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Association of mental health symptoms on HIV care outcomes and retention in treatment. Gen Hosp Psychiatry 2023; 82:41-46. [PMID: 36934530 DOI: 10.1016/j.genhosppsych.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE The purpose was to examine associations between HIV care engagement and mental health symptoms among persons living with HIV (PLWH) receiving ART. This study builds upon previous findings indicating a significant association between mental health and retention in HIV care,1 while also advancing the literature by examining the impact of substance use on this link, as well as potential bidirectional associations. METHOD Participants of the current study were 493 patients who engaged in care and received antiviral therapy (ART) from Infectious Disease physicians between 2017 and 2019 in a large academic medical center. RESULTS Results from hierarchical regression analyses revealed that patients who missed more days of ART medication had higher depressive symptoms, even when accounting for the effect of demographic variables and alcohol use. Further, depressive symptoms predicted significant variance in number of "no show" visits, but was not individually predictive of ""no show"" visits beyond the effect of other HIV care outcomes (e.g., number of days of medication missed). CONCLUSION Findings reflect linkages among HIV treatment adherence, mental health, and substance use, and highlight the need to target mental health symptoms to improve outcomes among PLWH and prevent HIV transmission.
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Okafor CN, Brennan-Ing M, Ware D, Haberlen S, Egan JE, Brown AL, Meanley S, Stosor V, Shoptaw S, Friedman MR, Plankey M. Grit is associated with psychological health among older sexual minority men. Aging Ment Health 2023; 27:434-444. [PMID: 35138200 PMCID: PMC9360198 DOI: 10.1080/13607863.2022.2032594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/17/2022] [Indexed: 01/21/2023]
Abstract
Objectives: Studies have shown that grit-defined as perseverance and passion for achieving one's long-term goals-is associated with improved health outcomes, including lower levels of psychological distress. However, the psychometric properties of the original Grit Scale (Grit-O Scale) has not been validated among sexual minority men (SMM). The present study aimed to validate the Grit-O Scale among a sample of older SMM and assess the relationships between the Grit-O Scale factors and symptoms of psychological distress.Method: We used data from a single visit of participants in the Multicenter AIDS Cohort Study (MACS) Healthy Aging longitudinal study. The sample included 981 older SMM (mean age = 61, SD = 8.5) with and without HIV. We conducted confirmatory factor analysis (CFA) to identify the two factors of the Grit-O Scale: consistency of interest and perseverance of effort. We also conducted a latent profile analysis (LPA) to identify distinct profiles of psychological distress from self-reported scales of depression, anxiety, and perceived stress.Results:The Grit-O Scale showed acceptable reliability estimates for the items with Cronbach's alpha reliability coefficients ranging from 0.77 to 0.82. The CFA identified the two factors of the Grit-O Scale with acceptable model fit (root mean square error of approximation = 0.058 [95% CI = 0.050, 0.067], comparative fit index = 0.95, Tucker-Lewis Index = 0.93, standardized root mean square residual = 0.07). The LPA yielded three mutually exclusive profiles of psychological distress (profile 1: low stress, anxiety, and depression; profile 2: high stress and depression and low anxiety; and profile 3: high stress, anxiety, and depression). In adjusted multinominal logistic regression analysis, we found that both higher levels of consistency of interest and perseverance of effort factors of the Grit-O Scale were significantly associated with decreased odds of being in profiles 2 and 3 compared with being in profile 1.Conclusion: Our findings support the use of the Grit-O Scale among older SMM. Grit factors could explain variability in the negative psychological symptoms among older SMM and warrant further investigation.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032594.
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Affiliation(s)
- Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, NY, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Valentina Stosor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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van Wyk ES, Kagee A. Coping with Mental Health Problems and Medication Adherence Challenges Among Persons Receiving Antiretroviral Therapy. AIDS Behav 2023; 27:2243-2254. [PMID: 36626033 DOI: 10.1007/s10461-022-03955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
Although several studies have investigated common mental disorders among persons living with HIV, few have explored how they cope with both a mental health condition and treatment adherence requirements. We conducted qualitative interviews with 20 South African antiretroviral treatment (ART) users living with a mental health condition, a sub-sample from a larger study, at a community clinic and a secondary hospital in the Western Cape of South Africa. The interviews were transcribed and analysed thematically. We found that participants used a range of coping methods to manage stressors pertaining to HIV, their mental health condition, and their environments. Participants used religion more frequently than any other way of coping. Both public and self-stigma challenged individuals and impacted HIV disclosure and social support seeking behaviour. Participants reported misconceptions held by themselves and others concerning mental health problems and HIV.
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Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, 7600, Matieland, South Africa.
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COYLE RP, MORROW M, MAWHINNEY S, COLEMAN SS, ZHENG JH, ELLISON L, BUSHMAN LR, KISER JJ, ANDERSON PL, CASTILLO-MANCILLA JR. Cumulative tenofovir diphosphate exposure in persons with HIV taking single- vs. multiple-tablet regimens. Pharmacotherapy 2022; 42:641-650. [PMID: 35707973 PMCID: PMC9870651 DOI: 10.1002/phar.2711] [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: 03/28/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND We assessed cumulative antiretroviral exposure-using tenofovir diphosphate (TFV-DP) in dried blood spots (DBS)-in persons with HIV (PWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) as single-tablet regimens (STR) or multiple-tablet regimens (MTR). METHODS Blood for DBS was prospectively collected in PWH on TDF during 1144 person visits (n = 523). Linear mixed-effects models, adjusted for baseline characteristics, were used to compare TFV-DP in STR versus MTR. Models adjusted for ART regimen using either anchor drug class, pharmacokinetic booster status (unboosted [u/] or boosted [b/]), or a combined STR/MTR and booster categorical variable. RESULTS In the anchor class-adjusted model, STR had 19% (95% confidence interval [CI]: 3%-37%; p = 0.02) higher TFV-DP concentrations than MTR. However, in the booster-adjusted model, STR was not significantly higher than MTR (estimate 5%, 95% CI: -9% to 21%; p = 0.48), although PWH on b/ART had 35% (95% CI: 16%-58%; p = 0.0001) higher TFV-DP than u/ART. In the STR/MTR-boosted variable model, when compared to u/MTR, b/STR, b/MTR, and u/STR had 25% (95% CI: 7%-47%; p = 0.005), 37% (95% CI: 17%-59%; p < 0.0001), and 7% (95% CI: -7% to 24%; p = 0.34) higher TFV-DP, respectively. Compared with b/MTR, b/STR had 9% (95% CI: -31% to 10%; p = 0.37) lower TFV-DP. In a sensitivity analysis of PWH with HIV viral load <20 copies/ml at all visits, b/STR and b/MTR had 34% (95% CI: 16%-55%; p < 0.0001) and 12% (95% CI: -2% to 27%; p = 0.09) higher TFV-DP, respectively, compared with u/MTR, while u/STR had 4% (95% CI: -15% to 8%; p = 0.50) lower TFV-DP. Compared with b/MTR, b/STR had 17% (95% CI: 2%-30%; p = 0.03) higher TFV-DP. CONCLUSIONS Persons with HIV on b/TDF-based ART had higher TFV-DP than u/ART, regardless of STR or MTR use. No significant differences in TFV-DP between regimens of the same boosting status (i.e., b/STR vs. b/MTR; u/STR vs. u/MTR) were observed in the full cohort. Future research should examine the clinical utility of these findings in patient-tailored ART selection.
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Affiliation(s)
- Ryan P. COYLE
- Division of Infectious Diseases, School of Medicine, University of Colorado-AMC, Aurora, CO, USA
| | - Mary MORROW
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, CO, USA
| | - Samantha MAWHINNEY
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, CO, USA
| | | | - Jia-Hua ZHENG
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA
| | - Lucas ELLISON
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA
| | - Lane R. BUSHMAN
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA
| | - Jennifer J. KISER
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA
| | - Peter L. ANDERSON
- Colorado Antiviral Pharmacology Laboratory and Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA
| | - Jose R. CASTILLO-MANCILLA
- Division of Infectious Diseases, School of Medicine, University of Colorado-AMC, Aurora, CO, USA
- Corresponding author: Jose R. Castillo-Mancilla, MD, Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus. 12700 E. 19 Ave., B168, Aurora, CO 80045, (o) 303-724-4934, (f) 303-724-4926,
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Degarege A, Krupp K, Tamargo J, Martinez SS, Campa A, Baum M. Polysubstance use and adherence to antiretroviral treatment in the Miami Adult Studies on HIV (MASH) cohort. AIDS Care 2021; 34:639-646. [PMID: 33663276 PMCID: PMC8418625 DOI: 10.1080/09540121.2021.1896660] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Evidence for a relationship between polysubstance use, depression, and adherence to antiretroviral therapy (ART) is limited. The objectives of this study were to examine the associations of depression, illicit drug, and alcohol use with adherence to ART. People living with HIV (PLHIV) from the Miami Adult Studies on HIV cohort were asked about the number of doses of their ART medication missed to assess ART adherence. Harmful alcohol drinking was evaluated using the Alcohol Use Disorders Identification Test and illicit substance use assessed with self-report and urine screen. The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms. Of 391 PLHIV, 16.6% missed at least one dose (range:1-4) in the past four days. Cocaine/crack, opiate use, and depression were significantly independently associated with a greater mean number of doses missed. The mean number of doses missed was significantly greater among participants who used alcohol in combination with cocaine/crack, marijuana, and tobacco compared to non-users. In conclusion, polysubstance use increased the risk for poor ART adherence among PLHIV. The use of cocaine/crack or opiates individually and depressive symptoms also promote poor ART adherence. An integrated approach targeting substance disorders and depression may help achieve better ART adherence.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Karl Krupp
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.,Public Health Research Institute of India, Mysore, India
| | - Javier Tamargo
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Sabrina Sales Martinez
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Marianna Baum
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Glynn TR, Mendez NA, Jones DL, Dale SK, Carrico AW, Feaster DJ, Rodriguez AE, Safren SA. Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami. J Behav Med 2020; 44:147-158. [PMID: 33098541 DOI: 10.1007/s10865-020-00191-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Individuals living with HIV report disproportionately high levels of trauma exposure and PTSD symptoms, both which have been associated with suboptimal ART adherence. Often conflated, the question arises as to which construct is driving subsequent HIV self-care behavior. Given the HIV disparities among Black and Hispanic/Latinx individuals, and that Miami is a geographic region with a high racial/ethnic minority make up and a unique socioeconomic environment, it is important to explore factors related to HIV outcomes in Miami to mitigate its uncontrolled epidemic. This study aimed to examine the association of trauma exposure, PTSD symptoms, and relevant additional key factors with adherence to ART among a sample of majority Black and Hispanic/Latinx individuals who are economically marginalized receiving public HIV care in Miami, FL (N = 1237) via a cross-sectional survey. Sequential linear regression was used to examine the study aim in four blocks: (1) trauma, (2) PTSD symptoms, and key covariates of ART adherence including (3) depression and substance use (potential psychological covariates), and (4) indicators of socioeconomic status (potential structural covariates). In the first block, trauma exposure was associated with worse adherence. However, in the second block, the association with trauma dropped and PTSD was significantly associated with worse adherence. Of note, for those experiencing high levels of trauma exposure, adherence was negatively impacted regardless of PTSD. When other key factors associated with adherence were entered in the third and fourth blocks, neither trauma exposure nor PTSD were uniquely significant. In this final model, depression, substance use, and unstable housing were uniquely associated with worse adherence. Trauma-informed models of HIV care that holistically address co-occurring factors are warranted to cater to communities with HIV health disparities and keep them from falling off the HIV care continuum.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
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