US health care system moves to expand access to and quality of medical care, the importance of addressing patient-level social needs and community-level social determinants of health (SDOH) is increasingly being recognized. This study evaluates individual- and community-level needs of housing (one of the SDOH domains) across the patient population of an academic medical center and explores how the level of housing needs impacts health care utilization. The authors performed a descriptive analysis of housing issues identified in both structured and unstructured (eg, clinical notes) data extracted from the electronic health record (EHR) and compared this to community-level characteristics of patients' neighborhood as measured by the Area Deprivation Index. Multivariate analyses were performed to assess the association between these and other factors on the frequency of service encounters. Among the 1,034,683 study participants, 59,703 (5.8%) had at least 1 housing issue identified in their EHR from structured or unstructured data combined. After adjusting for other factors, patients with housing instability and homelessness had 49% and 34% more encounters with the health care system compared to patients without housing issues (P < 0.00001). Patients living in the most disadvantaged neighborhoods had 55% more encounters with the health care system compared to those living in the most advantaged neighborhoods (P < 0.00001). This data collection approach and findings can inform health care systems aiming to make use of their EHRs and community-level SDOH information to provide a full assessment of patients' social needs and challenges.
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Affiliation(s)
- Elham Hatef
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Health Policy and Management at Bloomberg School of Public Health, Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland, USA
| | - Xiaomeng Ma
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Masoud Rouhizadeh
- Center for Clinical Data Analysis, Institute for Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gurmehar Singh
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan P Weiner
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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27
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Associations between food insecurity and psychotropic medication use among women living with HIV in the United States. Epidemiol Psychiatr Sci 2020; 29:e113. [PMID: 32248873 PMCID: PMC7214522 DOI: 10.1017/s2045796020000232] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. METHODS We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). RESULTS Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). CONCLUSIONS Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.
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28
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Weigel MM, Armijos RX. Food Insecurity, Cardiometabolic Health, and Health Care in U.S.-Mexico Border Immigrant Adults: An Exploratory Study. J Immigr Minor Health 2020; 21:1085-1094. [PMID: 30159707 DOI: 10.1007/s10903-018-0817-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Household food insecurity (HFI) has been linked to poorer cardiometabolic health and reduced health care access but few studies have examined these issues in the large Mexican immigrant population living on the U.S.-Mexico border. This exploratory study examined the association of HFI with cardiometabolic conditions and health care in 40-84 year urban border immigrants (n = 75). Data were collected on HFI, self-reported and clinical cardiometabolic conditions, health care sources and use. HFI affected 45% of participants. HFI was associated with self-reported and clinical diabetes but not hypertension, hyperlipidemia, obesity, or metabolic syndrome. It also was associated with increased emergency room visits and hospitalizations but not source of primary health care or preventative health care use. These findings highlight the need for additional research on the relationship of HFI with cardiometabolic health and health care in border immigrants as well as reassessment of current immigrant food security and health laws and policies.
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Affiliation(s)
- M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, USA.
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, USA
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29
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Comparing Unsheltered and Sheltered Homeless: Demographics, Health Services Use and Predictors of Health Services Use. Community Ment Health J 2020; 56:271-279. [PMID: 31552539 DOI: 10.1007/s10597-019-00470-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 09/18/2019] [Indexed: 10/26/2022]
Abstract
Secondary data obtained through the 2015 point-in-time homelessness count and an administrative health care utilization database was used to identify differences in demographic characteristics, health service use, and predictors of health service use among people experiencing unsheltered and sheltered homelessness. Compared to sheltered participants, unsheltered participants had higher proportions of males and Caucasians, were younger, were more likely to use any type of health service and ED services, and used significantly more of any health service and ED and outpatient services. Results also confirm that health services utilization is a complex phenomenon predicted by a variety of predisposing, enabling, and need-related factors, including mental health problems. Together, these findings demonstrate important differences between people living unsheltered and those residing in shelters and they inform local health policy and program initiatives tailored towards these homeless populations.
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30
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Willig A, Wright L, Galvin TA. Practice Paper of the Academy of Nutrition and Dietetics: Nutrition Intervention and Human Immunodeficiency Virus Infection. J Acad Nutr Diet 2019; 118:486-498. [PMID: 29477186 DOI: 10.1016/j.jand.2017.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 12/18/2022]
Abstract
Nutrition is an integral component of medical care for people living with human immunodeficiency virus (HIV)/autoimmune deficiency syndrome (AIDS) (PLWHA). The Academy of Nutrition and Dietetics supports integration of medical nutrition therapy into routine care for this population. Fewer PLWHA experience wasting and undernutrition, while the prevalence of obesity and other chronic diseases has increased significantly. Improved understanding of HIV infection's impact on metabolism and chronic inflammation has only increased the complexity of managing chronic HIV infection. Nutrition assessment should encompass food insecurity risk, changes in body composition, biochemical indices, and clinical indicators of comorbid disease. Side effects from current antiretroviral therapy regimens are less prevalent than with previous generations of therapy. However, micronutrient deficiencies and chronic anemia also remain significant nutritional risks for PLWHA, making vitamin and mineral supplementation necessary in cases of acute deficiency or food insecurity. Additional factors can impact HIV-related nutrition care among the pediatric population, older adults, minority groups, those co-infected with tuberculosis or hepatitis, and PLWHA in rural or underserved areas. Registered dietitian nutritionists and nutrition and dietetic technicians, registered should participate in multidisciplinary care to incorporate nutrition into the medical management of PLWHA.
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Ghose T, Shubert V, Poitevien V, Choudhuri S, Gross R. Effectiveness of a Viral Load Suppression Intervention for Highly Vulnerable People Living with HIV. AIDS Behav 2019; 23:2443-2452. [PMID: 31098747 DOI: 10.1007/s10461-019-02509-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We examine the effect of the Undetectables Intervention (UI) on viral loads among socially vulnerable HIV-positive clients. The UI utilized a toolkit that included financial incentives, graphic novels, and community-based case management services. A pre-post repeated measures analysis (n = 502) through 4 years examined longitudinal effects of the intervention. Logistic models regressed social determinants on viral loads. Finally, in-depth qualitative interviews (n = 30) examined how UI shaped adherence. The proportion of virally suppressed time-points increased 15% (from 67 to 82% pre to post-enrollment, p < 0.0001). The proportion of the sample virally suppressed at all time-points increased by 23% (from 39 to 62% pre to post-enrollment, p < 0.0001). African Americans and the homeless were the most likely to be unsuppressed at baseline, but, along with substance users, benefitted the most from UI. The intervention shaped adherence through two pathways, by: (1) establishing worth around adherence, and (2) increasing motivation to become suppressed, and maintain adherence.
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Affiliation(s)
- Toorjo Ghose
- School of Social Policy and Practice, University of Pennsylvania, D17 Caster Building, 3401 Locust Walk, Philadelphia, PA, 19104, USA.
| | | | | | - Sambuddha Choudhuri
- School of Social Policy and Practice, University of Pennsylvania, D17 Caster Building, 3401 Locust Walk, Philadelphia, PA, 19104, USA
| | - Robert Gross
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Riley ED, Vittinghoff E, Koss CA, Christopoulos KA, Clemenzi-Allen A, Dilworth SE, Carrico AW. Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco. AIDS Behav 2019; 23:2326-2336. [PMID: 31324996 PMCID: PMC7478361 DOI: 10.1007/s10461-019-02601-w] [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: 12/16/2022]
Abstract
While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine A Koss
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Samantha E Dilworth
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Wright L, Konlan MB, Boateng L, Epps JB. Nutrition risk and validation of an HIV disease-specific nutrition screening tool in Ghana. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2019. [DOI: 10.1080/16070658.2019.1638609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lauri Wright
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | | | | | - James B Epps
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Giday M, Hawes M, Madhavan A, Bann M. Factors other than medical acuity that influence hospitalisation: a scoping review protocol. BMJ Open 2019; 9:e028949. [PMID: 31203251 PMCID: PMC6588960 DOI: 10.1136/bmjopen-2019-028949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is evidence that patients are admitted to the hospital with low-acuity medical issues, though delineation of the underlying factors has not been comprehensively explored. This scoping review will provide an overview of the existing literature regarding factors outside of acute medical illness that influence hospitalisation of adults. The review will also seek to provide a review of common language and definitions used in the research on this phenomenon. METHODS AND ANALYSIS The scoping review framework, outlined by Arksey and O'Malley and expanded on by Levac et al, will be used as the basis for this study. A systematic search of seven databases (PubMed, CINAHL, PsycINFO, EMBASE, Web of Science, Sociological Abstracts and Social Science Abstracts) will be conducted to identify existing literature followed by a standardised two-phase, two-reviewer process to select relevant papers for inclusion. Relevant studies will investigate adult non-psychiatric hospital admission plus at least one additional factor unrelated to medical acuity. Details of the work will be extracted, including the terminology used and perspectives included. An assessment of methodological quality will be performed using a tool designed for mixed-methods systematic review. ETHICS AND DISSEMINATION The scoping review protocol delineates a transparent and rigorous review process, the results of which will be disseminated through peer-reviewed publication and presentation at relevant local or national meetings. The study does not require ethics approval as the data will be accumulated through the review of published, peer-reviewed literature and grey literature.
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Affiliation(s)
- Mellena Giday
- Division of General Internal Medicine/Hospital Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Meghaan Hawes
- Division of General Internal Medicine/Hospital Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ann Madhavan
- Health Sciences Library, University of Washington, Seattle, Washington, USA
| | - Maralyssa Bann
- Division of General Internal Medicine/Hospital Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Clemenzi-Allen A, Neuhaus J, Geng E, Sachdev D, Buchbinder S, Havlir D, Gandhi M, Christopoulos K. Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort. Open Forum Infect Dis 2019; 6:ofz148. [PMID: 31139668 PMCID: PMC6534280 DOI: 10.1093/ofid/ofz148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) who experience homelessness and unstable housing (HUH) often have fragmented health care. Research that incorporates granular assessments of housing status and primary care visit adherence to understand patterns of acute care utilization can help pinpoint areas for intervention. Methods We collected self-reported living situation, categorized as stable (rent/own, hotel/single room occupancy), unstable (treatment/transitional program, staying with friends), or homeless (homeless shelter, outdoors/in vehicle) at an urban safety-net HIV clinic between February and August 2017 and abstracted demographic and clinical information from the medical record. Regression models evaluated the association of housing status on the frequency of acute care visits—urgent care (UC) visits, emergency department (ED) visits, and hospitalizations—and whether suboptimal primary care visit adherence (<75%) interacted with housing status on acute care visits. Results Among 1198 patients, 25% experienced HUH. In adjusted models, unstable housing resulted in a statistically significant increase in the incidence rate ratio for UC visits (incidence rate ratio [IRR], 1.35; 95% confidence interval [CI], 1.10 to 1.66; P < .001), ED visits (IRR, 2.12; 95% CI, 1.44 to 3.13; P < .001), and hospitalizations (IRR, 1.75; 95% CI, 1.10 to 2.77; P = 0.018). Homelessness led to even greater increases in UC visits (IRR, 1.75; 95% CI, 1.29 to 2.39; P < .001), ED visits (IRR, 4.18; 95% CI, 2.77 to 6.30; P < .001), and hospitalizations (IRR, 3.18; 95% CI, 2.03 to 4.97; P < .001). Suboptimal visit adherence differentially impacted UC and ED visits by housing status, suggesting interaction. Conclusions Increased acute care visit frequency among HUH-PLWH suggests that interventions at these visits may create opportunities to improve care.
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Affiliation(s)
- Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Elvin Geng
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - Darpun Sachdev
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital.,San Francisco Department of Public Health, San Francisco, California
| | - Susan Buchbinder
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,San Francisco Department of Public Health, San Francisco, California
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
| | - Katerina Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital
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Kihlström L, Burris M, Dobbins J, McGrath E, Renda A, Cordier T, Song Y, Prendergast K, Serrano Arce K, Shannon E, Himmelgreen D. Food Insecurity and Health-Related Quality of Life: A Cross-Sectional Analysis of Older Adults in Florida, U.S. Ecol Food Nutr 2018; 58:45-65. [PMID: 30582362 DOI: 10.1080/03670244.2018.1559160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Individuals 65 years or older will comprise an estimated 20.0% of the U.S. population by 2030. This study investigated the association between food insecurity and health-related quality of life (HRQoL) among an older adult population (n = 234). HRQoL was measured using Healthy Days, a validated survey tool developed by the Centers of Disease Control and Prevention. Food-insecure individuals were more likely to report ≥14 physically unhealthy days (OR = 1.49, 95% CI 0.47-4.78) and ≥14 days with activity limitations (OR = 4.07, 95% CI 0.68-24.1). Although nonsignificant, the findings highlight food insecurity as a potentially important social determinant of health throughout the life course, including at an older age.
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Affiliation(s)
- L Kihlström
- a Department of Anthropology , University of South Florida , Tampa , FL , USA.,b Department of Family and Community Health , University of South Florida , Tampa , FL , USA
| | - M Burris
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - J Dobbins
- c Humana, Inc ., Louisville , KY , USA
| | - E McGrath
- c Humana, Inc ., Louisville , KY , USA
| | - A Renda
- c Humana, Inc ., Louisville , KY , USA
| | - T Cordier
- c Humana, Inc ., Louisville , KY , USA
| | - Y Song
- c Humana, Inc ., Louisville , KY , USA
| | | | - K Serrano Arce
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - E Shannon
- e Feeding Tampa Bay , Tampa , FL , USA
| | - D Himmelgreen
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
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Derose KP, Palar K, Farías H, Adams J, Martínez H. Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research. Food Nutr Bull 2018; 39:549-563. [PMID: 30453759 DOI: 10.1177/0379572118809302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC). OBJECTIVE To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy. METHODS Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects. RESULTS Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists. CONCLUSION High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.
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Affiliation(s)
| | - Kartika Palar
- 2 Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Hugo Farías
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Jayne Adams
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- 1 RAND Corporation, Santa Monica, CA, USA.,4 Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,5 Nutrition International, Ottawa, Canada
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Afulani PA, Coleman-Jensen A, Herman D. Food insecurity, mental health, and use of mental health services among nonelderly adults in the United States. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2018.1537868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Patience A. Afulani
- Obstetrics, Gynecology and Reproductive Sciences Dept., School of Medicine, University of California, San Francisco, California, USA
| | - Alisha Coleman-Jensen
- Economic Research Service, United Stated Department of Agriculture, Washington, D.C., USA
| | - Dena Herman
- Department of Family and Consumer Sciences, California State University, Northridge, CA, USA
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Pellowski JA, Huedo-Medina TB, Kalichman SC. Food Insecurity, Substance Use, and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1899-1907. [PMID: 28429158 PMCID: PMC5650554 DOI: 10.1007/s10508-017-0942-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/02/2023]
Abstract
People living with HIV in poverty have limited tangible and mental resources coupled with competing demands for these resources. Competing demands require individuals to make choices that may be beneficial to them in the short term but not in the long term. Past research has shown that food insecurity is related to sexual risk behaviors among people living with HIV. Individuals who are food insecure may sell sex in order to obtain food or lack of food may lead to a depletion of mental resources to negotiate safe sex. Substance use may also create additional constraints on these already limited resources. The current study tested the relation between food insecurity and day-level sexual risk behavior and the possible mediating role that alcohol/substance use may play. Men and women living with HIV were enrolled in a 28-day prospective study between October 2012 and April 2014 in which they completed daily text message surveys regarding their sex behaviors and substance/alcohol use in the context of sex. A total of 796 participants reported sex on 3894 days. On days in which sex occurred, baseline food insecurity was negatively associated with daily condom use. There was also a significant effect of substance use in the context of sex on the rates of change in condom use over time, and this interaction between substance use and time was a partial mediator of the relation between food insecurity and condom use. Gender did not moderate this mediation. Situation-specific alcohol and drug use should be integrated into interventions that target food insecurity and HIV prevention.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, 2nd Floor, Providence, RI, 02903, USA.
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences and Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Weigel MM, Armijos RX. Food Insecurity, Cardiometabolic Health, and Health Care in U.S.-Mexico Border Immigrant Adults: An Exploratory Study. J Immigr Minor Health 2018. [PMID: 30159707 DOI: 10.1007/s10903-018-0817-3+[doi]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Household food insecurity (HFI) has been linked to poorer cardiometabolic health and reduced health care access but few studies have examined these issues in the large Mexican immigrant population living on the U.S.-Mexico border. This exploratory study examined the association of HFI with cardiometabolic conditions and health care in 40-84 year urban border immigrants (n = 75). Data were collected on HFI, self-reported and clinical cardiometabolic conditions, health care sources and use. HFI affected 45% of participants. HFI was associated with self-reported and clinical diabetes but not hypertension, hyperlipidemia, obesity, or metabolic syndrome. It also was associated with increased emergency room visits and hospitalizations but not source of primary health care or preventative health care use. These findings highlight the need for additional research on the relationship of HFI with cardiometabolic health and health care in border immigrants as well as reassessment of current immigrant food security and health laws and policies.
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Affiliation(s)
- M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA. .,Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, USA.
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.,Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, USA
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Food Insecurity, Cardiometabolic Health, and Health Care in U.S.-Mexico Border Immigrant Adults: An Exploratory Study. J Immigr Minor Health 2018. [DOI: 10.1007/s10903-018-0817-3 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amato S, Nobay F, Amato DP, Abar B, Adler D. Sick and unsheltered: Homelessness as a major risk factor for emergency care utilization. Am J Emerg Med 2018; 37:415-420. [PMID: 29891125 DOI: 10.1016/j.ajem.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Homelessness is a critical public health issue and socioeconomic epidemic associated with a disproportionate burden of disease and significant decrease in life expectancy. We compared emergency care utilization between individuals with documented homelessness to those enrolled in Medicaid without documented homelessness. METHODS We conducted a retrospective cohort study consisting of electronic medical record review of demographics, chief complaints, and health care utilization metrics of adults with homelessness compared to a group enrolled in Medicaid without identified homelessness. The chart review spanned two years of emergency visits at a single urban, academic, tertiary care medical center. Descriptive statistics, bivariate and multivariate analyses were utilized. RESULTS Over the study period, 986 patients experiencing homelessness accounted for 7532 ED visits, with a mean of 7.6 (SD 19.9) and max of 316 visits. The control group of 3482 Medicaid patients had 5477 ED visits, with a mean of 1.6 visits (SD 2.1) and max of 49 visits. When controlling for age, sex, race, ethnicity, and ESI, those living with homelessness were 7.65 times more likely to return to the ED within 30 days of their previous visit, 9.97 times more likely to return within 6 months, 10.63 times more likely to return within one year, and 11 times more likely to return within 2 years. CONCLUSIONS Compared to non-homeless Medicaid patients, patients with documented homelessness were over seven times more likely to return to the ED within 30 days and over eleven times more likely to return to the ED in two years.
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Affiliation(s)
- Stas Amato
- University of Vermont Medical Center, Department of General Surgery, 111 Colchester Avenue, Burlington, VT 05401, United States; University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Flavia Nobay
- University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | | | - Beau Abar
- University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - David Adler
- University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Rochester, NY 14642, United States.
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Brown RT, Hemati K, Riley ED, Lee CT, Ponath C, Tieu L, Guzman D, Kushel MB. Geriatric Conditions in a Population-Based Sample of Older Homeless Adults. THE GERONTOLOGIST 2018; 57:757-766. [PMID: 26920935 DOI: 10.1093/geront/gnw011] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/17/2015] [Indexed: 01/23/2023] Open
Abstract
Purpose of the Study Older homeless adults living in shelters have high rates of geriatric conditions, which may increase their risk for acute care use and nursing home placement. However, a minority of homeless adults stay in shelters and the prevalence of geriatric conditions among homeless adults living in other environments is unknown. We determined the prevalence of common geriatric conditions in a cohort of older homeless adults, and whether the prevalence of these conditions differs across living environments. Design and Methods We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling in Oakland, CA. We evaluated participants for common geriatric conditions. We assessed living environment using a 6-month follow-back residential calendar, and used cluster analysis to identify participants' primary living environment over the prior 6 months. Results Participants stayed in 4 primary environments: unsheltered locations (n = 162), multiple locations including shelters and hotels (n = 88), intermittently with family/friends (n = 57), and, in a recently homeless group, rental housing (n = 43). Overall, 38.9% of participants reported difficulty performing 1 or more activities of daily living, 33.7% reported any falls in the past 6 months, 25.8% had cognitive impairment, 45.1% had vision impairment, and 48.0% screened positive for urinary incontinence. The prevalence of geriatric conditions did not differ significantly across living environments. Implications Geriatric conditions were common among older homeless adults living in diverse environments, and the prevalence of these conditions was higher than that seen in housed adults 20 years older. Services that address geriatric conditions are needed for older homeless adults living across varied environments.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatrics, University of California, San Francisco.,San Francisco VA Medical Center, California
| | - Kaveh Hemati
- School of Medicine, Stony Brook University, New York
| | - Elise D Riley
- Division of HIV/AIDS, San Francisco General Hospital, University of California
| | - Christopher T Lee
- Division of General Internal Medicine, San Francisco General Hospital, University of California
| | - Claudia Ponath
- Division of General Internal Medicine, San Francisco General Hospital, University of California
| | - Lina Tieu
- Division of General Internal Medicine, San Francisco General Hospital, University of California
| | - David Guzman
- Division of General Internal Medicine, San Francisco General Hospital, University of California
| | - Margot B Kushel
- Division of General Internal Medicine, San Francisco General Hospital, University of California
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Kalichman SC, Kalichman MO. HIV-Related Stress and Life Chaos Mediate the Association Between Poverty and Medication Adherence Among People Living with HIV/AIDS. J Clin Psychol Med Settings 2018; 23:420-430. [PMID: 27873055 DOI: 10.1007/s10880-016-9481-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV treatment depends on high-levels of antiretroviral therapy (ART) adherence, which is severely impeded by poverty. Men and women living with HIV infection (N = 92) completed computerized interviews of demographic and health characteristics, poverty markers, stressful life events, and life chaos, as well as unannounced pill counts to determine prospective medication adherence and medical record chart abstractions for HIV viral load. Poverty markers were associated with both stressors and chaos, and the direct effects of all three factors predicted ART non-adherence. The multiple mediation model showed that accounting for stressors and chaos resulted in a non-significant association between poverty markers and ART adherence. The indirect effect of poverty markers on adherence through life chaos was significant, whereas the indirect effect of poverty markers on adherence through stressors was not significant. Factors that render HIV-related stress and create chaos offer intervention targets that are more amenable to change than poverty itself.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Moira O Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Palar K, Wong MD, Cunningham WE. Competing subsistence needs are associated with retention in care and detectable viral load among people living with HIV. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2018; 17:163-179. [PMID: 30505245 PMCID: PMC6261356 DOI: 10.1080/15381501.2017.1407732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Competing priorities between subsistence needs and health care may interfere with HIV health. Longitudinal data from the Los Angeles-based HIV Outreach Initiative were analyzed to examine the association between competing subsistence needs and indicators of poor retention-in-care among hard-to-reach people with HIV. Sacrificing basic needs for health care in the previous six months was associated with a 1.55 times greater incidence of missed appointments (95% CI 1.17, 2.05), 2.32 times greater incidence of emergency department visits (95% CI 1.39, 3.87), 3.66 times greater incidence of not receiving ART if CD4 < 350 (95% CI 1.60, 8.37), and 1.35 times greater incidence of detectable viral load (95% CI 1.07, 1.70) (all p < 0.01). Among hard-to-reach PLHIV, sacrificing basic needs for health care delineates a population with exceptional vulnerability to poor outcomes along the HIV treatment cascade. Efforts to identify and reduce competing needs for this population are crucial to HIV health outcomes.
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Affiliation(s)
- Kartika Palar
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mitchell D. Wong
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - William E. Cunningham
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA, Los Angeles, CA, USA
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Pellowski JA, Kalichman SC, Cherry S, Conway-Washington C, Cherry C, Grebler T, Krug L. The Daily Relationship Between Aspects of Food Insecurity and Medication Adherence Among People Living with HIV with Recent Experiences of Hunger. Ann Behav Med 2017; 50:844-853. [PMID: 27333898 DOI: 10.1007/s12160-016-9812-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Limited access to resources can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between lacking access to nutritious food and antiretroviral (ARV) medication non-adherence in a variety of social contexts. PURPOSE This study aims to determine if several aspects of food insecurity co-occur with missed doses of medication on a daily basis among a sample of people living with HIV who have recently experienced hunger. METHODS The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Participants were followed for 45 days and completed daily assessments of food insecurity and alcohol use via interactive text message surveys and electronic medication adherence monitoring using the Wisepill. RESULTS Fifty-nine men and women living with HIV contributed a total of 2,655 days of data. Results showed that severe food insecurity (i.e., hunger), but not less severe food insecurity (i.e., worrying about having food), significantly predicted missed doses of medication on a daily level. Daily alcohol use moderated this relationship in an unexpected way; when individuals were hungry and drank alcohol on a given day, they were less likely to miss a dose of medication. CONCLUSIONS Among people living with HIV with recent experiences of hunger, this study demonstrates that there is a daily relationship between hunger and non-adherence to antiretroviral therapy. Future research is needed to test interventions designed to directly address the daily relationship between food insecurity and medication non-adherence.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Sabrina Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Larissa Krug
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Bekele T, Globerman J, Watson J, Jose-Boebridge M, Kennedy R, Hambly K, Anema A, Hogg RS, Rourke SB. Prevalence and predictors of food insecurity among people living with HIV affiliated with AIDS service organizations in Ontario, Canada. AIDS Care 2017; 30:663-671. [PMID: 29082788 DOI: 10.1080/09540121.2017.1394435] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Up to half of people living with HIV in resource-rich settings experience moderate to severe food insecurity. Food insecurity, in turn, has been linked to adverse health outcomes including poor antiretroviral adherence, poor HIV viral suppression, frailty, and mortality. We estimated the prevalence of food insecurity among 649 adults living with HIV and recruited from community-based AIDS service organizations in Ontario, Canada. Food security was assessed using the Canadian Household Food Security module. We used logistic regression modeling to identify demographic, socioeconomic, and psychosocial factors independently associated with food insecurity. Almost three-fourths of participants (70.3%) were food insecure and a third (31%) reported experiencing hunger. The prevalence of food insecurity in this sample is approximately six times higher than that of the general population. Factors independently associated with food insecurity were: having dependent children at home, residing in large urban areas, low annual household income (<$40,000), difficulty meeting housing-related expenses, cigarette smoking, harmful drug use, and depression. Broad, multisector interventions that address income, housing affordability, substance use and mental health issues are needed and could offset future public health expenditures.
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Affiliation(s)
| | | | - James Watson
- a Ontario HIV Treatment Network , Toronto , Canada
| | | | | | | | - Aranka Anema
- e Department of Pediatrics , Harvard Medical School, Harvard University , Boston , USA.,f Department of Medicine , Boston Children's Hospital , Boston , USA.,g Department of Food, Nutrition and Health, Faculty of Land and Food Systems , University of British Columbia , Vancouver , Canada
| | - Robert S Hogg
- h HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , Canada.,i Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
| | - Sean B Rourke
- j Center for Urban Health Solutions , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.,k Department of Psychiatry , University of Toronto , Toronto , Canada
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- l Members of the Canada CIHR Food Security Study Team is provided in Appendix 1
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Sunguya BF, Ulenga NK, Siril H, Puryear S, Aris E, Mtisi E, Tarimo E, Urassa DP, Fawzi W, Mugusi F. High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania--a call to include nutrition care and treatment in the test and treat model. BMC Nutr 2017; 3:58. [PMID: 32153838 PMCID: PMC7050693 DOI: 10.1186/s40795-017-0180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/06/2017] [Indexed: 01/17/2023] Open
Abstract
Background Undernutrition among people living with HIV (PLWHIV) can be ameliorated if nutrition specific and sensitive interventions are integrated into their HIV care and treatment centers (CTC). Integrated care is lacking despite expansion of antiretroviral therapy (ART) coverage, representing a substantial missed opportunity. This research aims to examine nutritional status and associated risk factors among HIV-positive adults prior to ART initiation in Tanzania in order to characterize existing gaps and inform early integration of nutrition care into CTC. Methods We analyzed data from 3993 pre-ART adults living with HIV enrolled in CTCs within the Trial of Vitamin (TOV3) and progression of HIV/AIDS study in Dar es salaam, Tanzania. The primary outcome for this analysis was undernutrition, measured as body mass index (BMI) below 18.5 kg/m2. We conducted descriptive analyses of baseline characteristics and utilized multiple logistic regression to determine independent factors associated with pre-ART undernutrition. Results Undernutrition was prevalent in about 27.7% of pre-ART adults, with a significantly higher magnitude among males compared to females (30% vs. 26.6%, p < 0.025). Severe undernutrition (BMI < 16.0 kg/m2) was prevalent in one in four persons, with a trend toward higher magnitudes among females (26.2% vs. 21.1% p = 0.123). Undernutrition was also more prevalent among younger adults (p < 0.001), those with lower wealth quintiles (p = 0.003), and those with advanced HIV clinical stage (p < 0.001). Pre-ART adults presented with poor feeding practices, hallmarked by low dietary diversity scores and infrequent consumption of proteins, vegetables, and fruits. After adjusting for confounders and important co-variates, pre-ART undernutrition was associated with younger age, low wealth indices, advanced clinical stage, and low dietary diversity. Conclusions One in every four pre-ART PLWHIV presented with undernutrition in Dar es salaam, Tanzania. Risk factors for undernourishment included younger age, lower household income, advanced HIV clinical stage, and lower dietary diversity score. Knowledge of the prevalence and prevailing risk factors for undernutrition among pre-ART PLWHIV should guide targeted, early integration of nutrition interventions into routine HIV care and treatment in high-prevalence, low-income settings such as Tanzania.
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Affiliation(s)
- Bruno F Sunguya
- 1Afya Bora Consortium, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9, United Nations Road, Upanga West, Dar es salaam, Tanzania
| | - Nzovu K Ulenga
- 2Management and Development for Health, Dar es salaam, Tanzania
| | - Hellen Siril
- 2Management and Development for Health, Dar es salaam, Tanzania
| | - Sarah Puryear
- 4Department of Global Health, University of Washington, Seattle, WA USA
| | - Eric Aris
- 2Management and Development for Health, Dar es salaam, Tanzania
| | | | - Edith Tarimo
- 1Afya Bora Consortium, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9, United Nations Road, Upanga West, Dar es salaam, Tanzania
| | - David P Urassa
- 1Afya Bora Consortium, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9, United Nations Road, Upanga West, Dar es salaam, Tanzania
| | - Wafaie Fawzi
- 5Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Ferdnand Mugusi
- 1Afya Bora Consortium, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, 9, United Nations Road, Upanga West, Dar es salaam, Tanzania
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Kim JE, Flentje A, Tsoh JY, Riley ED. Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 2017; 94:514-524. [PMID: 28589340 PMCID: PMC5533665 DOI: 10.1007/s11524-017-0166-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Smoking prevalence remains high among individuals who are homeless, partly due to stressors related to homelessness. Beyond housing insecurity, homelessness involves financial stresses and unmet subsistence needs. In particular, food insecurity contributes to negative health outcomes and other health risks. This study examined associations between food insecurity severity and smoking among homeless and marginally housed women in San Francisco, California. We used data from 247 women from a longitudinal cohort study. Generalized estimating equations were used to estimate longitudinal associations between study factors and smoking based on data from five biannual assessment points between 2009 and 2012. The longitudinal adjusted odds of smoking were higher among severely food insecure individuals compared to those who were not food insecure (AOR = 1.68, 95% CI [1.02, 2.78]), while associations with other study factors, including demographics, time, HIV status, mental health, and substance use (except marijuana use), did not reach levels of significance. Similar adjusted longitudinal results were observed when food insecurity was the dependent variable and smoking an independent variable, suggesting the possibility of a bidirectional association. Considering unmet needs, such as food and hunger, may improve comprehensive smoking cessation strategies targeting individuals for whom mainstream tobacco control efforts have not been effective. Similarly, offering improved access to smoking cessation resources should be considered in efforts to address food insecurity among individuals experiencing homelessness.
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Affiliation(s)
- Jin E Kim
- University of California San Francisco, San Francisco, CA, USA.
| | - Annesa Flentje
- University of California San Francisco, San Francisco, CA, USA
| | - Janice Y Tsoh
- University of California San Francisco, San Francisco, CA, USA
| | - Elise D Riley
- University of California San Francisco, San Francisco, CA, USA
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Chop E, Duggaraju A, Malley A, Burke V, Caldas S, Yeh PT, Narasimhan M, Amin A, Kennedy CE. Food insecurity, sexual risk behavior, and adherence to antiretroviral therapy among women living with HIV: A systematic review. Health Care Women Int 2017; 38:927-944. [PMID: 28586273 DOI: 10.1080/07399332.2017.1337774] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Gender inequalities shape the experience of food insecurity among women living with HIV (WLHIV). We systematically reviewed the impact of food insecurity on sexual risk behaviors and antiretroviral therapy (ART) adherence among WLHIV. We included qualitative or quantitative peer-reviewed articles, extracted data in duplicate, and assessed rigor. Seven studies, from sub-Saharan Africa, North America, and Europe, met inclusion criteria. Food insecurity was associated with increased sexual risk through transactional sex and inability to negotiate safer sex. Hunger and food insecurity were barriers to ART initiation/adherence. Multidimensional programming and policies should simultaneously address poverty, gender inequality, food insecurity, and HIV.
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Affiliation(s)
- Elisabeth Chop
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Avani Duggaraju
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Angela Malley
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Virginia Burke
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Stephanie Caldas
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Ping Teresa Yeh
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Manjulaa Narasimhan
- b Department of Reproductive Health and Research , World Health Organization , Geneva , Switzerland
| | - Avni Amin
- b Department of Reproductive Health and Research , World Health Organization , Geneva , Switzerland
| | - Caitlin E Kennedy
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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