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Gray A, Ward MK, Fernandez SB, Nawfal ES, Gwanzura T, Li T, Sheehan DM, Jean-Gilles M, Beach MC, Ladner RA, Trepka MJ. Exploring the use of self-management strategies for antiretroviral therapy adherence among women with HIV in the Miami-Dade County Ryan White Program. J Behav Med 2024; 47:282-294. [PMID: 37946027 PMCID: PMC10947905 DOI: 10.1007/s10865-023-00459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Women with HIV (WWH) face increased difficulties maintaining adherence to antiretroviral therapy (ART) due to a variety of demographic and psychosocial factors. To navigate the complexities of ART regimens, use of strategies to maintain adherence is recommended. Research in this area, however, has largely focused on adherence interventions, and few studies have examined self-reported preferences for adherence strategies. The purpose and objectives of this study were to explore the use of ART self-management strategies among a diverse sample of WWH, examine demographic and psychosocial differences in strategy use, and assess the association between strategies and ART adherence. The current study presents secondary data of 560 WWH enrolled in the Miami-Dade County Ryan White Program. Participants responded to questionnaire items assessing demographic and psychosocial characteristics, use of adherence strategies, and ART adherence during the past month. Principal component analysis identified four categories among the individual strategies and multivariable binomial logistic regression assessed adherence while controlling for individual-level factors. The majority of WWH reported optimal ART adherence, and nearly all used multiple individual strategies. The number of individual strategies used and preferences for strategy types were associated with various demographic and psychosocial characteristics. Adjusting for demographic and psychosocial characteristics, optimal ART adherence during the past month was associated with the use of four or more individual strategies. When conducting regular assessments of adherence, it may be beneficial to also assess use of adherence strategies and to discuss with WWH how using multiple strategies contributes to better adherence.
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Affiliation(s)
- Aaliyah Gray
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA.
| | - Melissa K Ward
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Sofia B Fernandez
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- School of Social Work, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Biostatistics, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, 2024 East Monument Street, Room 2-511, Baltimore, MD, 21287, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Boulevard, Suite 240, Coral Gables, FL, 33134, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
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Tam C, Wesseling T, Wang L, Salters K, Moore DM, Dawydiuk N, Zhu J, Grieve S, Bingham B, McLinden T, Hogg R, Barrios R. It's all about connection: Determinants of social support and the influence on HIV treatment interruptions among people living with HIV in British Columbia, Canada. BMC Public Health 2023; 23:2524. [PMID: 38104090 PMCID: PMC10725596 DOI: 10.1186/s12889-023-17416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Social support has previously been found to be associated with improved health outcomes of individuals managing chronic illnesses, including amongst people living with HIV (PLWH). For women and people who use injection drugs who continue to experience treatment disparities in comparison to other PLWH, social support may have potential in facilitating better treatment engagement and retention. In this analysis, we examined determinants of social support as measured by the Medical Outcomes Study - Social Support Survey (MOS-SSS) scale, and quantified the relationship between MOS-SSS and HIV treatment interruptions (TIs) among PLWH in British Columbia, Canada. METHODS Between January 2016 and September 2018, we used purposive sampling to enroll PLWH, 19 years of age or older living in British Columbia into the STOP HIV/AIDS Program Evaluation study. Participants completed a baseline survey at enrolment which included the MOS-SSS scale, where higher MOS-SSS scores indicated greater social support. Multivariable linear regression modeled the association between key explanatory variables and MOS-SSS scores, whereas multivariable logistic regression modeled the association between MOS-SSS scores and experiencing TIs while controlling for confounders. RESULTS Among 644 PLWH, we found that having a history of injection drug use more than 12 months ago but not within the last 12 months, self-identifying as Indigenous, and sexual activity in the last 12 months were positively associated with MOS-SSS, while being single, divorced, or dating (vs. married), experiences of lifetime violence, and diagnosis of a mental health disorder were inversely associated. In a separate multivariable model adjusted for gender, ethnicity, recent homelessness, sexual activity in the last 12 months, and recent injection drug use, we found that higher MOS-SSS scores, indicating more social support, were associated with a lower likelihood of HIV treatment interruptions (adjusted odds ratio: 0.90 per 10-unit increase, 95% confidence interval: 0.83, 0.99). CONCLUSIONS Social support may be an important protective factor in ensuring HIV treatment continuity among PLWH. Future research should examine effective means to build social support among communities that have potential to promote increased treatment engagement.
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Affiliation(s)
- Clara Tam
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada.
| | - Tim Wesseling
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nicole Dawydiuk
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Julia Zhu
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Sean Grieve
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - Brittany Bingham
- Centre for Gender & Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Indigenous Health, Vancouver Coastal Health, Vancouver, Canada
| | - Taylor McLinden
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert Hogg
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Barthold D, Saldarriaga EM, Brah AT, Hauber B, Banerjee P, Fuller SM, McCaslin D, Moldoveanu AM, Marconi VC, Simoni JM, Graham SM. Preference for daily oral pills over long-acting antiretroviral therapy options among people with HIV. AIDS 2023; 37:1545-1553. [PMID: 37289570 PMCID: PMC10355802 DOI: 10.1097/qad.0000000000003620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the characteristics of people with HIV (PWH) who prefer remaining on daily oral antiretroviral therapy (ART), rather than switching to long-acting ART (LA-ART). DESIGN Building upon a discrete choice experiment (DCE), we examined characteristics of individuals who always selected their current daily oral tablet regimen over either of two hypothetical LA-ART options presented in a series of 17 choice tasks. METHODS We used LASSO to select sociodemographic, HIV-related, and other health-related predictors of preferring current therapy over LA-ART, and logistic regression to measure the associations with those characteristics. RESULTS Among 700 PWH in Washington State and Atlanta, Georgia, 11% of participants ( n = 74) chose their current daily treatment over LA-ART in all DCE choice tasks. We found that people with lower educational attainment, good adherence, more aversion to injections, and who participated from Atlanta to be more likely to prefer their current daily regimen over LA-ART. CONCLUSIONS Gaps in ART uptake and adherence remain, and emerging LA-ART treatments show promise to address these challenges and help a larger portion of PWH to achieve viral suppression, but preferences for these new treatments are understudied. Our results show that certain drawbacks of LA-ART may help to maintain demand for daily oral tablets, especially for PWH with certain characteristics. Some of these characteristics (lower educational attainment and Atlanta participation) were also associated with a lack of viral suppression. Future research should focus on overcoming barriers that impact preferences for LA-ART among those patients who could benefit most from this innovation.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | - Enrique M. Saldarriaga
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | - Aaron T. Brah
- School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Brett Hauber
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
- Pfizer, Inc, New York, New York
| | - Pallavi Banerjee
- Information School, University of Washington, Seattle, Washington
| | | | | | | | - Vincent C. Marconi
- Department of Medicine, Emory University School of Medicine
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Susan M. Graham
- Department of Global Health
- Division of Allergy & Infectious Diseases, Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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4
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Sanders JN, Glynn TR, Mayo D, Dale SK, Harkness A, Safren SA. Does Problematic Substance Use Moderate Efficacy of Cognitive Behavioral Therapy for Adherence and Depression in HIV? AIDS Behav 2023; 27:1123-1132. [PMID: 36318424 PMCID: PMC10150732 DOI: 10.1007/s10461-022-03849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 03/24/2023]
Abstract
Problematic substance use may attenuate the effect of treating depression in people living with HIV (PLWH). We examined the potential moderating effect of problematic substance use on depression and adherence outcomes in PLWH (N = 143) who participated in a randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) and were randomized to either CBT-AD or enhanced treatment as usual (ETAU). Problematic substance use was operationalized as either having substance use-related diagnosis or current substance use in the past 30 days with a lifetime history of problematic use. Acute (baseline to 4-month) and follow up (4, 8, and 12-month) general linear modeling with time, condition, problematic baseline substance use, and corresponding interactions demonstrated that substance use did not significantly moderate the effects of CBT-AD on adherence or depression improvements. Therefore, CBT-AD was beneficial for PLWH with depression, regardless of problematic substance use when starting depression treatment. Based on these results, clinicians should not withhold CBT treatment for depression in patients with HIV and problematic substance use to attain reductions in depression and gains in adherence.
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Affiliation(s)
| | - Tiffany R Glynn
- Department of Psychology, University of Miami, Miami, USA
- Massachusetts General Hospital, Boston, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, USA
| | | | - Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, USA
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5
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Sun CJ, Shato T, Steinbaugh A, Pradeep S, Amico KR, Horvath K. Virtual voices: examining social support exchanged through participant-generated and unmoderated content in a mobile intervention to improve HIV antiretroviral therapy adherence among GBMSM. AIDS Care 2023; 35:7-15. [PMID: 35156485 PMCID: PMC9374845 DOI: 10.1080/09540121.2022.2038364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Antiretroviral therapy (ART) adherence is suboptimal among gay, bisexual, and other men who have sex with men (GBMSM). Online interventions that incorporate social support represent new opportunities to improve adherence. This study focused on how social support was provided and sought within a technology-based ART adherence intervention. We coded and analyzed 1,751 messages. Within the social support messages, half of the time participants sought social support and half of the time they provided social support. Emotional and informational support were the most frequently exchanged forms. The most frequent topic that participants sought support around was interpersonal relationships (29%), followed by HIV care and treatment (28%). Similarly, 31% and 27% of messages in which participants provided support was related to HIV treatment and care and interpersonal relationships, respectively. HIV treatment and care issues most salient were ART adherence, lab results and upcoming tests, ART side effects, changes in ART regimens, and relationships with healthcare providers. Participants used the messaging feature in this intervention to spontaneously discuss and exchange support around HIV treatment and care. This analysis provided an opportunity to understand how participants informally interact with one another, how they seek and provide social support online, and their salient personal issues.
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Affiliation(s)
- Christina J. Sun
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Thembekile Shato
- Implementation Science Center for Cancer Control, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Sharanya Pradeep
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - K. Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Keith Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
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6
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Brathwaite R, Ssewamala FM, Mutumba M, Neilands TB, Byansi W, Namuwonge F, Damulira C, Nabunya P, Nakigozi G, Makumbi F, Mellins CA, McKay MM, Team SAF. The Long-term (5-year) Impact of a Family Economic Empowerment Intervention on Adolescents Living with HIV in Uganda: Analysis of Longitudinal Data from a Cluster Randomized Controlled Trial from the Suubi+Adherence Study (2012-2018). AIDS Behav 2022; 26:3337-3344. [PMID: 35429307 PMCID: PMC9474691 DOI: 10.1007/s10461-022-03637-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
150/150 words.We examined the 5-year impact of an economic empowerment (EE) intervention on: adherence, viral suppression, sexual risk-taking intentions (primary); and physical health, educational and economic (secondary) outcomes among adolescents living with HIV in Uganda. The Suubi + Adherence study (2012-2018) randomized clinics to: (1) Control group, n = 19 clinics, n = 344 participants; (2) intervention group which received matched savings accounts, mentorship, financial management and, business development training, n = 20 clinics, n = 358 participants. Participants completed post-baseline assessments at 12-, 24-, 36-, and 48-months. No significant differences in viral load, sexual risk-intentions and physical health perception were observed. The intervention group had better adherence (at 24-months) (Contrast=-0.28; 95% CI: -0.55, -0.004), higher school enrolment (OR = 2.18; 95% CI:1.30, 3.66); reported savings OR = 2.03 (1.29, 3.18) and higher savings (Contrast = 0.40; 95% CI:0.10, 0.70) than controls at 48-months. The EE intervention was efficacious in improving adherence, school enrolment, and economic outcomes creating opportunities for improved overall health among adolescents living with HIV.
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Affiliation(s)
- Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA.
- Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA.
| | - Massy Mutumba
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, USA
| | - William Byansi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Christopher Damulira
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA
| | | | - Fredrick Makumbi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Medical Center, New York, NY, USA
| | - Mary M McKay
- Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA
| | - Suubi Adherence Field Team
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, 63130, St. Louis, MO, USA
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Sematlane NP, Knight L, Masquillier C, Wouters E. A cross-cultural adaptation and validation of a scale to assess illness identity in adults living with a chronic illness in South Africa: a case of HIV. AIDS Res Ther 2022; 19:39. [PMID: 35989334 PMCID: PMC9392862 DOI: 10.1186/s12981-022-00464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
The chronic illness trajectory and its outcomes are well explained by the concept of illness identity; the extent to which ill individuals have integrated their diagnosed chronic illness into their identity or sense of self. The capacity to measure illness identity in people living with HIV (PLHIV) is still relatively unexplored. However, this is potentially useful to help us understand how outcomes for PLHIV could be improved and sustained. This paper aims to explore the cross-cultural adaptation of a Belgian developed Illness Identity Questionnaire (IIQ) and validate the instrument using a sample of South African adults living with HIV. We followed a phased scale adaptation and validation process which included an investigation of conceptual, item, semantic and operational equivalence and also examined the psychometric properties of the IIQ. The concept of illness identity with its four factors; engulfment, rejection, acceptance and enrichment in PLHIV, was found to be relevant within this context. Five items from the original IIQ were excluded from the adapted IIQ due to either semantic insufficiency and/or inadequate measurement equivalence. The mode of administration of the IIQ was changed to accommodate current study participants. The original four factor 25-item model did not fit current data, however, a better contextualized, four-factor, 20-item model was identified and found valid in the current setting. The results showed adequate statistical fit; χ2/d.f. = 1.516, RMSEA = 0.076, SRMR = 0.0893, and CFI = 0.909. Convergent and discriminant validity were also tenable. The cross-cultural adaptation and validation of the IIQ was successful, resulting in the availability of an instrument capable of measuring illness identity in PLHIV in a high HIV prevalence and resource-constrained setting. This therefore addresses the paucity of information and expands on knowledge about illness identity.
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Gumede SB, de Wit JBF, Venter WDF, Lalla-Edward ST. Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa. PLoS One 2021; 16:e0261107. [PMID: 34932588 PMCID: PMC8691643 DOI: 10.1371/journal.pone.0261107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient's overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.
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Affiliation(s)
- Siphamandla Bonga Gumede
- Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Faculty of Social and Behavioural Sciences, Department of Interdisciplinary Social Science, Utrecht University, The Netherlands
| | - John Benjamin Frank de Wit
- Faculty of Social and Behavioural Sciences, Department of Interdisciplinary Social Science, Utrecht University, The Netherlands
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9
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Kalichman SC, Katner H, Hill M, Ewing W, Kalichman MO. Perceived sensitivity to medicines and the experience of side-effects: understanding intentional medication nonadherence among people living with HIV. PSYCHOL HEALTH MED 2021; 27:2261-2272. [PMID: 34319180 DOI: 10.1080/13548506.2021.1960391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patient initiated decisions to forgo taking medications (i.e. intentional nonadherence) pose significant challenges to managing chronic health conditions. Identifying factors and their underlying mechanisms that impede medication adherence is essential to designing treatment improvement interventions. This study tested a conceptual model that posits the effects of perceived sensitivity to medicines on adherence can be explained by the experience of side-effects, leading to intentionally nonadherent behaviors. Patients receiving HIV care in the southern United States (N = 209) completed measures of perceived sensitivity to medicines, antiretroviral therapy (ART) side-effects, intentional nonadherence and overall adherence. Patients also provided consent to access their electronic medical records to collect subsequent reports of HIV viral load tests. Results indicated that more than one in four participants were intentionally nonadherent to ART. Mediation modeling showed that perceived sensitivity to medicines was associated with greater experience of ART side-effects and intentional nonadherence, which impacted overall ART adherence and HIV viral load. There were also significant indirect effects of perceived sensitivity to medicines on HIV viral load through side-effects and intentional nonadherence. Patients with increased perceived sensitivity to medicines are at risk for poor treatment outcomes and these negative outcomes are partly explained by experiencing greater side-effects and intentional nonadherence.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School
| | - Wendy Ewing
- Department of Medicine, Mercer University Medical School
| | - Moira O Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
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10
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Nyamaruze P, Cowden RG, Padgett RN, Govender K. Body image and antiretroviral therapy adherence among people living with HIV: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e045700. [PMID: 34233973 PMCID: PMC8264875 DOI: 10.1136/bmjopen-2020-045700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/18/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) remains a key challenge to achieving the fast-track goal of ending the HIV epidemic by 2030. To provide a more comprehensive indication of whether interventions designed to promote ART adherence might benefit from targeting body image perceptions, we aim to conduct a systematic review to synthesise existing evidence on the association between body image and ART adherence. METHODS AND ANALYSIS A systematic review of peer-reviewed observational studies and randomised controlled trials that have investigated the association between body image and adherence to ART will be performed. JSTOR, PsycARTICLES, PsycINFO, PubMed, ScienceDirect and Web of Science databases will be searched from 1 January 2000 to 31 March 2021. Eligible records will consider body image as either an independent variable or a mediator, whereas ART adherence will be assessed as an outcome variable. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed using relevant tools developed by the National Institute of Health. If sufficient data are available, a meta-analysis will be conducted. Effect size estimates will be aggregated using a random effects meta-analysis approach. Publication bias and its impact will be evaluated through the use of a funnel plot and the trim-and-fill method. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to report on the overall quality of evidence. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review protocol. Findings of the proposed systematic review will be disseminated through conference presentations and publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020212597.
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Affiliation(s)
- Patrick Nyamaruze
- Psychology, University of KwaZulu-Natal College of Humanities, Durban, Kwazulu Natal, South Africa
| | - Richard Gregory Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
| | - R Noah Padgett
- Department of Educational Psychology, Baylor University, Waco, Texas, USA
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
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11
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Sematlane NP, Knight L, Masquillier C, Wouters E. Adapting to, integrating and self-managing HIV as a chronic illness: a scoping review protocol. BMJ Open 2021; 11:e047870. [PMID: 34162650 PMCID: PMC8231044 DOI: 10.1136/bmjopen-2020-047870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The process of adapting to a life with a chronic illness, is a well-researched phenomenon for a number of common chronic illnesses. The construct, adaptation, embeds the notions of integration of the chronic illness into identity and self-management. Integration precedes self-management and is key to living positively with a chronic illness. Adaptation is an important concept in understanding trajectory and outcomes of living with a chronic illness. Applicability of these concepts to HIV as a chronic illness; when suppressive adherence has been achieved, however, is unknown. Specifically, the adaptation process to living with HIV as a chronic illness, the integration of HIV into identity and the resulting self-management behaviours by adults living with HIV are relatively unexplored. We describe a protocol for a scoping review of adaptation to living with HIV, we structure the enquiry around integration of HIV into identity and self-management and interrogate theories, models and frameworks that have been proposed and studied and we evaluate them for relevance and usefulness in the care and management of HIV. METHODS AND ANALYSIS Methods proposed by the Johanna Briggs Institute will be followed. The protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews and was registered with the Open Science Framework. MEDLINE, SCOPUS, Cochrane Library, CINHAL and SocINDEX databases will be searched. A search in Social Science Research Network eLibrary and Open Access Theses and Dissertations will gather grey literature and reference lists of included sources will be screened. Study selection process will involve a title and abstract review and full text review, guided by clearly defined inclusion and exclusion criteria. ETHICS AND DISSEMINATION Ethical approval is not required because this is a proposed review and collection of data on publicly available materials. The results will be published in a topic relevant journal and presented at related scientific events.
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Affiliation(s)
- Neo Phyllis Sematlane
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Bellville, South Africa
| | - Lucia Knight
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Bellville, South Africa
- Division of Social and Bahavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Caroline Masquillier
- Centre for Population, Family & Health, Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, Department of Sociology, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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12
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Lacombe-Duncan A, Guta A, Newman PA. Pre-Exposure Prophylaxis (PrEP) Implementation for Gay, Bisexual, and Other Men Who Have Sex with Men: Implications for Social Work Practice. HEALTH & SOCIAL WORK 2021; 46:22-32. [PMID: 33637990 DOI: 10.1093/hsw/hlaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 10/07/2019] [Indexed: 06/12/2023]
Abstract
Social workers have been critical in the response to HIV from its inception, in HIV prevention, support, and advocacy for stigmatized populations including gay, bisexual, and other men who have sex with men (GBM). Recently, social workers have been tasked with working in an era of increasingly biomedicalized HIV prevention, including pre-exposure prophylaxis (PrEP), a safe and highly effective new prevention technology. However, disparities in PrEP access due to structural barriers, including lack of health insurance coverage, and complex decision-making pathways and processes of engagement present substantial challenges for PrEP implementation. Ensuring equitable access to resources and supporting informed decision making are paramount to social work values, yet scant published literature has considered PrEP social work intervention. This article draws on qualitative data from 29 GBM respondents to highlight gaps in PrEP decision-making support and access that may be amenable to social work intervention. Authors describe opportunities for individual, interpersonal, organizational, and structural social work interventions to address multilevel gaps in PrEP implementation. Findings illuminate the complexity of individual experiences and social discourses regarding PrEP and their impact on GBM and raise important issues for social workers to consider in working with GBM clients, service providers, and administrators.
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13
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Stecher C, Mukasa B, Linnemayr S. Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda. JOURNAL OF HEALTH ECONOMICS 2021; 77:102443. [PMID: 33831632 PMCID: PMC8122069 DOI: 10.1016/j.jhealeco.2021.102443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 05/14/2023]
Abstract
Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persistence of the behavior after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sample for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strategy that is associated with persistently high medication adherence after controlling for observable individual-level characteristics and the receipt of incentives. We find evidence supporting a psychological theory of habits as reflexive context-behavior associations, which suggests new ways of designing incentive-based interventions for better promoting persistent, healthier behaviors.
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Affiliation(s)
- Chad Stecher
- Arizona State University, 500 N 3rd Street, Phoenix, AZ 85004, United States.
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14
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York LD, Fisher JM, Malladi L, August JA, Ellis KE, Marquez JL, Kaveti A, Khachatryan M, Paz MK, Adams MD, Bedrick EJ, Fantry LE. Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond. AIDS Res Hum Retroviruses 2021; 37:297-303. [PMID: 33567992 DOI: 10.1089/aid.2020.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH). The purpose of this study was to examine the clinical significance of renal, liver, and lipid testing. We reviewed the charts of 261 PWH who initiated care at an academic HIV clinic between January 1, 2016 and December 21, 2018. Analysis included one-sided binomial exact tests and multiple linear, Poisson, and Beta regression models. The most common abnormality was a glomerular filtration rate (GFR) <60 mL/min (10%). Age <40 years [estimated relative rate (rr) 0.017, 95% confidence interval (CI) 0.207 to 0.494], cobicistat (rr 0.284, 95% CI 0.128 to 0.63), and tenofovir alafenamide (rr 0.295 95% CI 0.151 to 0.573) were associated with a decreased risk of GFR <60 mL/min. An increased AST and ALT ≥2 × upper limit of normal (ULN) was found in 5% and 3%, respectively. Hepatitis C and use of darunavir and lopinavir were associated with increased AST or ALT. When a GFR was <60 mL/min or an AST or ALT was ≥2 × ULN, no action was taken in 53% of cases. In 18% of cases the only intervention was repeat testing. The most common interventions after lipid results were calculation of a 10-year cardiovascular risk score (31%) and addition of a statin (18%). Taking action after lipid results was strongly associated with age ≥40 (rr 7.37, 95% CI 3.0 to 18.3). Young PWH without hepatitis C rarely have renal, liver, or lipid test results that alter clinical care. Decreased testing should be considered.
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Affiliation(s)
- Lawrence D York
- Department of Medicine, University of Arizona, College of Medicine, Tucson, Arizona, USA
| | - Julia M Fisher
- Statistics Consulting Laboratory, BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Lakshmeeramya Malladi
- College of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | | | - Kristen E Ellis
- Department of Medicine, University of Arizona, College of Medicine, Tucson, Arizona, USA
| | - Jose L Marquez
- Department of Medicine, University of Arizona, College of Medicine, Tucson, Arizona, USA
| | - Ashwini Kaveti
- College of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Marine Khachatryan
- College of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Marissa K Paz
- College of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Matthew D Adams
- Department of Medicine, University of Arizona, College of Medicine, Tucson, Arizona, USA
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona Health Sciences Center, Tuscon, Arizona, USA
| | - Lori E Fantry
- Department of Medicine, University of Arizona, College of Medicine, Tucson, Arizona, USA
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15
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Puttkammer N, Simoni JM, Sandifer T, Chéry JM, Dervis W, Balan JG, Dubé JG, Calixte G, Robin E, François K, Casey C, Wilson I, Honoré JG. An EMR-Based Alert with Brief Provider-Led ART Adherence Counseling: Promising Results of the InfoPlus Adherence Pilot Study Among Haitian Adults with HIV Initiating ART. AIDS Behav 2020; 24:3320-3336. [PMID: 32715409 DOI: 10.1007/s10461-020-02945-8] [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] [Indexed: 01/19/2023]
Abstract
To promote HIV antiretroviral therapy (ART) outcomes in Haiti, we developed a culturally relevant intervention (InfoPlus Adherence) that combines an electronic medical record alert identifying patients at elevated risk of treatment failure and provider-delivered brief problem-solving counseling. We conducted a quasi-experimental mixed-methods study among 146 patients at two large ART clinics in Haiti with 728 historical controls. We conducted quantitative assessments of patients at baseline and intervention completion (6 months) as well as focus groups with health workers and exit interviews with patients. The primary quantitative outcome measures were HIV viral suppression according to medical record and ART adherence in terms of ≥ 90% for "proportion of days covered" (PDC) according to pharmacy dispensing data. Results indicated that the proportion of intervention patients with suppressed VL during the study/historical periods was 80.0%/86.0% and 76.8%/87.4% for controls. In a difference-in-differences (DID) analytic model, the adjusted relative risk for viral suppression with the intervention was 1.15 (95% CI 0.92-1.45, p = 0.21), representing favorable but non-significant association between the intervention and the trajectory of VL outcomes. PDC ≥ 90% during the study/historical periods was 30.9%/11.0% among intervention participants and 16.9%/19.4% among controls. In the adjusted DID model, the relative risk for of PDC ≥ 90% with the intervention was 4.00 (95% CI 1.91-8.38, p < 0.001), representing a highly favorable association between the intervention and the trajectory of PDC outcomes. Qualitative data affirmed acceptability of the intervention, although providers reported some challenges consistently implementing it. Future research is needed to demonstrate efficacy and explore optimal implementation strategies.
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16
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Psychosocial support interventions for improved adherence and retention in ART care for young people living with HIV (10-24 years): a scoping review. BMC Public Health 2020; 20:1841. [PMID: 33261566 PMCID: PMC7708133 DOI: 10.1186/s12889-020-09717-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Background Mental health disorders such as high levels of anxiety, isolation, depression and suicide ideation reported among young people living with HIV (10–24 years;YPLHIV) contribute significantly to poor medication adherence and retention in care. While there is evidence supporting the role of psychosocial support interventions in promoting adherence and retention in antiretroviral treatment (ART) among adults living with HIV, there is little evidence on the role of psychosocial support on medication adherence among YPLHIV. This scoping review was designed to identify and classify the types and effects of psychosocial support interventions designed to improve adherence and retention in ART among YPLHIV globally. Method We searched six electronic databases (i.e., Scopus, Pubmed and EBSCOHost (Academic Search Premier, CINAHL, Psycarticles and Medline). Six relevant articles published between 2011 and 2019 met our inclusion criteria. We extracted information relevant to the nature and outcomes of the reported interventions using thematic content analysis informed by the Population, Intervention, comparison, outcome, and time (PICOT) framework. Results Four distinctive treatment modalities that focused on improving ART adherence and retention in care were identified: individual counselling, support groups, family-centered services, and treatment supporters. Conclusion There is a dearth of psychosocial support interventions to improve adherence and retention in ART amongst adolescents and young adults living with HIV. Future research and programming should seek to address psychosocial support interventions or approaches specifically designed to address the needs of YPLHIV. Trial registration PROSPERO: Registration CRD42018105057.
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17
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Turner CM, Trujillo D, Le V, Wilson EC, Arayasirikul S. Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study. JMIR Mhealth Uhealth 2020; 8:e22733. [PMID: 33055070 PMCID: PMC7596651 DOI: 10.2196/22733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. OBJECTIVE The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. METHODS Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. RESULTS Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. CONCLUSIONS Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant's dynamic risk environment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16406.
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Affiliation(s)
- Caitlin Marie Turner
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States.,Doctoral Program in Epidemiology & Translational Science, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Dillon Trujillo
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Victory Le
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States.,California School of Professional Psychology, Alliant International University, San Francisco, CA, United States
| | - Erin C Wilson
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Sean Arayasirikul
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States.,Department of Pediatrics, School of Medicine, University of California, San Francisco, CA, United States
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18
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A Behavioral Adherence Intervention Improves Rates of Viral Suppression Among Adherence-Challenged People Living with HIV in South India. AIDS Behav 2020; 24:2195-2205. [PMID: 31933020 DOI: 10.1007/s10461-020-02785-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The success of antiretroviral therapy (ART) has led to both extended life expectancy and improved quality of life among people living with HIV (PLWH). To maximize the efficacy of first line ART regimens in low- and middle-income countries (LMIC), we need culturally-relevant interventions that empower participants to reduce barriers to long-term uninterrupted adherence. The Chetana adherence intervention trial was designed in collaboration with local community groups as a comprehensive wellness program for adherence-challenged PLWH and included peer-led adherence support, yoga, nutrition, information about local resources, and individual counseling using motivational interviewing techniques. Intervention arm participants were almost twice as likely to be virally suppressed at their 12-month follow-up visit (AOR = 1.98; 95% CI [1.2, 3.23]) as were participants in the active control arm. They were also about twice as likely as control arm participants to self-report ≥ 95% adherence (AOR = 1.86, 95% CI [1.09, 3.15]), and as having eliminated individual adherence barriers (AOR = 2.33, 95% CI [1.51, 3.62]) and clinic attendance barriers (AOR = 2.01, 95% CI [1.20, 3.38]) These low-cost strategies can be implemented by local NGOs, making it both scalable and sustainable in this and similar settings.
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Pasipanodya EC, Montoya JL, Watson CWM, Marquine MJ, Hoenigl M, Garcia R, Kua J, Gant V, Trambley J, Moore DJ. Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study. PLoS One 2020; 15:e0233217. [PMID: 32516317 PMCID: PMC7282643 DOI: 10.1371/journal.pone.0233217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants’ comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.
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Affiliation(s)
| | - Jessica L. Montoya
- University of California-San Diego, San Diego, California, United States of America
| | - Caitlin W.-M. Watson
- University of California-San Diego, San Diego, California, United States of America
- San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, United States of America
| | - María J. Marquine
- University of California-San Diego, San Diego, California, United States of America
| | - Martin Hoenigl
- University of California-San Diego, San Diego, California, United States of America
| | - Rogelio Garcia
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - John Kua
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - Verna Gant
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - Joel Trambley
- Universal Health Services Southern California Medical Education Consortium, Temecula, California, United States of America
| | - David J. Moore
- University of California-San Diego, San Diego, California, United States of America
- * E-mail:
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20
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Topp SM, Carbone NB, Tseka J, Kamtsendero L, Banda G, Herce ME. " Most of what they do, we cannot do!" How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi. BMJ Glob Health 2020; 5:e002220. [PMID: 32561513 PMCID: PMC7304641 DOI: 10.1136/bmjgh-2019-002220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the era of Option B+ and 'treat all' policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi's three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT. METHODS We conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2-4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches. RESULTS Across all three models, PMTCT LHWs carried out a number of 'targeted' activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women's fears and uncertainties; (ii) enhancing women's social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members' recognition of and trust in services. CONCLUSION PMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the 'treat-all' era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | | | | | - Godfrey Banda
- University of North Carolina Project, Lilongwe, Malawi
| | - Michael E Herce
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel HIll, North Carolina, USA
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
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21
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Cernasev A, Larson WL, Peden-McAlpine C, Rockwood T, Ranelli PL, Okoro O, Schommer JC. "Stigma and HIV Are Like Brother and Sister!": The Experience of African-Born Persons Living with HIV in the US. PHARMACY 2020; 8:pharmacy8020092. [PMID: 32486263 PMCID: PMC7357078 DOI: 10.3390/pharmacy8020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/02/2022] Open
Abstract
Minnesota has seen an increase in the number of immigrants from Africa, notably in the mid-1990s, making up around 2% of Minnesota’s total population. This population also faces many impediments that cause important difficulties not only for HIV prevention but also for treatment and care options. The objectives of this study were to capture the experiences of Persons Living with HIV (PLWH) in Minnesota (US) and to elicit their stories about their diagnosis news and what management strategies they use for coping with the stigma associated with the disease. Participants were recruited via fliers in pharmacies, clinics, and HIV service centers located in Minnesota. Recruitment continued until thematic saturation was obtained. Fourteen subjects participated in audio-recorded, semi-structured interviews that were transcribed verbatim into written text. The transcriptions were analyzed using Thematic Analysis. Three themes emerged from the data. Theme 1: Cruel News: “HIV-Oooooo! I wish I was dead”, Theme 2: This is My Secret! and Theme 3: “Stigma and HIV are brother and sister”. The results demonstrate that stigma is an ever-present problem in African-born PLWH living in the US. Participants perceived the stigma associated with HIV status to affect their lives and culture at individual, familial, and societal levels.
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Affiliation(s)
- Alina Cernasev
- College of Pharmacy, The University of Tennessee Health Science Center, 301 S Perimeter Park Drive, Suite 220, Nashville, TN 37211, USA
- Correspondence:
| | - William L. Larson
- Allina Health Uptown Clinic, 1221 West Lake St., Suite 201, Minneapolis, MN 55455, USA;
| | - Cynthia Peden-McAlpine
- School of Nursing, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA;
| | - Todd Rockwood
- School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA;
| | - Paul L. Ranelli
- College of Pharmacy, University of Minnesota, 232 Life Science Duluth, 111 Kirby Drive, Minneapolis, MN 55812, USA; (P.L.R.); (O.O.)
| | - Olihe Okoro
- College of Pharmacy, University of Minnesota, 232 Life Science Duluth, 111 Kirby Drive, Minneapolis, MN 55812, USA; (P.L.R.); (O.O.)
| | - Jon C. Schommer
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA;
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22
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Tattsbridge J, Wiskin C, de Wildt G, Clavé Llavall A, Ramal-Asayag C. HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: a qualitative study. BMC Public Health 2020; 20:728. [PMID: 32429863 PMCID: PMC7238527 DOI: 10.1186/s12889-020-08745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto. METHODS Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used. RESULTS A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes. CONCLUSION More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.
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Affiliation(s)
- Jasmine Tattsbridge
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Connie Wiskin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna Clavé Llavall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - César Ramal-Asayag
- Department of Infectious Diseases, Regional Hospital of Loreto, Iquitos, Peru.,Department of Clinical Sciences, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
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23
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Nyoni T, Sallah YH, Okumu M, Byansi W, Lipsey K, Small E. The effectiveness of treatment supporter interventions in antiretroviral treatment adherence in sub-Saharan Africa: a systematic review and meta-Analysis. AIDS Care 2020; 32:214-227. [PMID: 32196385 DOI: 10.1080/09540121.2020.1742870] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.
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Affiliation(s)
- Thabani Nyoni
- Washington University in St. Louis, St. Louis, MO, USA
| | | | - Moses Okumu
- University of North Carolina, Chapel Hill, NC, USA
| | | | - Kim Lipsey
- Washington University in St. Louis, St. Louis, MO, USA
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24
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Wijnen BFM, Oberjé EJM, Evers SMAA, Prins JM, Nobel HE, van Nieuwkoop C, Veenstra J, Pijnappel FJ, Kroon FP, van Zonneveld L, van Hulzen AGW, van Broekhuizen M, de Bruin M. Cost-effectiveness and Cost-utility of the Adherence Improving Self-management Strategy in Human Immunodeficiency Virus Care: A Trial-based Economic Evaluation. Clin Infect Dis 2020; 68:658-667. [PMID: 30239629 DOI: 10.1093/cid/ciy553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023] Open
Abstract
Background Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven-effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration NCT01429142.
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Affiliation(s)
- Ben F M Wijnen
- Department of Health Services Research, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center of Economic Evaluations, Utrecht
| | - Edwin J M Oberjé
- Amsterdam School of Communication Research, University of Amsterdam.,Zuyd University of Applied Sciences, Faculty of Healthcare, Heerlen
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center of Economic Evaluations, Utrecht
| | - Jan M Prins
- Department of Internal Medicine, Academic Medical Center, Amsterdam
| | - Hans-Erik Nobel
- Department of Internal Medicine, Academic Medical Center, Amsterdam
| | | | - Jan Veenstra
- Department of Internal Medicine, Sint Lucas Andreas Hospital, Amsterdam
| | | | - Frank P Kroon
- Department of Infectious Diseases, Leiden University Medical Center
| | | | | | | | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, United Kingdom
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25
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Ssewamala FM, Dvalishvili D, Mellins CA, Geng EH, Makumbi F, Neilands TB, McKay M, Damulira C, Nabunya P, Sensoy Bahar O, Nakigozi G, Kigozi G, Byansi W, Mukasa M, Namuwonge F. The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial. PLoS One 2020; 15:e0228370. [PMID: 32040523 PMCID: PMC7010288 DOI: 10.1371/journal.pone.0228370] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment. METHODS We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 -intervention group from 20 clinics, 130 -non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as < 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects. FINDINGS The Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064-2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073-1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275-2.690, p = 0.001). INTERPRETATION A family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries.
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Affiliation(s)
- Fred M. Ssewamala
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- SMART Africa Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- * E-mail:
| | - Darejan Dvalishvili
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Claude A. Mellins
- Department of Psychiatry, New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies at Columbia University Medical Center, The City of New York, NY, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Torsten B. Neilands
- Division of Prevention Science, Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Mary McKay
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- SMART Africa Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Christopher Damulira
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka, Uganda
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- SMART Africa Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | | | - William Byansi
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Miriam Mukasa
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka, Uganda
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26
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Kalichman SC, Mathews C, Banas E, Kalichman MO. Alcohol-related beliefs and non-adherence to antiretroviral therapy in Cape Town, South Africa. J Behav Med 2020; 43:764-772. [PMID: 31955306 DOI: 10.1007/s10865-020-00135-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023]
Abstract
The life-saving effects of antiretroviral therapy (ART) in treating HIV infection are compromised by alcohol use. A growing body of research shows that both unintentional (e.g., memory lapses) and intentional (e.g., forgoing ART to avoid mixing with alcohol) contribute to ART non-adherence. Beliefs that it is harmful to mix alcohol with ART (alcohol-ART interactive toxicity beliefs) contribute to intentional non-adherence, but their role in overall adherence is not clear. This study conducted a clinic-based survey with 100 men and 193 women (mean age = 36) to examine the prevalence of alcohol-ART interactive toxicity beliefs and whether they contribute to treatment non-adherence in South Africa. One in three (36%, n = 106) participants reported no current alcohol use and 64% (n = 187) reported current alcohol use. The majority of participants, including current alcohol drinkers, endorsed beliefs that it is harmful to mix ART and alcohol, with 57% who currently drink reporting that they forgo taking ART when they are drinking. Participants reported being warned not to mix alcohol and ART from family, friends, and health care providers. In addition, 62% of participants who do not drink, as well as 36% of those who do drink, tell others not to mix alcohol and ART. Mediation modelling found that alcohol use directly predicts ART adherence, and that this relationship is partially mediated by alcohol-ART interactive toxicity beliefs. Health care providers can play a critical role in disputing interactive toxicity beliefs and encouraging patients to take ART even when they are drinking.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ellen Banas
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
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27
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Sabino TE, Avelino-Silva VI, Cavalcantte C, Goulart SP, Luiz OC, Fonseca LAM, Casseb JS. Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil. AIDS Care 2020; 33:31-38. [PMID: 31906696 DOI: 10.1080/09540121.2019.1710449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study focused on factors associated with antiretroviral therapy (ART) adherence and quality of life among transgenderwomen in Sao Paulo, Brazil, using univariable and adjusted analysis. Adherence was evaluated with a self-report tool and with HIV viral load (VL) measurement. PROQOL-HIV was used to assess quality of life. 106 TGW with median 41 years old were included; most were white (56%) and had >10 years of education (57%). Median time since HIV/AIDS diagnosis was 10 years. Overall, participants had high T CD4+ counts (median 659 cells/mm3) and most (75%) had undetectable HIV VL. 85% were considered adherent using self-report (95%CI 77-91), whereas 72% (95%CI 62-80) were considered adherent when self-report and undetectable HIV VL were analyzed jointly. Older age was associated with higher ART adherence; each year increase in age was associated with 5% higher odds of adherence (p = 0.021). Quality of life ranged from good-excellent in 5 of 8 domains. Younger age, lower education, higher time since HIV diagnosis, comorbidities, illicit drugs use and depression were associated with lower PROQOL scores in specific domains in univariable analysis, while depression was also associated with lower total PROQOL score even after adjustment for age, comorbidities and time since HIV diagnosis (p = 0.048).
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Affiliation(s)
- Thiago E Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clara Cavalcantte
- School of Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia P Goulart
- HIV/AIDS Reference and Treatment Center in São Paulo, Centro de Referência e Tratamento de DST Aids, São Paulo, Brazil
| | - Olinda C Luiz
- Departament of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz A M Fonseca
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Jorge S Casseb
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
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28
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Galárraga O, Enimil A, Bosomtwe D, Cao W, Barker DH. Group-based economic incentives to improve adherence to antiretroviral therapy among youth living with HIV: safety and preliminary efficacy from a pilot trial. VULNERABLE CHILDREN AND YOUTH STUDIES 2019; 15:257-268. [PMID: 33281920 PMCID: PMC7717062 DOI: 10.1080/17450128.2019.1709678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/23/2019] [Indexed: 06/12/2023]
Abstract
Poor adherence to antiretroviral therapy (ART) has significant consequences for adolescents. Conditional economic incentives (CEI) is an approach that may help address this challenge. This study evaluated the safety and preliminary efficacy of a group-based CEI program for ART adherence improvement among a sample of adolescents living in Ghana. A total of 35 adolescents (mean age: 14.7 years) on ART, though still with detectable viral load, were recruited from an HIV clinic and divided into 5 balanced groups to participate in peer-led group-based CEI activities during routine clinic visits. Four assessments were conducted across four visits at baseline and 3-, 6-, and 9-month follow-up, respectively. Main outcomes were ART adherence and viral load. Linear mixed models and thematic analysis were used for data analyses. The majority (91.4%) of the participants attended all four intervention activities. Participants reported missing an average of 1.06, 0.50, 0.91, 0.55 doses of ART in the past 7 days at baseline, 3-, 6-, and 9-month assessments, respectively. Most viral loads were ≥5,000 copies/ml at both baseline (68.6%) and 6-month assessments (54.3%). The incentive was divided between individual compensation for attending clinic and completing the assessment ($5 each, $20 in total) and a group-based compensation valued at $40 that was distributed during the 9-month assessment according to average group attendance (A≥90%, B≥75%, C≥60%, D<60%) and group-average viral load (A=undetectable, B=50-499, C=500-4999, D≥5,000). The mean earnings for the participants was $46.70 (77.8% of possible earning). Qualitative data suggested that the CEI helped ART adherence through gaining personal and group benefits. Participants reported no teasing, bullying, or other undesirable behaviors from group members. They liked getting money for attending clinics/group meetings and obtaining undetectable viral load. We concluded that a group-based CEI was safe and had the potential to improve ART adherence and reduce viral load among Ghanaian adolescents.
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Affiliation(s)
- Omar Galárraga
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, United States
| | - Anthony Enimil
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dennis Bosomtwe
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Wangnan Cao
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, United States
| | - David H. Barker
- Department of Psychiatry, Rhode Island Hospital, Providence, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, United States
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29
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Mukumbang FC, Knight L, Masquillier C, Delport A, Sematlane N, Dube LT, Lembani M, Wouters E. Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review. BMC Public Health 2019; 19:1682. [PMID: 31842846 PMCID: PMC6916449 DOI: 10.1186/s12889-019-8020-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/29/2019] [Indexed: 12/31/2022] Open
Abstract
Background HIV remains a major public health challenge in many low- and middle-income countries (LMICs). The initiation of a greater number of people living with HIV (PLHIV) onto antiretroviral therapy (ART) following the World Health Organization’s ‘universal test and treat’ recommendation has the potential to overstretch already challenged health systems in LMICs. While various mainstream and community-based care models have been implemented to improve the treatment outcomes of PLHIV, little effort has been made to harness the potential of the families or households of PLHIV to enhance their treatment outcomes. To this end, we sought to explore the characteristics and effectiveness of household-focused interventions in LMICs on the management of HIV as measured by levels of adherence, viral suppression and different dimensions of HIV competence. Additionally, we sought to explore the mechanisms of change to explain how the interventions achieved the expected outcomes. Methods We systematically reviewed the literature published from 2003 to 2018, obtained from six electronic databases. We thematically analysed the 11 selected articles guided by the population, intervention, comparison and outcome (PICO) framework. Following the generative causality logic, whereby mechanisms are postulated to mediate an intervention and the outcomes, we applied a mechanism-based inferential reasoning, retroduction, to identify the mechanisms underlying the interventions to understand how these interventions are expected to work. Results The identified HIV-related interventions with a household focus were multi-component and multi-dimensional, incorporating aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health. Most of the interventions sought to empower and stimulate self-efficacy while strengthening the perceived social support of the PLHIV. Studies reported a significant positive impact on improving various aspects of HIV competent household – positive effects on HIV knowledge, communication between household members, and improved mental health outcomes of youths living in HIV-affected households. Conclusion By aiming to strengthen the perceived social support and self-efficacy of PLHIV, household-focused HIV interventions can address various aspects of household HIV competency. Nevertheless, the role of the household as an enabling resource to improve the outcomes of PLHIV remains largely untapped by public HIV programmes; more research on improving household HIV competency is therefore required. Trial registration PROSPERO registration: CRD42018094383.
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Affiliation(s)
| | - Lucia Knight
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Anton Delport
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Neo Sematlane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Martina Lembani
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Edwin Wouters
- Department of Social Sciences, Antwerp University, Antwerp, Belgium
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30
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Whitfield THF, Jones SS, Wachman M, Grov C, Parsons JT, Rendina HJ. The Impact of Pre-Exposure Prophylaxis (PrEP) Use on Sexual Anxiety, Satisfaction, and Esteem Among Gay and Bisexual Men. JOURNAL OF SEX RESEARCH 2019; 56:1128-1135. [PMID: 30777781 PMCID: PMC6699935 DOI: 10.1080/00224499.2019.1572064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Gay and bisexual men (GBM) with heightened fears of human immunodeficiency virus (HIV) acquisition have reported high levels of sexual anxiety and low sexual self-esteem. Similarly, sexual satisfaction has been reported to be lower among some GBM who rely solely on condom use as HIV prevention. We sought to explore whether pre-exposure prophylaxis (PrEP) had an impact on the sexual satisfaction, anxiety, and esteem of GBM. As part of a longitudinal cohort study of 1,071 GBM, participants reported at three time points on PrEP use and completed the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ). A total of 137 GBM began taking PrEP in the 24 months following baseline. Comparing their responses during times before initiating PrEP and after, within adjusted multilevel models, there was a significant decrease in sexual anxiety (B = -0.27, p = 0.03) but no significant changes in sexual esteem or satisfaction. Our findings indicate important psychological improvements resulting from PrEP initiation. Further research should explore the potential for other psychological benefits of PrEP use among GBM.
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Affiliation(s)
- Thomas H. F. Whitfield
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
| | - Stephen S. Jones
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY
| | - Matthew Wachman
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, NY
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY
| | - H. Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY
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31
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Meyers DJ, Cole MB, Rahman M, Lee Y, Rogers W, Gutman R, Wilson IB. The association of provider and practice factors with HIV antiretroviral therapy adherence. AIDS 2019; 33:2081-2089. [PMID: 31577572 PMCID: PMC6980422 DOI: 10.1097/qad.0000000000002316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE While antiretroviral therapy (ART) is essential to patients with HIV, there is substantial variation in adherence nationally. We assess how provider and practice factors contribute to successful HIV ART adherence. DESIGN We used Medicaid Analytic Extract claims from 2008 to 2012. We attributed patients with HIV to the provider that provided the plurality of HIV-related services or primary care in a given year and assigned these providers to a medical practice based on the National Provider Identifier registry file. We fit successive linear hierarchical models with patient, provider, and practice characteristics to partition the variation in adherence driven by each factor. Our unit of analysis was the patient-year. SETTING Fourteen US states with the highest HIV prevalence. PARTICIPANTS A total of 111 013 patient-years representing 60 496 Medicaid enrollees living with HIV attributed to 4930 providers and 1960 practices. MAIN OUTCOME MEASURE Percentage of year individual patients were adherent to an ART regimen. RESULTS Provider and practice random effects jointly explained 6.8% of variation in adherence with patient differences accounted for 45.2% of the variation. Patients seen by generalists and other specialists had a 1.6 [95% confidence interval (CI): 0.6-2.5] and 5.1 (95% CI: 4.1-6.1) percentage point greater adherence than those seen by infectious disease specialists (P < 0.001). Every additional year a patient saw the same provider was associated with a 6% increase in adherence (95% CI: 5.7-6.3). CONCLUSION There is substantial variation in ART adherence attributable to providers and practices and between provider specialties. To improve ART adherence for patients living with HIV, structural aspects of care should be considered.
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Affiliation(s)
- David J Meyers
- aDepartment of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island bDepartment of Health Law, Policy, & Management, Boston University School of Public Health cInstitute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts dDepartment of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
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32
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Ssewamala FM, Byansi W, Bahar OS, Nabunya P, Neilands TB, Mellins C, McKay M, Namuwonge F, Mukasa M, Makumbi FE, Nakigozi G. Suubi+Adherence study protocol: A family economic empowerment intervention addressing HIV treatment adherence for perinatally infected adolescents. Contemp Clin Trials Commun 2019; 16:100463. [PMID: 31872152 PMCID: PMC6915750 DOI: 10.1016/j.conctc.2019.100463] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Globally, 1.8 million children<15 years are living with HIV. Sub-Saharan Africa (SSA), as a region, is heavily burdened by HIV, with 90% of new infections among children happening there. Within SSA, Uganda has an HIV prevalence of 7.2% among 15-49-year-olds, with high prevalence in Masaka region (12%). Uganda also reports unprecedented numbers of perinatally HIV-infected children, with close to 150,000 children (ages 0–14) living with HIV (CLHA). However adherence to antiretroviral therapy (ART) among children and youth is poor, and has been attributed to economic insecurity, including lack of finances for transportation to clinic appointments, inadequate meals to support medication consumption, and resource prioritization towards school expenses. Yet, few programs aimed at addressing ART adherence have applied combination interventions to address economic stability and ART Adherence within the traditional framework of health education and HIV care. This paper describes a study protocol for a 5-year, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) funded, cluster randomized-controlled trial to evaluate a combination intervention, titled Suubi + Adherence, aimed at improving ART adherence among HIV perinatally infected adolescents (ages 10–16 at study enrollment) in Uganda. Methods Suubi + Adherence was evaluated via a two-arm cluster randomized-controlled trial design in 39 health clinics, with a total enrollment of 702 HIV + adolescents (ages 10–16 at enrollment). The study addresses two primary outcomes: 1) adherence to HIV treatment regimen and 2) HIV knowledge and attitudes. Secondary outcomes include family functioning, sexual risk-taking behavior, and financial savings behavior. For potential scale-up, cost effectiveness analysis was employed to compare the relative costs and outcomes associated with each study arm: family economic strengthening comprising matched savings accounts, financial management training and small business development, all intended for family economic security versus bolstered usual care (SOC) comprising enhanced adherence sessions to ensure more standardized and sufficient adherence counseling. Discussion This study aims to advance knowledge and inform the development of the next generation of programs aimed at increasing adherence to HIV treatment for HIV + adolescents in low-resource regions such as SSA. To our knowledge, the proposed study is the first to integrate and test family economic empowerment and stability-focused interventions for HIV + adolescents in Uganda (and much of SSA)—so families would have the necessary finances to manage HIV/AIDS as a chronic illness. The study would provide crucial evidence about the effects of an economic empowerment program on short and long-term impact, which is essential if such interventions are to be taken to scale. Trial registration This trial was registered with ClinicalTrials.gov (registration number: NCT01790373) on 13 February 2013.
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Affiliation(s)
- Fred M. Ssewamala
- Washington University in St. Louis, Brown School, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, United States
- Corresponding author.
| | | | | | | | | | | | - Mary McKay
- Washington University in St. Louis, MO, United States
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Miriam Mukasa
- International Center for Child Health and Development, Masaka, Uganda
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Kibicho J, Dilworth T, Owczarzak J, Ndakuya F. Pharmacist-initiated adherence promotion activities for persons living with HIV in ambulatory care settings: Instrument development and initial psychometric testing. Res Social Adm Pharm 2019; 16:921-927. [PMID: 31636008 DOI: 10.1016/j.sapharm.2019.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/19/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Consistent adherence to antiretroviral therapy (ART) remains a challenge for half the people living with HIV (PLWH) in the U.S. Pharmacists have the expertise in pharmacology and pharmacotherapeutics to manage ART and optimize PLWH outcomes. We developed and validated the psychometric properties of a scale to measure the breadth and depth of adherence promotion activities provided by pharmacists to PLWH in ambulatory care settings. METHODS An initial 37-item instrument was developed from 31 pharmacists' interviews and a comprehensive literature review. Psychometric properties were assessed from responses to questionnaires of 10 content experts and 184 ambulatory pharmacists in 37 States. Psychometric tests included: content validity index (CVI); Exploratory Factor Analysis (EFA); and internal reliability using Cronbach's alpha (α). RESULTS 26 items were eliminated in the item reduction stage. The final 11-item adherence promotion activities scale (APAS) was a single factor with high loadings (0.51-0.85), good internal consistency (α ≤ 0.93) and an explained variance of 60%. For known-groups validity, HIV-certified pharmacists had comparatively higher and statistically significant APAS score compared to non-certified pharmacists (4.00, p < .001). CONCLUSIONS Preliminary psychometric testing-factor analysis, and high internal consistency-depict that APAS can be useful in scientific research and pharmacy practice to assess the nature and range of pharmacists' above-and-beyond prescription services in real-world ambulatory settings. Further validation work is needed to establish conclusive reliability and validity of the newly developed scale.
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Affiliation(s)
- Jennifer Kibicho
- College of Nursing, University of Wisconsin-Milwaukee, P O Box 413, Milwaukee, WI, USA.
| | - Thomas Dilworth
- Department of Pharmacy Services, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Jill Owczarzak
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - Florine Ndakuya
- College of Nursing, University of Wisconsin-Milwaukee, P O Box 413, Milwaukee, WI, USA
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Patel M, Tedaldi E, Armon C, Nesheim S, Lampe M, Palella F, Novak R, Sutton M, Buchacz K. HIV RNA Suppression during and after Pregnancy among Women in the HIV Outpatient Study, 1996 to 2015. J Int Assoc Provid AIDS Care 2019; 17:2325957417752259. [PMID: 29357772 PMCID: PMC6748471 DOI: 10.1177/2325957417752259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine HIV viral suppression during/after pregnancy. DESIGN Prospective observational cohort. METHODS We identified pregnancies from 1996 to 2015. We examined HIV RNA viral load (VL), VL suppression (≤500 copies/mL), and antiretroviral therapy (ART) status at pregnancy start, end, and 6 months postpartum. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for VL nonsuppression. RESULTS Among 253 pregnancies analyzed, 34.8% of women exhibited VL suppression at pregnancy start, 60.1% at pregnancy end, and 42.7% at 6 months postpartum. Median VL (log10 copies/mL) was 2.80 (interquartile range [IQR]: 1.40-3.85) at pregnancy start, 1.70 (IQR: 1.40-2.82) at pregnancy end, and 2.30 (IQR: 1.40-3.86) at postpartum. Risk of postpartum VL nonsuppression was also lower among women on ART and with VL suppression at pregnancy end (versus those not; adjusted RR = 0.30, 95% CI: 0.17-0.53). CONCLUSIONS Maintaining VL suppression among US women remains a challenge, particularly during postpartum. Achieving VL suppression earlier during pregnancy benefits women subsequently.
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Affiliation(s)
- Monita Patel
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen Tedaldi
- 2 Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Carl Armon
- 3 Cerner Corporation, Kansas City, MO, USA
| | - Steven Nesheim
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret Lampe
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Frank Palella
- 4 Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard Novak
- 5 University of Illinois at Chicago, Chicago, IL, USA
| | - Madeline Sutton
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Buchacz
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
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A Systematic Review and Meta-analysis of Antiretroviral Therapy (ART) Adherence Interventions for Women Living with HIV. AIDS Behav 2019; 23:1998-2013. [PMID: 30443806 DOI: 10.1007/s10461-018-2341-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A systematic review and meta-analysis was conducted to determine the efficacy of women-focused ART adherence interventions. Included studies (a) reported on a behavioral ART adherence intervention for cis-women living with HIV, (b) measured ART adherence as an outcome, and (c) employed a randomized controlled trial design. Thirteen studies were included in the meta-analysis. Overall, interventions significantly improved ART adherence compared to control conditions (random-effects d = 0.82, 95% CI [0.18, 1.45], p = 0.01), however, this was largely driven by two studies that had effect sizes greater than 3 standard errors above the mean effect size. Key moderators were location, recruitment method, group-based intervention, and alteration of the healthcare system. Innovative behavioral interventions that focus on young women and adolescents, target the critical periods of pregnancy and postpartum and test the integration of multiple levels of intervention to create lasting effects on ART adherence are needed.
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Barchi F, Winter SC, Ketshogile FM, Ramogola-Masire D. Adherence to screening appointments in a cervical cancer clinic serving HIV-positive women in Botswana. BMC Public Health 2019; 19:318. [PMID: 30885175 PMCID: PMC6423763 DOI: 10.1186/s12889-019-6638-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background The link between human immunodeficiency virus (HIV) and cervical cancer is of particular concern in Botswana, where one in four women at risk for cervical cancer is HIV-positive. In settings where co-occurrence of these diseases is high, adherence to screening appointments is essential to ensure detection and early treatment. Methods This study took place in a cervical cancer-screening program in an HIV clinic in Botswana. Data for this analysis came from 1789 patient records and 257 semi-structured surveys about the screening consent process that were completed by a subset of patients. Results Forty percent of women kept their scheduled follow-up appointments. Findings suggest that women treated at first visit or referred for additional treatment due to the presence of more advanced disease had more than double the odds of adhering to follow-up appointments compared to women with negative screens. Women who completed the 35-min surveys in the embedded consent study were found to have 3.7 times greater odds of adhering to follow-up appointment schedules than women who did not. Factors such as age, education, income and marital status that have been shown elsewhere to be important predictors of adherence were not found to be significant predictors in this study. Conclusions HIV-positive women in Botswana who are symptom free at initial screening may be lost to essential future screening and follow-up care without greater targeted communication regarding cervical cancer and the importance of regular screening. Strategies to reinforce health messages using cell phone reminders, appointment prompts at time of anti-retroviral drug (ARV) refills, and use of trained community workers to review cervical cancer risks may be effective tools in reducing the burden of cervical cancer disease in HIV-positive women in this setting. Electronic supplementary material The online version of this article (10.1186/s12889-019-6638-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francis Barchi
- Edward J. Bloustein School of Planning & Public Policy, Rutgers, The State University of New Jersey, 33 Livingston Avenue, New Brunswick, NJ, 08901, USA.
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Kalichman S, Mathews C, Banas E, Kalichman M. Alcohol-related intentional nonadherence to antiretroviral therapy among people living with HIV, Cape Town, South Africa. AIDS Care 2019; 31:951-957. [PMID: 30884956 DOI: 10.1080/09540121.2019.1587357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Alcohol use may have significant negative impacts on individuals' ability to remain adherent to antiretroviral therapy (ART), and may also yield other negative psychosocial, health-related, and behavioral outcomes. In addition, false beliefs about the consequences of mixing alcohol with ART use may cause individuals to avoid taking ART when drinking (alcohol-related ART avoidance). Although research conducted in the U.S. and Europe has reported on alcohol-ART avoidance, the current study presents among the first quantitative evidence of alcohol-related intentional ART nonadherence in South Africa. Patients receiving ART from a community clinic in Cape Town (N = 441) completed anonymous surveys of alcohol use, ART adherence, and alcohol-ART avoidance. Results showed that 292 (66%) participants reported current alcohol use; 25% who use alcohol believed that people who drink should stop taking ART when they are drinking and 24% stop their own ART when drinking. Alcohol-ART avoidance mediated the association between alcohol use and ART adherence. Results were robust when controlling for participant age, gender, current care status, and first- versus second-line ART. We found alcohol-ART avoidance may threaten successful ART in South Africa. Corrective messages that take a harm reduction approach to maximize ART adherence when drinking should be implemented in existing clinical services.
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Affiliation(s)
- Seth Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Catherine Mathews
- b Health Systems Research Unit , Medical Research Council , Cape Town , South Africa
| | - Ellen Banas
- a Department of Psychology , University of Connecticut , Storrs , CT , USA.,b Health Systems Research Unit , Medical Research Council , Cape Town , South Africa
| | - Moira Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
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Godersky ME, Saxon AJ, Merrill JO, Samet JH, Simoni JM, Tsui JI. Provider and patient perspectives on barriers to buprenorphine adherence and the acceptability of video directly observed therapy to enhance adherence. Addict Sci Clin Pract 2019; 14:11. [PMID: 30867068 PMCID: PMC6417248 DOI: 10.1186/s13722-019-0139-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/27/2019] [Indexed: 12/04/2022] Open
Abstract
Background Buprenorphine effectively reduces opioid craving and illicit opioid use. However, some patients may not take their medication as prescribed and thus experience suboptimal outcomes. The study aim was to qualitatively explore buprenorphine adherence and the acceptability of utilizing video directly observed therapy (VDOT) among patients and their providers in an office-based program. Methods Clinical providers (physicians and staff; n = 9) as well as patients (n = 11) were recruited from an office-based opioid treatment program at an urban academic medical center in the northwestern United States. Using a semi-structured guide, interviewers conducted individual interviews and focus group discussions. Interviews were digitally recorded and transcribed verbatim. Transcripts were independently coded to identify key themes related to non-adherence and then jointly reviewed in an iterative fashion to develop a set of content codes. Results Among providers and patients, perceived reasons for buprenorphine non-adherence generally fell into several thematic categories: social and structural factors that prevented patients from consistently accessing medications or taking them reliably (e.g., homelessness, transportation difficulties, chaotic lifestyles, and mental illness); refraining from taking medication in order to use illicit drugs or divert; and forgetting to take medication, especially in the setting of taking split-doses. Some participants perceived non-adherence to be less of a problem for buprenorphine than for other medications. VDOT was viewed as potentially enhancing patient accountability, leading to more trust from providers who are concerned about diversion. On the other hand, some participants expressed concern that VDOT would place undue burden on patients, which could have the opposite effect of eroding patient-provider trust. Others questioned the clinical indication. Conclusions Findings suggest potential arenas for enhancing buprenorphine adherence, although structural barriers will likely be most challenging to ameliorate. Providers as well as patients indicated mixed attitudes toward VDOT, suggesting it would need to be thoughtfully implemented.
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Affiliation(s)
- Margo E Godersky
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Andrew J Saxon
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Joseph O Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Jeffrey H Samet
- Division of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Jane M Simoni
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA.
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Abstract
Pill aversion, defined as difficulty swallowing pills without identifiable medical cause, is a poorly characterized barrier to sustained viral suppression for many HIV-infected persons. We aimed to quantify the frequency of self-reported pill aversion, characterize its symptoms, and measure the association between self-reported pill aversion and missing antiretroviral doses. This is a prospective, observational, exploratory survey study of English-speaking persons living with HIV (PLHIV) at a single urban tertiary outpatient clinic. Participants completed anonymous questionnaires about their experiences of swallowing antiretroviral pills. The primary outcome was skipping pills due to pill aversion symptoms. Of 384 participants, a quarter (25.5%) skipped pills due to pill aversion symptoms. Younger age, being Non-Hispanic Black or Hispanic, not being married or partnered, having public insurance, not being employed, having less than a college education, and having a mental health diagnosis were associated with skipping pills due to pill aversion. On multivariable regression analyses, PLHIV who skipped pills were more likely to report symptoms of gagging, nausea at the time of swallowing, and heavy feeling in the stomach, as well as being bothered by the taste, smell, and size of the pills. PLHIV who skipped pills were also more likely to report negative and fear-based emotions about pill-taking than PLHIV who did not skip pills due to pill aversion. HIV-related pill aversion may represent a significant and frequent barrier to adherence in an adult HIV population.
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Affiliation(s)
- Robin M. Dorman
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sarah H. Sutton
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Gamarel KE, Chakravarty D, Neilands TB, Hoff CC, Lykens J, Darbes LA. Composite Risk for HIV: A New Approach Towards Integrating Biomedical and Behavioral Strategies in Couples-Based HIV Prevention Research. AIDS Behav 2019; 23:283-288. [PMID: 30003506 PMCID: PMC6368473 DOI: 10.1007/s10461-018-2229-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A substantial number of new HIV infections among gay, bisexual, and other men who have sex with men and transgender women occurs in the context of primary partnerships. Given the diversity of risk reduction needs and various approaches available for reducing risk within couples, condomless sex is no longer the gold standard HIV outcome. We present a novel, comprehensive, and flexible Composite Risk for HIV (CR-HIV) approach for integrating evolving biomedical and behavioral HIV prevention strategies into couples-based HIV prevention intervention and survey research. We provide illustrative examples of the utility of the CR-HIV approach based on couples' HIV status.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - James Lykens
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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Perceptions and decision-making with regard to pregnancy among HIV positive women in rural Maputo Province, Mozambique - a qualitative study. BMC WOMENS HEALTH 2018; 18:166. [PMID: 30305066 PMCID: PMC6180632 DOI: 10.1186/s12905-018-0644-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 09/12/2018] [Indexed: 12/04/2022]
Abstract
Background In preventing the transfer of HIV to their children, the Ministry of Health in Mozambique recommends all couples follow medical advice prior to a pregnancy. However, little is known about how such women experience pregnancy, nor the values they adhere to when making childbearing decisions. This qualitative study explores perceptions and decision-making processes regarding pregnancy among HIV positive women in rural Maputo Province. Methods In-depth interviews and five focus group discussions with fifty-nine women who had recently become mothers were carried out. In addition, six semi-structured interviews were held with maternity and child health nurses. The ethnographic methods employed here were guided by Bourdieu’s practice theory. Results The study indicated that women often perceived pregnancy as a test of fertility and identity. It was not only viewed as a rite of passage from childhood to womanhood, but also as a duty for married women to have children. Most women did not follow recommended medical advice prior to gestation. This was primarily due to perceptions that decision-making about pregnancy was regarded as a private issue not requiring consultation with a healthcare provider. Additionally, stigmatisation of women living with HIV, lack of knowledge about the need to consult a healthcare provider prior to pregnancy, and unintended pregnancy due to inadequate use of contraceptive were crucial factors. Conclusion Women’s experiences and decisions regarding pregnancy are more influenced by social and cultural norms than medical advice. Therefore, education concerning sexual and reproductive health in relation to HIV/AIDS and childbearing is recommended. In particular, we recommend maternal and child healthcare nurses need to be sensitive to women’s perceptions and the cultural context of maternity when providing information about sexual and reproductive health.
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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Slavin S. HIV Treatment as Prevention: Implications for Health Promotion. Health Promot Int 2018; 33:325-333. [PMID: 28334739 DOI: 10.1093/heapro/daw080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Evidence has been accumulating in recent years that individuals with HIV who are effectively treated with antiretroviral drugs are highly unlikely to transmit the virus to their sexual partners. This approach has great potential to contribute to ongoing prevention efforts and has been termed 'treatment as prevention'. International political momentum has been building in recent years to attempt to significantly reduce new HIV infections globally and end the epidemic by 2030. In pursuit of such aims a number of local health authorities and communities have adopted intensified 'test and treat' strategies to quickly diagnose infections and reduce the risk of onward transmission through an immediate offer of treatment. These have most commonly been driven through enhancements to clinical services and health promoters have been engaged in limited ways. People with HIV often have high rates of health literacy and are now expressing interest in knowing more about how treatment as prevention might work to reduce their individual risk of sexual transmission. For some this represents an added risk reduction measure and for others it may replace condoms. There is currently an opportunity for health promotors to engage with this approach both to exploit its prevention benefits and to counter the stigma that attaches to HIV infectiousness. It is hoped that any reduction in stigma and fear of transmission will help improve the quality of social and sexual relationships among affected groups.
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Affiliation(s)
- Sean Slavin
- Centre for Social Research in Health, University of New South Wales, Australia
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Harkness A, Bainter SA, O'Cleirigh C, Mendez NA, Mayer KH, Safren SA. Longitudinal Effects of Syndemics on ART Non-adherence Among Sexual Minority Men. AIDS Behav 2018; 22:2564-2574. [PMID: 29860556 DOI: 10.1007/s10461-018-2180-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study examined longitudinally the additive effect of syndemics, or co-occurring psychosocial problems, on antiretroviral treatment (ART) non-adherence among 390 HIV-positive sexual minority men. Participants completed measures of ART adherence (reduced to a non-adherence score using exploratory factor analysis) and six syndemic conditions. We employed multilevel modeling with the number of syndemics as a longitudinal predictor of non-adherence, and logistic regression with baseline syndemics predicting follow up viral load. Number of syndemics was a significant longitudinal predictor of non-adherence, with each additional syndemic associated with a 0.13 increase in non-adherence (p = 0.004). Each additional syndemic was also associated with 1.27 greater odds of detectable viral load (p = 0.002). Among HIV-positive sexual minority men in this sample, more syndemics were associated with lower ART adherence and greater odds of detectable viral load, suggesting the need for behavioral intervention to facilitate care for this population.
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Affiliation(s)
- Audrey Harkness
- Department of Psychology, University of Miami, Clinical Research Building (C-204), 1120 NW 14th Street, Suite 786, Miami, FL, 33136, USA.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, Clinical Research Building (C-204), 1120 NW 14th Street, Suite 786, Miami, FL, 33136, USA
| | - Conall O'Cleirigh
- Fenway Community Health, The Fenway Institute, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami, Clinical Research Building (C-204), 1120 NW 14th Street, Suite 786, Miami, FL, 33136, USA
| | - Kenneth H Mayer
- Fenway Community Health, The Fenway Institute, Boston, MA, USA
- Division of Infectious Disease, Department of Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Clinical Research Building (C-204), 1120 NW 14th Street, Suite 786, Miami, FL, 33136, USA
- Fenway Community Health, The Fenway Institute, Boston, MA, USA
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Palmer A, Gabler K, Rachlis B, Ding E, Chia J, Bacani N, Bayoumi AM, Closson K, Klein M, Cooper C, Burchell A, Walmsley S, Kaida A, Hogg R. Viral suppression and viral rebound among young adults living with HIV in Canada. Medicine (Baltimore) 2018; 97:e10562. [PMID: 29851775 PMCID: PMC6392935 DOI: 10.1097/md.0000000000010562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Describe the prevalence and covariates of viral suppression and subsequent rebound among younger (≤29 years old) compared with older adults.A retrospective clinical cohort study; eligibility criteria: documented HIV infection; resident of Canada; 18 years and over; first antiretroviral regimen comprised of at least 3 individual agents on or after January 1, 2000.Viral suppression and rebound were defined by at least 2 consecutive viral load measurements <50 or >50 HIV-1 RNA copies/mL, respectively, at least 30 days apart, in a 1-year period. Time to suppression and rebound were measured using the Kaplan-Meier method and Life Table estimates. Accelerated failure time models were used to determine factors independently associated with suppression and rebound.Younger adults experienced lower prevalence of viral suppression and shorter time to viral rebound compared with older adults. For younger adults, viral suppression was associated with being male and later era of combination antiretroviral initiation (cART) initiation. Viral rebound was associated with a history of injection drug use, Indigenous ancestry, baseline CD4 cell count >200, and initiating cART with a protease inhibitor (PI) containing regimen.The influence of age on viral suppression and rebound was modest for this cohort. Our analysis revealed that key covariates of viral suppression and rebound for young adults in Canada are similar to those of known importance to older adults. Women, people who use injection drugs, and people with Indigenous ancestry could be targeted by future health interventions.
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Affiliation(s)
- Alexis Palmer
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Gabler
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | | | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, Montreal, QB
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Ann Burchell
- Dalla Lana School of Public Health, University of Toronto
- St. Michael's Hospital, Toronto, ON
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON
| | - Angela Kaida
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Cook PF, Schmiege SJ, Bradley-Springer L, Starr W, Carrington JM. Motivation as a Mechanism for Daily Experiences' Effects on HIV Medication Adherence. J Assoc Nurses AIDS Care 2018; 29:383-393. [PMID: 28967490 PMCID: PMC5844787 DOI: 10.1016/j.jana.2017.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
Medication adherence is a challenge for people living with HIV (PLWH), who may experience a gap between their intentions and everyday behaviors. We measured PLWH's (n = 87) daily experiences and tested a model to explain the intention-behavior gap. Participants completed baseline questionnaires, then used a smartphone-based survey and an electronic pill bottle to provide daily data for the next 10 weeks. These PLWH, with generally well-controlled HIV, were nevertheless adherent on only 73% of study days. Multilevel analyses were used to test predicted relationships between variables (n = 58). Four of five theory-based daily measures predicted motivation for antiretroviral therapy (betas = 0.06-0.10), and motivation, in turn, predicted adherence. Consistent with our theory, control beliefs, mood, and social support had indirect effects on adherence. However, stress and coping did not. Daily experiences affect adherence, even in PLWH with well-controlled HIV. Providers should ask about everyday changes in motivation.
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Affiliation(s)
- Paul F. Cook
- Associate Professor, University of Colorado College of Nursing, Aurora, Colorado, USA
| | - Sarah J. Schmiege
- Associate Professor, Colorado School of Public Health, Aurora, Colorado, USA
| | - Lucy Bradley-Springer
- Associate Professor, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Whitney Starr
- Instructor, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jane M. Carrington
- Assistant Professor, University of Arizona College of Nursing, Tucson, Arizona, USA
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Kipsang J, Chen J, Tang C, Li X, Wang H. Self reported adherence to antiretroviral treatment and correlates in Hunan province, the Peoples Republic of China. Int J Nurs Sci 2018; 5:162-167. [PMID: 31406819 PMCID: PMC6626245 DOI: 10.1016/j.ijnss.2018.04.008] [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: 12/16/2017] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 11/19/2022] Open
Abstract
Aims This study aimed to describe the adherence level to antiretroviral therapy and its associated factors among people living with HIV in Hunan province, China. Methods Across-sectional survey study was done at two major HIV treatment sites within Hunan province in China from July 2011 to Oct 2012 through face-to-face interviews. Adherence measures were captured using a 30-day visual analog scale (VAS). Results A total of 418 participants consented and completed the questionnaires with the mean age being 38 years old. Based on VAS, 28% of the participants had lower than 90% ART adherence level. The main reasons for missing drugs were; forgetting, being away from home, being busy and feeling worse after taking drugs. Logistic regression results showed that drug use (B = 0.68, OR = 2.11), time on ART (B = -0.31, OR = 0.72) and side effects (B = 0.64, OR = 1.82) were significantly associated with adherence to ART. Conclusion Patients on ARVs in Hunan province are faced with adherence challenges notably drug abuse, drug regime scheduling challenges at the initial stages of therapy and drug side effects. It is therefore necessary to institute specific adherence interventions that target those who abuse drugs, ART naïve patients, and those experiencing side effects in order to achieve optimal ART adherence.
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Affiliation(s)
- John Kipsang
- Xiangya School of Nursing, Central South University, Hunan, China
| | - Jia Chen
- School of Nursing of Central South University, Hunan, China
| | - Chulei Tang
- Xiangya School of Nursing, Central South University, Hunan, China
| | - Xianhong Li
- School of Nursing of Central South University, Hunan, China
| | - Honghong Wang
- School of Nursing of Central South University, Hunan, China
- Corresponding author.
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Nsubuga-Nyombi T, Sensalire S, Karamagi E, Aloyo J, Byabagambi J, Rahimzai M, Nabitaka LK, Calnan J. Multivariate analysis of covariates of adherence among HIV-positive mothers with low viral suppression. AIDS Res Ther 2018; 15:9. [PMID: 29604955 PMCID: PMC5878417 DOI: 10.1186/s12981-018-0197-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022] Open
Abstract
Background As part of efforts to improve the prevention of mother-to-child transmission in Northern Uganda, we explored reasons for poor viral suppression among 122 pregnant and lactating women who were in care, received viral load tests, but had not achieved viral suppression and had more than 1000 copies/mL. Understanding the patient factors associated with low viral suppression was of interest to the Ministry of Health to guide the development of tools and interventions to achieve viral suppression for pregnant and lactating women newly initiating on ART as well as those on ART with unsuppressed viral load. Methods A facility-based cross-sectional and mixed methods study design was used, with retrospective medical record review. We assessed 122 HIV-positive mothers with known low viral suppression across 31 health facilities in Northern Uganda. Adjusted odds ratios were used to determine the covariates of adherence among HIV positive mothers using logistic regression. A study among health care providers shed further light on predictors of low viral suppression and a history of low early retention. This study was part of a larger national evaluation of the performance of integrated care services for mothers. Results Adherence defined as taking antiretroviral medications correctly everyday was low at 67.2%. The covariates of low adherence are: taking other medications in addition to ART, missed appointments in the past 6 months, experienced violence in the past 6 months, and faces obstacles to treatment. Mothers who were experiencing each of these covariates were less likely to adhere to treatment. These covariates were triangulated with perspectives of health providers as covariates of low adherence and included: long distances to health facility, missed appointments, running out of pills, sharing antiretroviral drugs, violence, and social lifestyles such as multiple sexual partners coupled with non-disclosure to partners. Inadequate counseling, stigma, and lack of client identity are the frontline factors accounting for the early loss of mothers from care. Conclusions Adherence of 67% was low for reliable viral suppression and accounts for the low viral suppression among HIV-positive mothers studied, in absence of any other factors. This study provided insights into the covariates for low adherence to ART and low viral load suppression; these covariates included taking other medications in addition to ART, missed appointments in the past 6 months, feels like giving up, doesn’t have someone with whom to share private concerns, experienced violence in the past 6 months, and faces obstacles to treatment and confirmed by health providers. To improve adherence, we recommend use of a screening tool to identify mothers with any of these covariates so that more intensive adherence support can be provided to these mothers.
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Arpadi SM, Shiau S, De Gusmao EP, Violari A. Routine viral load monitoring in HIV-infected infants and children in low- and middle-income countries: challenges and opportunities. J Int AIDS Soc 2018; 20 Suppl 7. [PMID: 29171190 PMCID: PMC5978643 DOI: 10.1002/jia2.25001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/21/2017] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The objective of this commentary is to review considerations for implementing routine viral load (VL) monitoring programmes for HIV-infected infants and children living in low- and middle-income countries (LMIC). Since 2013, the World Health Organization (WHO) guidelines recommend VL testing as the preferred monitoring approach for all individuals treated with ART in order to assess treatment response, detect treatment failure and determine the need to switch to a second-line regimen in a timely manner. More recently, WHO guidelines from 2016 identify HIV-infected infants and children as a priority group for routine VL monitoring. DISCUSSION There are a number of reasons why HIV-infected infants and children should be prioritized for routine VL monitoring. Data from national VL monitoring programmes as well as systematic reviews and meta-analyses from LMIC indicate rates of viral suppression are lower for infants and children compared to adults. The number of antiretroviral drugs and palatable formulations suitable for young children are limited. In addition, emotional and developmental issues particular to children can make daily medication administration difficult and pose a challenge to adherence and achievement of sustained viral suppression. VL monitoring can be instrumental for identifying those in need of additional adherence support, reducing regimen switches and preserving treatment options. The needs of infants and children warrant consideration in all aspects of VL monitoring services. If capacity for paediatric venipuncture is not assured, platforms that accept dried blood spot specimens are necessary in order for infants and children to have equitable access. Healthcare systems also need to prepare to manage the substantial number of infants and children identified with elevated VL, including adherence interventions that are appropriate for children. Establishing robust systems to evaluate processes and outcomes of routine VL monitoring services and to support drug forecasting and supply management is essential to determine best practices for infants and children in LMIC. CONCLUSIONS The particular concerns of HIV-infected infants and children warrant attention during all phases of planning and implementation of VL monitoring services. There are a number of key areas, including frequency of monitoring, blood specimen type and adherence challenges, where specific approaches tailored for infants and children may be required.
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Affiliation(s)
- Stephen M Arpadi
- ICAP Columbia University, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Shiau
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Avy Violari
- Perinatal Health Research Unit, University of Witwatersrand, Johannesburg, South Africa
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Mukumbang FC, Van Belle S, Marchal B, van Wyk B. An exploration of group-based HIV/AIDS treatment and care models in Sub-Saharan Africa using a realist evaluation (Intervention-Context-Actor-Mechanism-Outcome) heuristic tool: a systematic review. Implement Sci 2017; 12:107. [PMID: 28841894 PMCID: PMC5574210 DOI: 10.1186/s13012-017-0638-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 08/16/2017] [Indexed: 01/24/2023] Open
Abstract
Introduction It is increasingly acknowledged that differentiated care models hold potential to manage large volumes of patients on antiretroviral therapy (ART). Various group-based models of ART service delivery aimed at decongesting local health facilities, encouraging patient retention in care, and enhancing adherence to medication have been implemented across sub-Saharan Africa. Evidence from the literature suggests that these models of ART service delivery are more effective than corresponding facility-based care and superior to individual-based models. Nevertheless, there is little understanding of how these care models work to achieve their intended outcomes. The aim of this study was to review the theories explicating how and why group-based ART models work using a realist evaluation framework. Methods A systematic review of the literature on group-based ART support models in sub-Saharan Africa was conducted. We searched the Google Scholar and PubMed databases and supplemented these with a reference chase of the identified articles. We applied a theory-driven approach—narrative synthesis—to synthesise the data. Data were analysed using the thematic content analysis method and synthesised according to aspects of the Intervention-Context-Actor-Mechanism-Outcome heuristic-analytic tool—a realist evaluation theory building tool. Results Twelve articles reporting primary studies on group-based models of ART service delivery were included in the review. The six studies that employed a quantitative study design failed to identify aspects of the context and mechanisms that work to trigger the outcomes of group-based models. While the other four studies that applied a qualitative and the two using a mixed methods design identified some of the aspects of the context and mechanisms that could trigger the outcomes of group-based ART models, these studies did not explain the relationship(s) between the theory elements and how they interact to produce the outcome(s). Conclusion Although we could distill various components of the Intervention-Context-Actor-Mechanism-Outcome analytic tool from different studies exploring group-based programmes, we could not, however, identify a salient programme theory based on the Intervention-Context-Actor-Mechanism-Outcome heuristic analysis. The scientific community, policy makers and programme implementers would benefit more if explanatory findings of how, why, for whom and in what circumstances programmes work are presented rather than just reporting on the outcomes of the interventions. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0638-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town, South Africa. .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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