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Dubé K, Shelton B, Patel H, Ndukwe SO, Concha-Garcia S, Dullano C, Solso S, Hendrickx S, Kaytes A, Taylor J, Villa TJ, Little SJ, Riggs PK, Lessard D, Arora AK, Costiniuk CT, Eskaf S, Smith DM, Gianella S. Perceived risks and benefits of enrolling people with HIV at the end of life in cure research in Southern California, United States. J Virus Erad 2023; 9:100328. [PMID: 37440872 PMCID: PMC10334343 DOI: 10.1016/j.jve.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Although current antiretroviral therapy allows most people with HIV (PWH) to experience normal longevity with a good quality of life, an HIV cure remains elusive due to HIV reservoir formation within deep tissues. An HIV cure remains highly desirable to the community of PWH. This study reports on the perceived risks and benefits of participation in the Last Gift study, a study aimed at characterizing HIV reservoirs via post-mortem autopsy, among PWH at the end of life (EOL) and their next-of-kin (NOK)/loved ones. Methods Last Gift participants (PWH with a terminal illness and/or near the end of life) and their NOK/loved ones were surveyed for perceptions of risks, benefits, and meaning for participation in the Last Gift study. Results The average age of the 17 Last Gift participants was 66.6 years, 3 were females, 1 person identified as Hispanic, and 15 as Caucasian. The average age of the 17 NOK/loved ones was 56.7 years, and relationships to Last Gift participants included partner/spouse, sibling, friend, child, parent, grandparent, and nephew. The only perceived personal risk of the Last Gift among participants was the blood draws (3/17). NOK/loved ones perceived the following risks: blood draws (2/17), physical pain (3/17), worry that something bad will happen (2/17), and unpleasant side effects (1/17). Participants in Last Gift and NOK/loved ones indicated the study had various positive social effects. For both participants and NOK/loved ones, the most frequent perceived personal benefit of the Last Gift was the satisfaction of supporting HIV cure research. Discussion Participants perceived minimal personal and societal risks and valued the altruistic benefits of participating in the Last Gift study. Last Gift participants and NOK/loved ones were cautious about possible personal risks of EOL HIV cure research but still viewed that the emotional, psychological and societal benefits of participation outweighed potential risks.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany Shelton
- Department of Public Health, College of Education, Health and Human Sciences, University of Tennessee Knoxville, TN, USA
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, USA
| | - Cheryl Dullano
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Stephanie Solso
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, CA, USA
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, CA, USA
- HIV+Aging Research Project-Palm Springs (HARP-PS), Palm Springs, CA, USA
| | - Thomas J. Villa
- Reversing Immune Dysfunction (RID) Martin Delaney Collaboratory for HIV Cure Research Community Advisory Board, Rockville, MD, USA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
| | - David Lessard
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Center (MUCH), Montreal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Anish K. Arora
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Cecilia T. Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Center (MUCH), Montreal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shadi Eskaf
- Public Health Research Consultant, Chapel Hill, NC, USA
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
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Dubé K, Villa TJ, Taylor J, Kaytes A, Moore DJ, Little SJ, Chaillon A, Smith DM, Gianella S. A Community-Driven Framework to Prioritize the Use of Donated Human Biological Materials in the Context of HIV Cure-Related Research at the End of Life. Pathog Immun 2023; 8:1-16. [PMID: 37252012 PMCID: PMC10225111 DOI: 10.20411/pai.v8i1.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Initiated in 2017 after extensive community engagement, the Last Gift program enrolls altruistic volunteers willing to donate their cells and tissues at the end of life to allow studies on HIV reservoir dynamics across anatomical sites. As the Last Gift team received tissue requests outside the scope of HIV cure research, we noticed the absence of guiding frameworks to help prioritize the use of altruistically donated human biological materials. In this commentary, we present a proposed framework for prioritizing the use of donated human biological materials within and outside the end-of-life (EOL) HIV cure research context, using the Last Gift study as an example. First, we discuss regulatory and policy considerations, and highlight key ethical values to guide prioritization decisions. Second, we present our prioritization framework and share some of our experiences prioritizing requests for donated human biological materials within and outside EOL HIV cure research.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Thomas J. Villa
- HIV Obstruction by Programmed Epigenetics Delaney Collaboratory Community Team, San Francisco, CA
- Reversing Immune Dysfunction Delaney Collaboratory for HIV Cure Research Community Advisory Board, La Jolla, CA
| | - Jeff Taylor
- Reversing Immune Dysfunction Delaney Collaboratory for HIV Cure Research Community Advisory Board, La Jolla, CA
- HIV + Aging Research Project – Palm Springs, Palm Springs, CA
- AntiViral Research Center Community Advisory Board, University of California San Diego, San Diego, CA
| | - Andy Kaytes
- Reversing Immune Dysfunction Delaney Collaboratory for HIV Cure Research Community Advisory Board, La Jolla, CA
- AntiViral Research Center Community Advisory Board, University of California San Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
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Kanazawa J, Rawlings SA, Hendrickx S, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Patel H, Ndukwe S, Little SJ, Smith D, Dubé K. Lessons learned from the Last Gift study: ethical and practical challenges faced while conducting HIV cure-related research at the end of life. JOURNAL OF MEDICAL ETHICS 2023; 49:305-310. [PMID: 35732421 PMCID: PMC9772357 DOI: 10.1136/medethics-2021-107512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/23/2022] [Indexed: 05/03/2023]
Abstract
The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen A Rawlings
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network (CNTN), University of California San Diego, San Diego, California, USA
| | - Jeff Taylor
- HIV + Aging Research Program - Palm Springs (HARP-PS), Palm Springs, California, USA
- AntiViral Research Center Community Advisory Board, University of California San Diego, La Jolla, California, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, University of California San Diego, La Jolla, California, USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan J Little
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Davey Smith
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Frey E, Johnston CD, Siegler EL. Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough? HIV AIDS (Auckl) 2023; 15:191-208. [PMID: 37153650 PMCID: PMC10155713 DOI: 10.2147/hiv.s311613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
With improved access to antiretroviral therapy throughout the world, people are aging with HIV, and a large portion of the global population of people with HIV (PWH) is now age 50 or older. Older PWH experience more comorbidities, aging-related syndromes, mental health challenges, and difficulties accessing fundamental needs than the population of older adults without HIV. As a result, ensuring that older PWH are receiving comprehensive healthcare can often be overwhelming for both PWH and the providers. Although there is a growing literature addressing the needs of this population, gaps remain in care delivery and research. In this paper, we suggest seven key components to any healthcare program designed to address the needs of older people with HIV: management of HIV, comorbidity screening and treatment, primary care coordination and planning, attention to aging related-syndromes, optimization of functional status, support of behavioral health, and improved access to basic needs and services. We review many of the difficulties and controversies related to the implementation of these components, which include the absence of screening guidelines for this population and the challenges of care integration, and we suggest key next steps.
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Affiliation(s)
- Emily Frey
- Department of Medicine, Weill Cornell/New York Presbyterian Hospital, New York, NY, USA
- Correspondence: Emily Frey, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY, 10021, USA, Tel +1 212 746 4749, Fax +1 212 746 4609, Email
| | - Carrie D Johnston
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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Post B, Badea C, Faisal A, Brett SJ. Breaking bad news in the era of artificial intelligence and algorithmic medicine: an exploration of disclosure and its ethical justification using the hedonic calculus. AI AND ETHICS 2022; 3:1-14. [PMID: 36338525 PMCID: PMC9628590 DOI: 10.1007/s43681-022-00230-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
An appropriate ethical framework around the use of Artificial Intelligence (AI) in healthcare has become a key desirable with the increasingly widespread deployment of this technology. Advances in AI hold the promise of improving the precision of outcome prediction at the level of the individual. However, the addition of these technologies to patient-clinician interactions, as with any complex human interaction, has potential pitfalls. While physicians have always had to carefully consider the ethical background and implications of their actions, detailed deliberations around fast-moving technological progress may not have kept up. We use a common but key challenge in healthcare interactions, the disclosure of bad news (likely imminent death), to illustrate how the philosophical framework of the 'Felicific Calculus' developed in the eighteenth century by Jeremy Bentham, may have a timely quasi-quantitative application in the age of AI. We show how this ethical algorithm can be used to assess, across seven mutually exclusive and exhaustive domains, whether an AI-supported action can be morally justified.
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Affiliation(s)
- Benjamin Post
- Department of Bioengineering, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre in AI for Healthcare, Imperial College London, London, UK
| | - Cosmin Badea
- Department of Computing, Imperial College London, London, UK
| | - Aldo Faisal
- Department of Bioengineering, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
- UKRI Centre in AI for Healthcare, Imperial College London, London, UK
- Institute of Artificial and Human Intelligence, University of Bayreuth, Bayreuth, Germany
| | - Stephen J. Brett
- UKRI Centre in AI for Healthcare, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Hutson SP, West FL, Giron J. Perceptions of Advance Care Planning Needs of Persons Living With HIV in Appalachia: A Qualitative Descriptive Study. Am J Hosp Palliat Care 2022; 39:1452-1459. [PMID: 35442114 DOI: 10.1177/10499091221087697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Persons living with Human immunodeficiency virus (HIV) are living longer, healthier lives due to advancements in antiretroviral therapies and access to lifelong treatment. Yet, in rural Appalachia, access to adequate medical care is complicated by factors such as geography and lack of access to resources. The purpose of this study was to explore the perceptions of advance care planning (ACP) needs of persons living with HIV (PLWH) in Appalachian Tennessee and Alabama. Using a qualitative-descriptive design, we analyzed patterns of responses to face-to-face, semi-structured interviews of 40 PLWH as part of a larger multi-site mixed method study. Data demonstrated high patient satisfaction with medical care and good relationships with providers. However, common themes arose surrounding stigma, inadequate finances, and dislike of the term "end-of-life." Findings from this study fill a gap in the extant science pertaining to the focus of ACP in the unique population of rural Appalachia.
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Affiliation(s)
| | - Frankie L West
- College of Arts and Sciences, 2739Western Carolina University, Cullowhee, NC, USA
| | - Joelle Giron
- College of Nursing Knoxville, University of Tennessee, Knoxville, TN, USA
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Kiplagat J, Tran DN, Barber T, Njuguna B, Vedanthan R, Triant VA, Pastakia SD. How health systems can adapt to a population ageing with HIV and comorbid disease. Lancet HIV 2022; 9:e281-e292. [PMID: 35218734 DOI: 10.1016/s2352-3018(22)00009-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
As people age with HIV, their needs increase beyond solely managing HIV care. Ageing people with HIV, defined as people with HIV who are 50 years or older, face increased risk of both age-regulated comorbidities and ageing-related issues. Globally, health-care systems have struggled to meet these changing needs of ageing people with HIV. We argue that health systems need to rethink care strategies to meet the growing needs of this population and propose models of care that meet these needs using the WHO health system building blocks. We focus on care provision for ageing people with HIV in the three different funding mechanisms: President's Emergency Plan for AIDS Relief and Global Fund funded nations, the USA, and single-payer government health-care systems. Although our categorisation is necessarily incomplete, our efforts provide a valuable contribution to the debate on health systems strengthening as the need for integrated, people-centred, health services increase.
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Affiliation(s)
| | - Dan N Tran
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Tristan Barber
- Department of HIV Medicine, Ian Charleson Day Centre, Royal Free Hospital, London, UK
| | - Benson Njuguna
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rajesh Vedanthan
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Virginia A Triant
- Divisions of Infectious Diseases and General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sonak D Pastakia
- Academic Model Providing Access to Healthcare, Eldoret, Kenya; Center for Health Equity and Innovation, College of Pharmacy, Purdue University, Indianapolis, IN, USA.
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Chan SY, Lai YJ, Ko MC, Chen YY, Tsai YF, Hsu LF, Ku PW, Chen LJ, Chuang PH, Chen CC, Yen YF. Is there lower utilisation of hospice care services during end-of-life care for people living with HIV? A population-based cohort study. BMJ Open 2022; 12:e058231. [PMID: 35288396 PMCID: PMC8921921 DOI: 10.1136/bmjopen-2021-058231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Hospice care could improve the quality of life among advanced HIV patients during end-of-life (EOL) treatment. However, providing hospice care services for people living with HIV (PLWH) is challenging due to HIV-related stigma. This nationwide cohort study aims to determine the utilisation of hospice care services among PLWH and HIV-negative individuals during EOL treatment. DESIGN A retrospective cohort study. SETTING From 2000 to 2018, we identified adult PLWH from the Taiwan centres for disease control HIV Surveillance System. Individuals who had positive HIV-1 western blots were regarded as HIV-infected. Age-matched and sex-matched controls without HIV infection were selected from the Taiwan National Health Insurance Research Database for comparison. All PLWH and controls were followed until death or 31 December 2018. PARTICIPANTS 32 647 PLWH and 326 470 HIV-negative controls were analysed. PRIMARY OUTCOME MEASURES Utilisation of hospice care services during the last year of life among PLWH and HIV-negative individuals. RESULTS A total of 20 413 subjects died during the 3 434 699 person-years of follow-up. Of the deceased patients, 2139 (10.5%) utilised hospice care services during their last year of life, including 328 (5.76%) PLWH and 1811 (12.30%) controls. Adjusting for demographics and comorbidities, PLWH were less likely to receive hospice care services during the last year of life, compared with HIV-negative individuals (adjusted OR: 0.66; 95% CI: 0.57 to 0.75). CONCLUSIONS PLWH had significantly lower utilisation of hospice care services during the last year of life. Our results suggest that future hospice care programmes should particularly target PLWH to increase the optimal utilisation of hospice care services during EOL treatment.
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Affiliation(s)
- Shang-Yih Chan
- Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
| | - Yun-Ju Lai
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Urology, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Fan Tsai
- Department of Nursing, Yangming Branch, Taipei, Taiwan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Fei Hsu
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health, National Chung Hsing University, Taichung, Taiwan
| | - Li-Jung Chen
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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Ruiz EL, Greene KY, Galea JT, Brown B. From surviving to thriving: the current status of the behavioral, social, and psychological issues of aging with HIV. Curr Opin HIV AIDS 2022; 17:55-64. [PMID: 35102052 DOI: 10.1097/coh.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite significant advances in knowledge regarding the biological and clinical issues related to aging with HIV, significantly less research has centered on related psychological, behavioral, and social issues, which are increasingly recognized as important for successfully aging with HIV. RECENT FINDINGS Barriers to successful aging include physical challenges from a sociobehavioral perspective, psychosocial challenges, and system-level challenges. In contrast, several resiliencies and interventions that help facilitate healthy aging with HIV are also emerging. Comprehensive interventions to address the physical, mental, and psychosocial needs of older people living with HIV (OPLWH) are necessary. CONCLUSION To promote healthy aging with HIV, we must utilize both clinical and biopsychosocial interventions. The lack of data on the needs of OPLWH is an important barrier to healthy aging in this population.
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Affiliation(s)
- Erik L Ruiz
- University of South Florida, College of Public Health
| | - Karah Y Greene
- University of South Florida, School of Social Work, Tampa, Florida
| | - Jerome T Galea
- University of South Florida, College of Public Health
- University of South Florida, School of Social Work, Tampa, Florida
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California, USA
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10
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Lai YJ, Ko MC, Chan SY, Chou YS, Wang CC, Ku PW, Chen LJ, Hsu LF, Chuang PH, Chen CC, Yen YF. Hospice Care Services Associated With a Lower Utilization of Life-Sustaining Treatments During End-Of-Life Care Among People Living With HIV/AIDS: A Population-Based Cohort Study. Am J Hosp Palliat Care 2022; 39:1165-1173. [PMID: 35044895 DOI: 10.1177/10499091211072240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hospice care involves improving quality of end-of-life (EOL) care and respecting patients' preferences regarding EOL treatment. However, the impact of hospice care services on the utilization of life-sustaining treatments during EOL care in patients with life-limiting diseases has not been extensively studied. Objectives: This nationwide cohort study aimed to determine the impact of hospice care services on the utilization of life-sustaining treatments during the last 3 months of life among people living with HIV/AIDS (PLWHA) in Taiwan. Methods: From 2000 to 2018, we identified adult PLWHA from Taiwan centers for disease control HIV Surveillance System. HIV-infected individuals were defined as positive HIV-1 Western blot. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, and defibrillation. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression. Results: Of 5691 PLWHA, 2595 (45.9%) subjects utilized life-sustaining treatments during the last 3 months of life. After adjusting for other covariates, PLWHA with hospice care services were less likely to receive life-sustaining treatments during the last 3 months of life than those without the services (adjusted odds ratio [AOR] = .50, 95% confidence interval [CI]: .37-.66). Considering the type of life-sustaining treatments, hospice care services were associated with lower likelihood of receiving cardiopulmonary resuscitation (AOR = .22, 95% CI: .13-.39), endotracheal intubation (AOR = .48, 95% CI: .35-.65), and mechanical ventilation support (AOR = .56, 95% CI: .42-.75). Conclusion: Hospice care services were associated with a lower utilization of life-sustaining treatments during the last 3 months of life among PLWHA.
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Affiliation(s)
- Yun-Ju Lai
- Department of Health Care Management, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,School of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, 63501Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Exercise Health Science, 145475National Taiwan University of Sport, Taichung, Taiwan
| | - Ming-Chung Ko
- Department of Health Care Management, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Urology, 38010Taipei City Hospital, Taipei, Taiwan
| | - Shang-Yih Chan
- Department of Health Care Management, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Internal Medicine, 205692Taipei City Hospital Yangming Branch, Taipei, Taiwan.,63390University of Taipei, Taipei, Taiwan
| | - Yi-Sheng Chou
- School of Medicine, 34914National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Hematology and Oncology, 156947Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Chun-Chieh Wang
- Division of Chest Medicine, Department of Internal Medicine, 63501Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Eldercare, 63340Central Taiwan University of Science and Technology Taichung, Nantou, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, 34916National Chung Hsing University, Taichung, Taiwan
| | - Li-Jung Chen
- Department of Exercise Health Science, 145475National Taiwan University of Sport, Taichung, Taiwan
| | - Li-Fei Hsu
- College of Public Health, 33561National Taiwan University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Health Care Management, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,63390University of Taipei, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Section of Infectious Diseases, 205692Taipei City Hospital Yangming Branch, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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Kanazawa J, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Christensen C, Patel H, Ndukwe S, Rawlings SA, Hendrickx S, Little S, Brown B, Smith D, Dubé K. Ethical and practical considerations for HIV cure-related research at the end-of-life: a qualitative interview and focus group study in the United States. BMC Med Ethics 2022; 23:2. [PMID: 35012544 PMCID: PMC8748179 DOI: 10.1186/s12910-022-00741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/21/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND One of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it. METHODS We conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable. RESULTS All four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants' comfort and needs at the EOL. CONCLUSION Because of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research's impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Sara Gianella
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network, University of California San Diego, 220 Dickson Street, Suite B, San Diego, CA USA
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
- HIV + Aging Research Project – Palm Springs (HARP-PS), 1775 Palm Canyon Drive, Suite 110-349, Palm Springs, CA USA
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Christopher Christensen
- HIV + Aging Research Project – Palm Springs (HARP-PS), 1775 Palm Canyon Drive, Suite 110-349, Palm Springs, CA USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Stephen A. Rawlings
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Susan Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, 3333 14th Street, Riverside, CA USA
| | - Davey Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
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12
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Kanazawa J, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Christensen C, Patel H, Ndukwe S, Rawlings S, Hendrickx S, Little S, Brown B, Smith D, Dubé K. Ethical and practical considerations for interventional HIV cure-related research at the end-of-life: A qualitative study with key stakeholders in the United States. PLoS One 2021; 16:e0254148. [PMID: 34270612 PMCID: PMC8284787 DOI: 10.1371/journal.pone.0254148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background A unique window of opportunity currently exists to generate ethical and practical considerations presented by interventional HIV cure-related research at the end-of-life (EOL). Because participants would enroll in these studies for almost completely altruistic reasons, they are owed the highest ethical standards, safeguards, and protections. This qualitative empirical ethics study sought to identify ethical and practical considerations for interventional HIV cure-related research at the EOL. Methods and findings We conducted 20 in-depth interviews and three virtual focus groups (N = 36) with four key stakeholder groups in the United States: 1) bioethicists, 2) people with HIV, 3) HIV care providers, and 4) HIV cure researchers. This study produced six key themes to guide the ethical implementation of interventional HIV cure-related research at the EOL: 1) all stakeholder groups supported this research conditioned upon a clearly delineated respect for participant contribution and autonomy, participant understanding and comprehension of the risks associated with the specific intervention(s) to be tested, and broad community support for testing of the proposed intervention(s); 2) to ensure acceptable benefit-risk profiles, researchers should focus on limiting the risks of unintended effects and minimizing undue pain and suffering at the EOL; 3) only well-vetted interventions that are supported by solid pre-clinical data should be tested in the EOL translational research model; 4) the informed consent process must be robust and include process consent; 5) research protocols should be flexible and adopt a patient/participant centered approach to minimize burdens and ensure their overall comfort and safety; and 6) a participant’s next-of-kin/loved ones should be a major focus of EOL research but only if the participant consents to such involvement. Conclusions To our knowledge, this empirical ethics study generated the first ethical and practical considerations for interventional HIV cure-related research at the EOL. The ethical complexities of such research must be considered now. We must navigate this ethical conundrum so that we are good stewards of the participants’ extremely altruistic gifts by maximizing the impact and social value of this research. We hope that this study will serve as the foundation for future research and discussion on this topic.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Susanna Concha-Garcia
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network, University of California San Diego, San Diego, California, United States of America
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, San Diego, California, United States of America
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, United States of America
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, San Diego, California, United States of America
| | - Christopher Christensen
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, United States of America
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rawlings
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Susan Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, United States of America
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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13
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Attitudes and perceptions of next-of-kin/loved ones toward end-of-life HIV cure-related research: A qualitative focus group study in Southern California. PLoS One 2021; 16:e0250882. [PMID: 33961653 PMCID: PMC8104928 DOI: 10.1371/journal.pone.0250882] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 04/15/2021] [Indexed: 01/02/2023] Open
Abstract
As end-of-life (EOL) HIV cure-related research expands, understanding perspectives of participants’ next-of-kin (NOK) is critical to maintaining ethical study conduct. We conducted two small focus groups and two one-on-one interviews using focus group guides with the NOK of Last Gift study participants at the University of California, San Diego (UCSD). Participating NOK included six individuals (n = 5 male and n = 1 female), including a grandmother, grandfather, partner, spouse, and two close friends. Researchers double-coded the transcripts manually for overarching themes and sub-themes using an inductive approach. We identified six key themes: 1) NOK had an accurate, positive understanding of the Last Gift clinical study; 2) NOK felt the study was conducted ethically; 3) Perceived benefits for NOK included support navigating the dying/grieving process and personal growth; 4) Perceived drawbacks included increased sadness, emotional stress, conflicted wishes between NOK and study participants, and concerns around potential invasiveness of study procedures at the EOL; 5) NOK expressed pride in loved ones’ altruism; and 6) NOK provided suggestions to improve the Last Gift study, including better communication between staff and themselves. These findings provide a framework for ethical implementation of future EOL HIV cure-related research involving NOK.
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14
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Perry KE, Dubé K, Concha-Garcia S, Patel H, Kaytes A, Taylor J, Javadi SS, Mathur K, Lo M, Brown B, Sauceda JA, Wohl DA, Little S, Hendrickx S, Rawlings SA, Smith DM, Gianella S. "My Death Will Not [Be] in Vain": Testimonials from Last Gift Rapid Research Autopsy Study Participants Living with HIV at the End of Life. AIDS Res Hum Retroviruses 2020; 36:1071-1082. [PMID: 32449625 PMCID: PMC7703253 DOI: 10.1089/aid.2020.0020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
End-of-life (EOL) HIV cure-related research provides a novel approach to studying HIV reservoirs. The Last Gift is a rapid autopsy research study at the University of California San Diego that enrolls terminally ill people living with HIV (PLWHIV) with a desire to contribute to HIV cure-related research. We conducted in-depth baseline and follow-up interviews with Last Gift study participants. We analyzed interview data applying conventional content analysis. Since summer 2017, 13 participants have been enrolled (n = 11 males and 2 females; aged 45-89 years) and 8 participants interviewed. Terminal illnesses included cancers, heart diseases, and neurodegenerative illnesses. Our analysis revealed five key themes: (1) The Last Gift study has tremendous meaning for participants at the end of their life. (2) HIV-specific altruism was a primary motivator to join the Last Gift study, nested within the context of community, scientific advancement, and moral obligation. (3) Participants did not expect physical benefits yet they perceived emotional/psychological, financial, and societal/scientific benefits. (4) There were minimal participant-perceived risks and concerns. (5) Last Gift participants expressed immense gratitude toward study staff. The Last Gift study provides a framework for ethical HIV cure-related research at EOL and highlighted participants' perspectives, motivations, and experiences. Knowing how PLWHIV understand and experience such studies will remain critical to designing ethical, fully informed HIV cure research protocols that are acceptable to PLWHIV.
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Affiliation(s)
- Kelly E. Perry
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Karine Dubé
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Susanna Concha-Garcia
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Hursch Patel
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andy Kaytes
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
| | - Jeff Taylor
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
- HIV+Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Sogol Stephanie Javadi
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Kushagra Mathur
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Megan Lo
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, USA
| | - John A. Sauceda
- Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - David A. Wohl
- Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Little
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Stephen A. Rawlings
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Davey M. Smith
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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15
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Dubé K, Patel H, Concha-Garcia S, Perry KE, Mathur K, Javadi SS, Taylor J, Kaytes A, Brown B, Sauceda JA, Little S, Hendrickx S, Rawlings SA, Smith DM, Gianella S. Perceptions of Next-of-Kin/Loved Ones About Last Gift Rapid Research Autopsy Study Enrolling People with HIV/AIDS at the End of Life: A Qualitative Interview Study. AIDS Res Hum Retroviruses 2020; 36:1033-1046. [PMID: 32449624 PMCID: PMC7703245 DOI: 10.1089/aid.2020.0025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A growing number of people living with HIV/AIDS are participating in HIV cure-related research at the end of life (EOL). Due to the novelty of EOL HIV cure-related research, there is a need to understand how their next-of-kin (NOK) perceive such research. We conducted in-depth interviews with NOK of the Last Gift study participants at the University of California, San Diego. The Last Gift study occurs in the context of the EOL and involves a full body donation. NOK completed two interviews: (1) shortly after the participants' enrollment in the study and (2) following death. We applied thematic analysis to analyze qualitative data. NOK included seven individuals (five males and two females), including two spouses, one ex-partner, one sister, a grandmother/grandfather, and a close friend. Thematic analysis revealed five key themes: (1) NOK viewed the Last Gift program in a positive light and had an accurate overall understanding of the study; (2) NOK identified factors that motivated participants to donate their body to science; (3) NOK identified benefits of the Last Gift program for both the donors and themselves; (4) NOK did not perceive any physical risks or decisional regrets of study but wanted to minimize psychosocial impacts and ensure the dignity of participants at all times; and (5) NOK noted elements that remained essential to the successful implementation of EOL HIV cure-related research, such as early involvement and clear communication. Our study uniquely contributes to increased understanding and knowledge of what is important from the point of view of supportive NOK to ensure successful implementation of EOL HIV cure-related research. More research will be needed to understand perspectives of less supportive NOK.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Hursch Patel
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Susan Concha-Garcia
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, California, USA
| | - Kelly E. Perry
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kushagra Mathur
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Sogol Stephanie Javadi
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, California, USA
- HIV+Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, California, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, University of California, San Francisco, California, USA
| | - Susan Little
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Stephen A. Rawlings
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Davey M. Smith
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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Cianelli R, Villegas N, Lewis-Pierre L, Valdes B, Iriarte E. Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection. Am J Hosp Palliat Care 2020; 38:583-589. [PMID: 33213192 DOI: 10.1177/1049909120971826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions. OBJECTIVES To examine predictors of EOL discussions with significant others, family members, and friends. METHODS Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV. RESULTS Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM. DISCUSSION Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .
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Affiliation(s)
- Rosina Cianelli
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
| | - Natalia Villegas
- 16134University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - LaToya Lewis-Pierre
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Beatriz Valdes
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Evelyn Iriarte
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
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Perry KE, Taylor J, Patel H, Javadi SS, Mathur K, Kaytes A, Concha-Garcia S, Little S, Smith D, Gianella S, Dubé K. "[It] is now my responsibility to fulfill that wish:" Clinical and rapid autopsy staff members' experiences and perceptions of HIV reservoir research at the end of life. PLoS One 2020; 15:e0242420. [PMID: 33206710 PMCID: PMC7673534 DOI: 10.1371/journal.pone.0242420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Little is known about the effects of HIV reservoir research at the end of life on staff members involved. Staff members' perceptions and experiences were assessed related to their involvement in the Last Gift, a rapid autopsy study at the University of California San Diego enrolling people living with HIV who are terminally ill and have a desire to contribute to HIV cure-related research. METHODS Two focus group discussions consisting of clinical (n = 7) and rapid research autopsy (n = 8) staff members were conducted to understand the perspectives of staff members and the impact the Last Gift rapid autopsy study had on them. The total sample consisted of 66.7% females and 33.3% males and was ethnically diverse (66.7% Caucasian, 6.7% African American, 20.0% Asian descent, 6.7% Hispanic descent and American Indian) with a range of experience in the HIV field from 1 year to 30 years. RESULTS Qualitative focus group data revealed five major themes underlying study staff members' multilayered mental and practical involvement: 1) positive perceptions of the Last Gift study, with sub-themes including Last Gift study participants' altruism, fulfillment, and control at the end of life, 2) perceptions of staff members' close involvement in the Last Gift study, with sub-themes related to staff members' cognitive processing, self-actualization and fulfillment, stress management and resilience, coping mechanisms, and gratitude toward Last Gift participants and toward the study itself, 3) considerations for successful and sustainable study implementation, such as ethical awareness and sustained community and patient engagement, 4) collaborative learning and organizational processes and the value of interdependence between staff members, and 5) considerations for potential study scale-up at other clinical research sites. DISCUSSION Understanding staff members' nuanced emotional and procedural experiences is crucial to the Last Gift study's sustainability and will inform similar cure research studies conducted with people living with HIV at the end of life. The study's potential reproducibility depends on a robust research infrastructure with established, interdependent clinical and rapid autopsy teams, continuous community engagement, and an ethical and well-informed engagement process with people living with HIV.
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Affiliation(s)
- Kelly E. Perry
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, CA, United States of America
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, CA, United States of America
| | - Hursch Patel
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Sogol Stephanie Javadi
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
| | - Kushagra Mathur
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, CA, United States of America
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, United States of America
| | - Susan Little
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Davey Smith
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Sara Gianella
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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Freedman SF, Johnston C, Faragon JJ, Siegler EL, Del Carmen T. Older HIV-infected adults. Complex patients (III): Polypharmacy. Eur Geriatr Med 2018; 10:199-211. [PMID: 31983932 DOI: 10.1007/s41999-018-0139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Polypharmacy is a well-described problem in the geriatric population. It is a relatively new problem for people living with HIV (PLWH), as this group now has a life expectancy approaching that of the general population. Defining polypharmacy for PLWH is difficult, since the most common traditional definition of at least five medications would encompass a large percentage of PLWH who are on antiretrovirals (ARVs) and medications for other medical comorbidities. Even when excluding ARVs, the prevalence of polypharmacy in PLWH is higher than the general population, and not just in resource-rich countries. Using a more nuanced approach with "appropriate" or "safer" polypharmacy allows for a better framework for discussing how to mitigate the associated risks. Some of the consequences of polypharmacy include adverse effects of medications including the risk of geriatric syndromes, drug-drug interactions, decreased adherence, and over- and undertreatment of medical comorbidities. Interventions to combat polypharmacy include decreasing pill burden-specifically with fixed-dose combination (FDC) tablets- and medication reconciliation/deprescription using established criteria. The goal of these interventions is to decrease drug interactions and improve quality of life and outcomes. Some special populations of interest within the community of PLWH include those with chronic pain, substance abuse, or requiring end of life care. A final look into the future of antiretroviral therapy (ART) shows the promise of possible two-drug regimens, which can help reduce the above risks of polypharmacy.
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Affiliation(s)
- Samuel F Freedman
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Carrie Johnston
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | | | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tessa Del Carmen
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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Dubé K, Gianella S, Concha-Garcia S, Little SJ, Kaytes A, Taylor J, Mathur K, Javadi S, Nathan A, Patel H, Luter S, Philpott-Jones S, Brown B, Smith D. Ethical considerations for HIV cure-related research at the end of life. BMC Med Ethics 2018; 19:83. [PMID: 30342507 PMCID: PMC6196016 DOI: 10.1186/s12910-018-0321-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022] Open
Abstract
Background The U.S. National Institute of Allergies and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH) have a new research priority: inclusion of terminally ill persons living with HIV (PLWHIV) in HIV cure-related research. For example, the Last Gift is a clinical research study at the University of California San Diego (UCSD) for PLWHIV who have a terminal illness, with a prognosis of less than 6 months. Discussion As end-of-life (EOL) HIV cure research is relatively new, the scientific community has a timely opportunity to examine the related ethical challenges. Following an extensive review of the EOL and HIV cure research ethics literature, combined with deliberation from various stakeholders (biomedical researchers, PLWHIV, bioethicists, and socio-behavioral scientists) and our experience with the Last Gift study to date, we outline considerations to ensure that such research with terminally ill PLWHIV remains ethical, focusing on five topics: 1) protecting autonomy through informed consent, 2) avoiding exploitation and fostering altruism, 3) maintaining a favorable benefits/risks balance, 4) safeguarding against vulnerability through patient-participant centeredness, and 5) ensuring the acceptance of next-of-kin/loved ones and community stakeholders. Conclusion EOL HIV cure-related research can be performed ethically and effectively by anticipating key issues that may arise. While not unique to the fields of EOL or HIV cure-related research, the considerations highlighted can help us support a new research approach. We must honor the lives of PLWHIV whose involvement in research can provide the knowledge needed to achieve the dream of making HIV infection curable.
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Affiliation(s)
- Karine Dubé
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA.
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA.,AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Susan Concha-Garcia
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA.,AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA.,HIV and Aging Research Project - Palm Springs (HARP-PS), 1775 East Palm Canyon Drive, Suite 110-349, Palm Springs, California, USA
| | - Kushagra Mathur
- AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Sogol Javadi
- AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Anshula Nathan
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA
| | - Stuart Luter
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA
| | - Sean Philpott-Jones
- Department of Bioethics, Clarkson University, 80 Nott Terrace, Schenectady, New York, USA
| | - Brandon Brown
- Center for Healthy Communities, Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, 3333 14th Street, Riverside, California, USA
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA.,AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
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