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Lier AJ, Tarfa A, Shenoi SV, Kuo I, Springer SA. HIV and Substance Use Disorders. Infect Dis Clin North Am 2024; 38:599-611. [PMID: 38960783 DOI: 10.1016/j.idc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Over 1.2 million Americans aged 13 years and older have been diagnosed with human immunodeficiency virus (HIV). While HIV incidence has been declining since 2017, the risk of HIV acquisition and transmission persists among persons who use drugs via injection drug use and unprotected sexual intercourse associated with substance use. Untreated substance use disorder (SUD) is associated with poor adherence to HIV antiretroviral therapy, poor HIV outcomes, and increased risk for HIV acquisition. Herein, we describe the intertwined syndemic of HIV and SUD, as well as treatment strategies and evidence-based public health efforts to engage and retain persons who use drugs into care.
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Affiliation(s)
- Audun J Lier
- Renaissance School of Medicine at Stony Brook University; Northport Veterans Administration Medical Center, 79 Middleville Road, Northport, NY 11768, USA
| | - Adati Tarfa
- Yale University School of Medicine, 135 College Street, Suite 280, New Haven, CT 06510, USA
| | - Sheela V Shenoi
- Veterans Administration Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA; Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA
| | - Irene Kuo
- Department of Epidemiology, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Avenue Northwest, Suite 500, Washington, DC 20052, USA
| | - Sandra A Springer
- Veterans Administration Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA; Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA.
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West BS, Krasnova A, Philbin MM, Diaz JE, Kane JC, Mauro PM. HIV status and substance use disorder treatment need and utilization among adults in the United States, 2015-2019: Implications for healthcare service provision and integration. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209440. [PMID: 38880303 DOI: 10.1016/j.josat.2024.209440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Substance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status. METHODS We included participants from the 2015-2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income. RESULTS Overall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08-3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07-4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20-0.77). CONCLUSIONS Despite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, New York, NY, United States of America.
| | - Anna Krasnova
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Morgan M Philbin
- Division of Vulnerable Populations, School of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - José E Diaz
- SUNY Downstate, New York, NY, United States of America
| | - Jeremy C Kane
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Pia M Mauro
- Department of Epidemiology, Columbia University, New York, NY, United States of America
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Hargovan M, London L, Orgill M. The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020-21). Health Policy Plan 2024; 39:753-770. [PMID: 38938168 PMCID: PMC11308613 DOI: 10.1093/heapol/czae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 06/29/2024] Open
Abstract
This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.
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Affiliation(s)
- Mumta Hargovan
- School of Public Health, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Leslie London
- School of Public Health, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Marsha Orgill
- The Children’s Institute, University of Cape Town, Rondebosch, Cape Town 7700, South Africa
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Matos VC, Torres TS, Luz PM. Adherence to antiretroviral therapy among cisgender gay, bisexual and other men who have sex with men in Brazil: Evaluating the role of HIV-related stigma dimensions. PLoS One 2024; 19:e0308443. [PMID: 39116156 PMCID: PMC11309385 DOI: 10.1371/journal.pone.0308443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In Brazil, ~35% of people living with HIV (PLHIV) have poor adherence to antiretroviral therapy (ART). HIV-related stigma is associated with worst continuum of care outcomes, however evidence from Brazil is scarce. We explored pathways between HIV-related stigma dimensions and ART adherence among Brazilian cisgender gay, bisexual and other men who have sex with men (MSM) living with HIV. METHODS A sample of MSM ≥18 years was recruited online between February/March 2020 through advertisements on Hornet, a location-based dating app. Validated scales were used to assess ART adherence and HIV-related stigma. Indirect and direct pathways between HIV-related stigma dimensions and ART adherence were estimated using structural equation models while considering socio-demographic and substance use related variables. Models were estimated using mean- and variance-adjusted weighted least squares, and goodness of fit indices were calculated. FINDINGS Among 1,719 MSM living with HIV who reported starting ART, 70% were adherent. There was evidence of indirect effects of concerns about public attitudes (standardized coefficient (SC) = -0.095, 95% confidence interval (95%CI) = -0.172 - -0.017) and personalized HIV-stigma (SC = -0.022, 95%CI = -0.043 - -0.001) on ART adherence mediated through negative self-image. Personalized HIV stigma and concerns about public attitudes were both positively associated with negative self-image (SC = 0.129, 95%CI = 0.066-0.193; SC = 0.549, 95%CI = 0.494-0.603), and concerns about public attitudes was associated with HIV disclosure concerns (SC = 0.522, 95%CI = 0.463-0.581). However, the direct paths from personalized HIV stigma and concerns about public attitudes to ART adherence were not significant. INTERPRETATION Our research underscores the critical need for multifaceted interventions to eliminate HIV-related stigma at both individual and societal levels. At the individual level, psychotherapeutic interventions to improve self-image might helpful. Additionally, public policy should aim to dismantle structural stigma with awareness campaigns on various media channels, integration of anti-stigma curriculum into schools, and training for professionals.
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Affiliation(s)
- Victor C. Matos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Gyamerah AO, Marr A, Maleke K, Manyuchi AE, Mirzazadeh A, Radebe O, Lane T, Puren A, Steward WT, Struthers H, Lippman SA. Correlates of viral suppression among sexual minority men and transgender women living with HIV in Mpumalanga, South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003271. [PMID: 39038019 PMCID: PMC11262663 DOI: 10.1371/journal.pgph.0003271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/07/2024] [Indexed: 07/24/2024]
Abstract
Sexual minority men (SMM) and transgender women in South Africa engage in HIV care at lower rates than other persons living with HIV and may experience population-specific barriers to HIV treatment and viral suppression (VS). As part of a pilot trial of an SMM-tailored peer navigation (PN) intervention in Ehlanzeni district, South Africa, we assessed factors associated with ART use and VS among SMM at trial enrolment. A total of 103 HIV-positive SMM and transgender women enrolled in the pilot trial. Data on clinical visits and ART adherence were self-reported. VS status was verified through laboratory analysis (<1000 copies/ml). We assessed correlates of VS at baseline using Poisson generalized linear model (GLM) with a log link function, including demographic, psychosocial, clinical, and behavioral indicators. Among participants, 52.4% reported ART use and only 42.2% of all participants had evidence of VS. Of the 49.5% who reported optimal engagement in HIV care (consistent clinic visits with pills never missed for ≥ 4 consecutive days) in the past 3-months, 56.0% were virally suppressed. In multivariable analysis, SMM were significantly more likely to be virally suppressed when they were ≥ 25 years of age (Adjusted prevalence ratio [APR] = 2.0, CI 95%:1.0-3.8); in a relationship but not living with partner, as compared to married, living together, or single (APR = 1.7, CI 95%:1.0-2.7), and optimally engaged in care (APR = 2.1, 95% CI:1.3-3.3). Findings indicate a need for targeted treatment and care support programming, especially for SMM and transgender women who are young and married/living with their partners to improve treatment outcomes among this population.
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Affiliation(s)
- Akua O. Gyamerah
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Alexander Marr
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | | | - Ali Mirzazadeh
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Oscar Radebe
- Anova Health Institute, Johannesburg, South Africa
| | - Tim Lane
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Adrian Puren
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Division of Virology School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Wayne T. Steward
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Brathwaite R, Mutumba M, Nannono S, Ssewamala FM, Filiatreau LM, Namatovu P. Prevalence and Correlates of Substance Use Among Youth Living with HIV in Fishing Communities in Uganda. AIDS Behav 2024; 28:2414-2426. [PMID: 38605252 DOI: 10.1007/s10461-024-04339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Alcohol and drug use (ADU) poses a significant barrier to optimal HIV treatment outcomes for adolescents and youths living with HIV (AYLHIV). We aimed to investigate the prevalence and correlates of ADU among ALHIV in Ugandan fishing communities, areas characterized by high HIV and poverty rates. AYLHIV aged 18-24, who knew they were HIV-positive, were selected from six HIV clinics. Substance use was determined through self-report in the last 12 months and urine tests for illicit substances. Utilizing a socioecological framework, the study structured variables into a hierarchical logistic regression analysis to understand the multi-layered factors influencing ADU. Self-reported past 12 months substance use was 42%, and 18.5% of participants had a positive urine test for one or more substances, with alcohol, benzodiazepines, and marijuana being the most commonly used. With the addition of individual-level socio-demographics, indicators of mental health functioning, interpersonal relationships, and community factors, the logistic regression analysis revealed greater exposure to adverse childhood experiences increased the odds of substance use (Odds Ratio [OR] = 1.24; 95% Confidence Interval [CI]: 1.03-1.55). Additionally, exposure to alcohol advertisements at community events significantly raised the odds of substance use (OR = 3.55; 95% CI: 1.43-8.83). The results underscore the high prevalence among AYLHIV and emphasize the need for comprehensive interventions targeting individual (e.g., life skills education and mental health supports), interpersonal (e.g., peer support and family-based interventions), community (e.g., community engagement programs, restricted alcohol advertisements and illicit drug access), and policies (e.g., integrated care models and a national drug use strategy), to address ADU.
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Affiliation(s)
- Rachel Brathwaite
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| | - Massy Mutumba
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building Ann Arbor, MI, 48109-5482, USA
| | - Sylvia Nannono
- International Center for Child Health and Development, Masaka, Uganda
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Lindsey M Filiatreau
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Phionah Namatovu
- International Center for Child Health and Development, Masaka, Uganda
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Knox J, Aharonovich E, Zingman BS, Stohl M, Walsh C, Elliott JC, Fink DS, Durant S, Menchaca R, Sharma A, Denning M, Hasin D. HealthCall: Smartphone Enhancement of Brief Interventions to Improve HIV Medication Adherence Among Patients in HIV Care. AIDS Behav 2024; 28:1912-1922. [PMID: 38478322 DOI: 10.1007/s10461-024-04289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 08/23/2024]
Abstract
Heavy drinking among people living with HIV (PLWH) reduces ART adherence and worsens health outcomes. Lengthy interventions are not feasible in most HIV care settings, and patients infrequently follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed HealthCall as an electronic means of increasing patient involvement in a brief intervention to reduce drinking and improve ART adherence. The objective of the current study is to evaluate the efficacy of HealthCall to improve ART adherence among PLWH who drink heavily when paired with two brief interventions: the National Institute on Alcoholism and Alcohol Abuse (NIAAA) Clinician's Guide (CG) or Motivational Interviewing (MI). Therefore, we conducted a 1:1:1 randomized trial among 114 participants with alcohol dependence at a large urban HIV clinic. Participants were randomized to one of three groups: (1) CG only (n = 37), (2) CG and HealthCall (n = 38), or (3) MI and HealthCall (n = 39). Baseline interventions targeting drinking reduction and ART adherence were ~ 25 min, with brief (10-15 min) booster sessions at 30 and 60 days. The outcome was ART adherence assessed using unannounced phone pill-count method (possible adherence scores: 0-100%) at 30-day, 60-day, 3, 6, and 12 months. Analyses were conducted using generalized linear mixed models with pre-planned contrasts. Of the 114 enrolled patients, 58% were male, 75% identified as Black/African American, 28% were Hispanic, and 62% had less than a high school education. The mean age was 47.5 years (standard deviation [SD] 10 years) and the mean number of years since they were diagnosed with HIV was 18.6 (SD 7.6). Participants assigned to HealthCall to extend the CG had increased levels of ART adherence at 60-day and 6-month follow-up (compared to CG only), although there was no statistically significant difference by 12-month follow-up. Participants who were assigned to HealthCall to extend the MI never had statistically significant higher levels of ART adherence. These results suggest that the use of a smartphone app can be used to initially extend the reach of a brief drinking intervention to improve ART adherence over a short period of time; however, sustained long-term improvements in ART adherence after intervention activity ends remains a challenge.
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Affiliation(s)
- Justin Knox
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA.
- New York State Psychiatric Institute, New York, NY, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Efrat Aharonovich
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Barry S Zingman
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Malka Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Claire Walsh
- New York State Psychiatric Institute, New York, NY, USA
| | - Jennifer C Elliott
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - David S Fink
- New York State Psychiatric Institute, New York, NY, USA
| | - Sean Durant
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Raquel Menchaca
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anjali Sharma
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Deborah Hasin
- Columbia University Irvine Medical Center, 722 West 168th street, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Comins CA, Baral S, Mcingana M, Shipp L, Phetlhu DR, Young K, Guddera V, Hausler H, Schwartz S. ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002783. [PMID: 38776334 PMCID: PMC11111033 DOI: 10.1371/journal.pgph.0002783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 05/24/2024]
Abstract
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.
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Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Lily Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Deliwe Rene Phetlhu
- Department of Nursing, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | | | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- University of Pretoria, Pretoria, South Africa
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [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: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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10
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Ayieko P, Kisanga E, Mshana G, Nkosi S, Hansen CH, Parry CDH, Weiss HA, Grosskurth H, Hayes RJ, Morojele NK, Kapiga S. Epidemiology of alcohol use and alcohol use disorders among people living with HIV on antiretroviral therapy in Northwest Tanzania: implications for ART adherence and case management. AIDS Care 2024; 36:652-660. [PMID: 38295268 DOI: 10.1080/09540121.2023.2299324] [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: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
Alcohol use disorders (AUD) among people living with HIV (PLHIV) are associated with poor health outcomes. This cross-sectional study examined current alcohol use and AUD among 300 PLHIV on ART at four HIV care centres in Northwest Tanzania. Participants' data were collected using questionnaires. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine associations between each outcome (current drinking and AUD) and sociodemographic and clinical factors. Association between alcohol use and ART adherence was also studied. The median age of participants was 43 years (IQR 19-71) and 41.3% were male. Twenty-two (7.3%) participants failed to take ART at least once in the last seven days. The prevalence of current drinking was 29.3% (95% CI 24.2-34.8%) and that of AUD was 11.3% (8.2%-15.5%). Males had higher odds of alcohol use (OR 3.03, 95% CI 1.79-5.14) and AUD (3.89, 1.76-8.60). Alcohol use was associated with ART non-adherence (OR = 2.78, 1.10-7.04). There was a trend towards an association between AUD and non-adherence (OR = 2.91, 0.92-9.21). Alcohol use and AUD were common among PLHIV and showed evidence of associations with ART non-adherence. Screening patients for alcohol use and AUD in HIV clinics may increase ART adherence.
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Affiliation(s)
- Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Sebenzile Nkosi
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles D H Parry
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Neo K Morojele
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Medical Research, Mwanza, Tanzania
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11
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Freibott CE, Biondi BE, Rao SR, Blokhina E, Dugas JN, Patts G, Bendiks S, Krupitsky E, Chichetto NE, Samet JH, Freiberg MS, Stein MD, Tindle HA. Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV? AIDS Behav 2024; 28:1447-1455. [PMID: 38285292 DOI: 10.1007/s10461-023-04231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
Achieving abstinence from alcohol, tobacco, or both may improve mental health, but is understudied in people with HIV (PWH). The St PETER HIV randomized clinical trial compared varenicline, cytisine, and nicotine replacement therapy on alcohol and smoking behavior among 400 PWH in Russia. The primary exposure was thirty-day point prevalence abstinence (PPA) from (1) alcohol, (2) smoking, (3) both, or (4) neither and was assessed at 1, 3, 6 and 12-months as were the study outcomes of anxiety (GAD-7) and depressive (CES-D) symptoms. The primary aim was to examine the association between smoking and/or alcohol abstinence and subsequent symptoms of depression and anxiety. Primary analysis used repeated measures generalized linear modeling to relate PPA with mental health scores across time. In secondary analyses, Kruskal-Wallis tests related PPA with mental health scores at each timepoint. Primary analyses did not identify significant differences in anxiety or depressive symptoms between exposure groups over time. Secondary analyses found CES-D scores across PPA categories were similar at 1-month (11, 10, 11, 11) and 6-months (10, 10, 11, 11) but differed at 3-months (9, 11, 10, 12; p = 0.035) and 12-months (10, 6, 11, 10; p = 0.019). GAD-7 scores did not vary across PPA categories at any time point. While abstinence was associated with fewer depressive symptoms at times, findings were not consistent during follow-up, perhaps reflecting intermittent relapse. PWH with polysubstance use and mental health comorbidity are complex, and larger samples with sustained abstinence would further elucidate effects of abstinence on mental health.
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Affiliation(s)
- Christina E Freibott
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA.
| | - Breanne E Biondi
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Julianne N Dugas
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Natalie E Chichetto
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Matthew S Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA
| | - Hilary A Tindle
- Vanderbilt Center for Tobacco, Addiction and Lifestyle (VITAL), Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC), Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Elliott JC, Ali M, Radecka O, Lerias D, Shalev N, Stohl M, Aharonovich E, Hasin DS. An Intervention to Reduce Drinking Among Individuals With HIV and Hepatitis C: A Pilot Randomized Controlled Trial. J Stud Alcohol Drugs 2024; 85:227-233. [PMID: 37947429 PMCID: PMC10941824 DOI: 10.15288/jsad.23-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Heavy drinking poses serious risks to individuals with HIV, hepatitis C virus (HCV), and especially HIV/HCV coinfection. We adapted the National Institute on Alcohol Abuse and Alcoholism Clinician's Guide to address HIV/HCV coinfection and paired this with the "HealthCall" smartphone app to create an intervention tailored to HIV/HCV. After formative work and pretesting with HIV/HCV coinfected heavy drinkers, we conducted a pilot trial to determine potential of this new intervention for decreasing drinking. METHOD A sample of 31 HIV/HCV coinfected heavy drinkers were randomly assigned to either intervention (n = 16) or control (n = 15; psychoeducation and brief advice) conditions. All participants completed a 60-day program consisting of approximately 25-minute-long baseline sessions and brief 5-10-minute booster sessions at 30 and 60 days, as well as an assessment-only follow-up at 90 days. Outcomes were measured using the Timeline Followback at baseline, 30, 60, and 90 days. Generalized linear models were used for analysis. RESULTS Intervention participants drank fewer mean drinks per drinking day at 60 days (incidence rate ratio [IRR] = 0.43, p = .03) and 90 days (IRR = 0.34, p < .01). Intervention participants also reported fewer drinking days at 90 days (mean difference = 34.5%; p < .01). Self-efficacy differed between groups during intervention (p < .05). CONCLUSIONS Although our sample was small, our results suggested lower drinking among participants who received a modified Clinician's Guide intervention plus use of the smartphone app HealthCall, in comparison with education and advice alone. A larger study is indicated to further examine this brief, disseminable intervention for HIV/HCV coinfected drinkers.
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Affiliation(s)
- Jennifer C. Elliott
- Department of Psychology, Molloy University, Rockville Centre, New York
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Mahnoor Ali
- New York State Psychiatric Institute, New York, New York
| | - Olga Radecka
- New York State Psychiatric Institute, New York, New York
| | | | - Noga Shalev
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York
| | - Malka Stohl
- New York State Psychiatric Institute, New York, New York
| | - Efrat Aharonovich
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Deborah S. Hasin
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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13
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Bantjes J, Morojele NK, Myers B, Swanevelder S, Parry C. Does Reducing Alcohol Use Among People with HIV Alleviate Psychological Distress and Symptoms of Depression? A Randomized Controlled Trial in Tshwane, South Africa. AIDS Behav 2024; 28:985-992. [PMID: 37855843 PMCID: PMC10896917 DOI: 10.1007/s10461-023-04205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
Although alcohol use is associated with depression, it is unclear if brief alcohol reduction interventions can ameliorate depression and psychological distress among people with HIV (PWH). We use data from a two-arm randomised controlled trial to examine this question. PWH on antiretroviral treatment (ART) were randomly assigned to receive a brief intervention or treatment as usual (n = 622). Screening was done with the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, Centre for Epidemiological Studies Depression inventory and Kessler Psychological Distress Scale, at baseline and at 3- and 6-months post-baseline. Changes in depression and psychological distress was assessed using analysis of covariance models with baseline measures of alcohol consumption, sex and age included as covariates and adjusting for baseline symptom severity. Changes in alcohol consumption between baseline and follow-up were included in the analysis to establish if this affected outcomes. For both the intervention and control groups, there were significant reductions in symptom severity at 3-months and 6-months for depression and psychological distress, but no significant between group differences were observed. Reductions in alcohol consumption were significantly associated with reductions in depression and psychological distress, supporting the hypothesis that alcohol use is linked to depression among PWH.Trial Registration Pan African Clinical Trials Register, PACTR201405000815100.nh.
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Affiliation(s)
- Jason Bantjes
- Mental health, Alcohol, Substance use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Neo K Morojele
- Mental health, Alcohol, Substance use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Bronwyn Myers
- Mental health, Alcohol, Substance use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Perth, Australia
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Charles Parry
- Mental health, Alcohol, Substance use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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14
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Rosen JG, Knox JR, Rucinski KB, Mcingana M, Mulumba N, Comins CA, Shipp L, Makama S, Beckham SW, Hausler H, Baral SD, Schwartz SR. Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis. J Acquir Immune Defic Syndr 2024; 95:222-230. [PMID: 38032752 PMCID: PMC10922222 DOI: 10.1097/qai.0000000000003356] [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: 12/23/2022] [Accepted: 09/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. SETTING A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). METHODS We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). RESULTS Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). CONCLUSION HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Justin R. Knox
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Katherine B. Rucinski
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - Carly A. Comins
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Lillian Shipp
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Siyanda Makama
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Harry Hausler
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Stefan D. Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sheree R. Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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15
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Chen JS, Hutton HE, Tran HV, Quang VN, Nguyen MX, Sripaipan T, Dowdy DW, Latkin CA, Chander G, Frangakis C, Go VF. Efficacy of Two Evidence-Based Alcohol Consumption Interventions on Positive, Negative, and Neutral Days Among Hazardous Alcohol Users Living with HIV in Vietnam. AIDS Behav 2024; 28:421-428. [PMID: 38085428 DOI: 10.1007/s10461-023-04234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/20/2024]
Abstract
Social events and stressful settings can be catalysts for alcohol consumption. Motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) are widely used in alcohol interventions. We assessed how alcohol consumption varied across three types of days (positive/social, negative/stressful, and neutral) among hazardous alcohol users living with HIV in Vietnam. We further evaluated how those consumption patterns changed after two MET/CBT alcohol reduction interventions versus the standard of care (SOC). The 'combined' intervention offered 6 individual sessions and 3 group sessions; the 'brief' intervention offered 2 individual sessions and 2 phone calls. A 30-day timeline follow-back was administered at study visits, detailing daily drinks and events. Days were categorized as neutral, positive/social, or negative/stressful; negative binomial models and generalized estimating equations were used to estimate drinks consumed by type of day at baseline and 12 months. Prior to intervention, more drinks were consumed on positive/social days (5.2 drinks; 95% Confidence Interval [CI]:4.8, 5.7) than negative/stressful (1.5; 95% CI:1.3, 1.9) and neutral days (2.2; 95% CI: 1.9, 2.5). After the brief intervention, drinks consumed decreased on neutral days (ratio: 0.5: 95% CI: 0.4, 0.7). After the combined intervention, drinks consumed decreased on neutral days (ratio: 0.4; 95% CI: 0.3, 0.6), positive/social days (ratio: 0.6; 95% CI: 0.5, 0.7) and negative/stressful days (ratio: 0.3; 95% CI: 0.2, 0.6). No reductions in consumption were observed in the SOC group. Social/positive days had the highest alcohol consumption prior to intervention, and the combined intervention showed the greatest decrease in consumption on those days. CLINICAL TRIAL REGISTRATION: The study is registered at clinicaltrials.gov (NCT02720237).
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Affiliation(s)
- Jane S Chen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ha Viet Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- University of North Carolina Vietnam, Hanoi, Vietnam
| | | | - Minh X Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- University of North Carolina Vietnam, Hanoi, Vietnam
| | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - David W Dowdy
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Carl A Latkin
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington, Seattle, USA
| | - Constantine Frangakis
- Department of Medicine, Johns Hopkins University, Baltimore, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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16
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Morrison CA, Corbeil T, Kluisza L, Poku O, Liotta L, Attoh Okine ND, Dolezal C, Wiznia A, Abrams EJ, Robbins RN, Mellins CA. Identifying the Mental Health Effects of Cumulative Traumatic Exposure in HIV-Affected Youth: A Longitudinal Assessment. J Acquir Immune Defic Syndr 2024; 95:18-25. [PMID: 37820277 PMCID: PMC10841068 DOI: 10.1097/qai.0000000000003313] [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: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Traumatic events (TEs) in early life can precede adult psychopathology. Limited research exists on this relationship in young adults with perinatally acquired HIV-infection (PHIV) or perinatal HIV-exposure without infection (PHEU), who often experience social and health disparities. This study examined TEs experienced in childhood/adolescence and their association with psychiatric and substance use disorders in young adults with PHIV and PHEU. METHODS Participants in a New York City-based longitudinal cohort study were assessed for TE exposure at enrollment (mean age = 12 years) and the first 2 follow-up interviews. Past-year psychiatric and substance use disorders were evaluated via psychiatric interview (DISC-IV) at the fifth follow-up interview (mean age = 22 years). Unadjusted and adjusted logistic regression models assessed associations between cumulative childhood/adolescence TEs and young adult psychiatric and substance use outcomes. Group differences were tested for PHIV and PHEU subgroups. RESULTS Among 236 participants (60% Black, 51% Latinx), mean cumulative traumatic event count was 3.09 (SD = 1.77); 26% had a past-year psychiatric diagnosis, and 28% had a past-year substance use diagnosis. Increased TEs were associated with past-year psychiatric diagnoses in young adulthood [average marginal effects (AME) 4.21, 95% confidence interval (CI): 0.83 to 7.58]; for PHEU participants, increased TEs were associated with a past-year substance use disorder (AME 15.67, 95% CI: 8.08 to 23.25). CONCLUSIONS High levels of TEs in childhood/adolescence may contribute to psychiatric and substance use disorders in young adults with PHIV or PHEU. Research exploring relationships between TE exposure and later psychiatric problems is needed to inform interventions for HIV-affected youth.
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Affiliation(s)
- Corey A Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Ohemaa Poku
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Lucy Liotta
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Naa-Djama Attoh Okine
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, NY; and
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
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17
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Biondi BE, Freibott CE, Cheng DM, Blokhina E, Lioznov D, Rateau L, Patts GJ, Bendiks S, Gnatienko N, Tindle HA, Freiberg MS, Krupitsky E, Samet JH, Stein MD. Healthcare Utilization Among Persons with HIV and Unhealthy Alcohol Use in St. Petersburg, Russia. AIDS Behav 2024; 28:19-25. [PMID: 37682403 PMCID: PMC10961700 DOI: 10.1007/s10461-023-04161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
Few studies have examined the association between healthcare utilization and heavy alcohol use in Russia among persons with HIV (PWH), a group with high healthcare needs. This study analyzed the association between unhealthy alcohol use (defined as AUDIT score ≥ 8) and healthcare utilization among PWH with heavy alcohol use and daily smoking in St. Petersburg, Russia. This secondary analysis used data from a randomized controlled trial addressing alcohol use. The primary outcome was seeing an infectionist for HIV care in the past year. Outcomes were measured at baseline, 6 months, and 12 months. We assessed the association between unhealthy alcohol use and healthcare utilization outcomes with a repeated measures logistic regression model, controlling for relevant covariates. Nearly all (96.0%) participants had unhealthy alcohol use at baseline, and 90.0% had seen an infectionist for HIV care in the past year. In adjusted analyses, unhealthy alcohol use was associated with a 36% decrease in seeing an infectionist for HIV care (aOR = 0.64, 95% CI 0.43-0.95). Participants reported low levels of emergency department visits and hospitalizations. Understanding how to engage this population in alcohol use disorder treatment and HIV care is an important next step for improving health outcomes for this population.
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Affiliation(s)
- Breanne E Biondi
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA.
| | - Christina E Freibott
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical, University of St. Petersburg, St. Petersburg, Russian Federation
| | - Dmitry Lioznov
- First Pavlov State Medical, University of St. Petersburg, St. Petersburg, Russian Federation
| | - Lindsey Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Gregory J Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Sally Bendiks
- Department of Medicine, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Natalia Gnatienko
- Department of Medicine, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Hilary A Tindle
- Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC), Vanderbilt Center for Tobacco, Addiction and Lifestyle (VITAL), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew S Freiberg
- Cardiovascular Division, Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical, University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
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DesLauriers N, Sambai B, Mbogo L, Ludwig-Barron N, Kingston H, Chohan B, Gitau E, Sinkele W, Masyuko S, Herbeck J, Bukusi D, Guthrie BL, Farquhar C, Monroe-Wise A. Alcohol use among people who inject drugs living with HIV in Kenya is associated with needle sharing, more new sex partners, and lower engagement in HIV care. AIDS Behav 2023; 27:3970-3980. [PMID: 37318665 DOI: 10.1007/s10461-023-04113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
We assessed the prevalence and correlates of alcohol use among 870 people who inject drugs living with HIV in Kenya, with attention toward (1) sexual and injecting risk behaviors for HIV transmission and (2) HIV care engagement. We defined heavy alcohol use as > 14 drinks/week for men and > 7 drinks/week for women, moderate alcohol use as any lesser but non-zero amount, and any alcohol use as either moderate or heavy use. Approximately 39% of participants reported any alcohol use and 15% heavy use. In multivariate analysis, any alcohol use compared to no use was associated with needle sharing, > 3 new sex partners in the past 3 months, being unaware of HIV status, never enrolling in HIV care, and not being on ART (all p < 0.05). Heavy alcohol use as compared to no use was associated with needle sharing (aOR = 2.72; 95% CI 1.43, 5.13), injection equipment sharing (aOR = 1.80; 95% CI 1.00, 3.16), > 3 new sex partners in the past 3 months (aOR = 1.99; 95% CI 1.12, 3.49), and being unaware of HIV status (aOR = 2.77; 95% CI 1.46, 5.19). There was no association between any measure of alcohol use and unsuppressed viral load. Alcohol use among people who inject drugs living with HIV may carry elevated risk of HIV transmission mediated by sexual and injecting practices and is associated with lower engagement in multiple stages of the HIV care cascade.
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Affiliation(s)
- N DesLauriers
- Department of Medicine, University of Washington, Seattle, USA.
| | - B Sambai
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - L Mbogo
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - N Ludwig-Barron
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - H Kingston
- Institute for Public Health Genetics, University of Washington, Seattle, USA
| | - B Chohan
- Department of Global Health, University of Washington, Seattle, USA
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - E Gitau
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - W Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - S Masyuko
- Department of Global Health, University of Washington, Seattle, USA
- National AIDS and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya
| | - J Herbeck
- Department of Global Health, University of Washington, Seattle, USA
| | - D Bukusi
- HIV Testing and Counseling and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - B L Guthrie
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - C Farquhar
- Department of Medicine, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - A Monroe-Wise
- Department of Global Health, University of Washington, Seattle, USA
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Brown JL, Capasso A, Revzina N, Boeva E, Rassokhin V, Sales JM, Gutova LV, Khalezova NB, Hitch AE, Twitty TD, DiClemente RJ. Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection. AIDS Behav 2023; 27:4062-4069. [PMID: 37378797 DOI: 10.1007/s10461-023-04120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p < .001; Phi coefficient = 0.69, p < .001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p's < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.
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Affiliation(s)
- Jennifer L Brown
- Department of Psychological Sciences, Purdue University, 703 3rd Street, Room 1242, West Lafayette, IN, 47907, USA.
| | | | - Natalia Revzina
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ekaterina Boeva
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
- Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Vadim Rassokhin
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
- Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Jessica M Sales
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lyudmila V Gutova
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
| | - Nadia B Khalezova
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
| | - Anthony E Hitch
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - T Dylanne Twitty
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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20
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Nguyen CT, Nguyen HT, Vu TMT, Le Vu MN, Vu GT, Latkin CA, Ho CSH, Ho RCM. Mapping Studies of Alcohol Use Among People Living with HIV/AIDS During 1990-2019 (GAPRESEARCH). AIDS Behav 2023; 27:3981-3991. [PMID: 37338623 DOI: 10.1007/s10461-023-04112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Alcohol drinking has long been reported to be common in people living with HIV/AIDS, having biological and behavioral impacts on the transmission, progression, and prevention of HIV/AIDS. A total of 7059 eligible articles and reviews published in English from 1990 to 2019 were extracted from the WOS. Results show an increase in publication volume, while citations peak for papers published in 2006. Content analysis reveals a wide-ranging coverage of topics, with the most popular being effects of alcohol consumption on ART adherence and outcomes, alcohol-related sexual behaviors, TB co-infection, and psycho-socio-cultural considerations in examining and designing measures targeting alcohol use and interventions to reduce alcohol dependence in PLWHA. This calls for more active engagement of governments in research and in designing and implementing interventions, as well as collaborations and knowledge transfer from high-income countries to developing counterparts, to effectively address alcohol use-related issues in PLWHA, moving toward the HIV/AIDS eradication target.
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Affiliation(s)
- Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Hien Thu Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam
| | - Thuc Minh Thi Vu
- Institute of Health Economics and Technology, Hanoi, 100000, Vietnam
| | - Minh Ngoc Le Vu
- Institute of Health Economics and Technology, Hanoi, 100000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
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21
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Puryear SB, Mwangwa F, Opel F, Chamie G, Balzer LB, Kabami J, Ayieko J, Owaraganise A, Kakande E, Agengo G, Bukusi E, Kabageni S, Omoding D, Bacon M, Schrom J, Woolf‐King S, Petersen ML, Havlir DV, Kamya M, Hahn JA. Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial. J Int AIDS Soc 2023; 26:e26187. [PMID: 38054564 PMCID: PMC10698822 DOI: 10.1002/jia2.26187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Unhealthy alcohol use significantly contributes to viral non-suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub-Saharan Africa (SSA). METHODS As part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills-based alcohol intervention among PWH with self-reported unhealthy alcohol use (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C], prior 3 months, ≥3/female; ≥4/male) and at risk of viral non-suppression, defined as either recent HIV viral non-suppression (≥400 copies/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3-month in-person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (<400 copies/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT-C or phosphatidylethanol (PEth), an alcohol biomarker, ≥50 ng/ml at 24 weeks. RESULTS Between April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol-serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93-1.1). Among PWH with baseline viral non-suppression, 24-week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93-1.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79-0.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56-0.88) than men (RR 0.93, 95% CI: 0.85-1.01) and among participants with a baseline PEth⩽200 ng/ml (RR 0.68, 95% CI: 0.53-0.87) versus >200 ng/ml (RR 0.97, 95% CI: 0.92-1.02). CONCLUSIONS In a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non-suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV-associated co-morbidities.
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Affiliation(s)
- Sarah B. Puryear
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Fred Opel
- Kenya Medical Research InstituteKisumuKenya
| | - Gabriel Chamie
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Laura B. Balzer
- Division of BiostatisticsSchool of Public HealthUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Jane Kabami
- Infectious Diseases Research CollaborationMbararaUganda
| | | | | | | | | | | | | | | | - Melanie Bacon
- National Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
| | - John Schrom
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Maya L. Petersen
- Division of BiostatisticsSchool of Public HealthUniversity of California BerkeleyBerkeleyCaliforniaUSA
| | - Diane V. Havlir
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Moses Kamya
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Judith A. Hahn
- Division of HIV, ID and Global MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Pitpitan EV, Wiginton JM, Bejarano-Romero R, Baker DA. Promoting HIV care continuum outcomes among people who use drugs and alcohol: a systematic review of randomized trials evaluating behavioral HIV care interventions published from 2011 to 2023. BMC Public Health 2023; 23:2182. [PMID: 37936103 PMCID: PMC10629072 DOI: 10.1186/s12889-023-17113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Substance use remains a robust predictor of HIV infection and a serious impediment to HIV care continuum progression for people living with HIV. The primary research question of this systematic review is focused on understanding the extent to which behavioral HIV care interventions have been efficacious in helping people who live with HIV and who use substances along the HIV care continuum. METHODS Using PubMed and ProQuest databases, we performed a systematic review of randomized trials of behavioral HIV care continuum interventions among people who use substances published from 2011 to August 2023, since the beginning of the treatment-as-prevention era. RESULTS We identified 11 studies (total participants: N = 5635), ten intentionally targeting substance-using populations. Four studies involved samples using ≥ 1 substance (e.g., alcohol, opioids, stimulants, marijuana); four involved injection drug use; one involved methamphetamine use; and one involved alcohol use. One study targeted a population with incidental substance use (i.e., alcohol, injection drug use, non-injection drug use reported in most participants). Each study defined one or more HIV care outcomes of interest. Viral suppression was an outcome targeted in 9/11 studies, followed by uptake of antiretroviral therapy (ART; 7/11), ART adherence (6/11), retention in care (5/11), and linkage to care (3/11). While most (nine) of the studies found significant effects on at least one HIV care outcome, findings were mostly mixed. Mediated (2/11) and moderated (2/11) effects were minimally examined. CONCLUSIONS The results from this systematic review demonstrate mixed findings concerning the efficacy of previous HIV care interventions to improve HIV care continuum outcomes among people who use substances. However, heterogeneity of study components (e.g., diversity of substances used/assessed, self-report vs. objective measures, attrition) prevent broad deductions or conclusions about the amenability of specific substance-using populations to HIV care intervention. More coordinated, comprehensive, and targeted efforts are needed to promote and disentangle intervention effects on HIV care continuum outcomes among substance-using populations.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Raul Bejarano-Romero
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
| | - Dania Abu Baker
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
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23
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Iloanusi S, Yunusa I, Mgbere O, Abughosh SM, Chen H, Essien EJ. Development and internal validation of a risk prediction model for HIV disease severity among people living with HIV and mental illness or substance use disorder. Ann Epidemiol 2023; 87:79-92. [PMID: 37742879 DOI: 10.1016/j.annepidem.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Mental illness (MI) and substance use disorders (SUD) are highly prevalent among people living with HIV (PLWH), and have been linked to poor HIV clinical outcomes. Innovative tools for early risk identification can facilitate timely interventions for PLWH and MI/SUD to improve their health outcomes, however, this is currently lacking in Texas, a state with the 4th largest population of PLWH in the United States. To address this gap, we developed a predictive model to estimate the risk of suboptimal HIV clinical outcomes among PLWH and MI/SUD in Texas. METHODS The Texas Medical Monitoring Project data obtained from June 2015-May 2020 were used to develop and internally validate the predictive model. Univariate descriptive and bivariate inferential statistics were performed to describe the characteristics of the study population and unadjusted associations with HIV clinical outcomes. Multivariable logistic regression was used to develop the prediction model. Internal validation was performed using the bootstrap method. RESULTS A total of 518 respondents aged 18 years and above, representing 27,255 adults living with HIV and mental illness or substance use disorders in Texas were included. Most participants were male (77.0%), less than 50 years of age (60.0%), and had mild diagnosed mental illness and substance use disorder (54.8%). The risk predictive model contained eight predictors, which together yielded an area under the receiver operating characteristic (ROC) curve of 0.727. Non-retention in care appeared to be the strongest risk predictor for having suboptimal HIV clinical outcome (adjusted odds ratio (aOR) = 3.27; 95% confidence interval (CI) = 1.45, 7.42). CONCLUSIONS The predictive model had good discrimination between persons at risk of poor HIV clinical outcomes and those not at risk.
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Affiliation(s)
- Sorochi Iloanusi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX.
| | - Ismaeel Yunusa
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia
| | - Osaro Mgbere
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Public Health Science and Surveillance Division, Houston Health Department, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
| | - Susan M Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
| | - Ekere J Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX; Institute of Community Health, University of Houston College of Pharmacy, Houston, TX
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24
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Mkochi T, Chitanda A, Kudowa E, Bula K, Msolola J, Chamangwana I, Matoga M. Assessing the Adoption, Acceptability and Fidelity of the Alcohol Use Disorders Test for Alcohol Use Disorders screening in HIV Clinics in Malawi. Alcohol 2023:S0741-8329(23)00267-7. [PMID: 37690677 PMCID: PMC10920388 DOI: 10.1016/j.alcohol.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Alcohol use disorders (AUD) are a common cause of poor treatment outcomes among people with HIV (PWH). In Malawi, routine screening for AUD among PWH is unavailable. We piloted the utility of the Alcohol Use Disorders Identification Test (AUDIT) in screening for AUD among PWH and assessed its adoption, acceptability and fidelity in HIV clinics in Malawi. METHODS We implemented the AUDIT tool at Mchinji, Kapiri and Kochirira hospitals in Mchinji District between April and May 2021. AUD were defined and classified based on WHO classification as low-risk, harmful/hazardous alcohol use or alcohol dependence. We calculated the prevalence of AUD, the proportion of providers who conducted AUD screening (adoption) and the proportion of providers who conducted AUD screening as intended (fidelity) and compared between clinics. Lastly, we assessed acceptability through a survey among providers. RESULTS Out of 2036 PWH, 875 (43%) were screened for AUD and 51% were female, mean age was 41 years (SD±12) and 338 (39%) had AUD. Adoption was highest at Mchinji (58%) compared to Kapiri (31%) and Kochiria (29%) (P<0.001). Overall Fidelity was 96%, and it was highest at Kapiri (99%) compared to Mchinji (95%) and Kochirira (98%) (P=0.01). AUD screening with AUDIT was highly acceptable as most providers agreed or completely agreed that the AUDIT was important (100%), easy to use (96%), satisfactory (96%), agreed to continue use (61%) and recommended it for other facilities in the district (100%). CONCLUSION AUD were common among PWH. While the adoption of AUDIT for AUD screening was moderate, acceptability and fidelity were high. The impact of AUD on HIV treatment outcomes needs to be assessed to determine the role of routine AUD screening in HIV clinics in Malawi.
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Affiliation(s)
- Tawonga Mkochi
- University of North Carolina Project Malawi, Lilongwe, Malawi.
| | | | | | - Khumbo Bula
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Jimmy Msolola
- Department of Psychiatry, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Mitch Matoga
- University of North Carolina Project Malawi, Lilongwe, Malawi
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25
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Cohen SM, DePhilippis D, Deng Y, Dziura J, Ferguson T, Fucito LM, Justice AC, Maisto S, Marconi VC, Molina P, Paris M, Rodriguez-Barradas MC, Simberkoff M, Petry NM, Fiellin DA, Edelman EJ. Perspectives on contingency management for alcohol use and alcohol-associated conditions among people in care with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1783-1797. [PMID: 37524371 PMCID: PMC10828101 DOI: 10.1111/acer.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Contingency management (CM) is an evidence-based approach for reducing alcohol use; however, its implementation into routine HIV primary care-based settings has been limited. We evaluated perspectives on implementing CM to address unhealthy alcohol use and associated conditions for people with HIV in primary care settings. METHODS From May 2021 to August 2021, we conducted two focus groups with staff involved in delivering the intervention (n = 5 Social Workers and n = 4 Research Coordinators) and individual interviews (n = 13) with a subset of participants involved in the multi-site Financial Incentives, Randomization, and Stepped Treatment (FIRST) trial. Qualitative data collection and analyses were informed by the Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework, including evidence (perception of CM), context (HIV primary care clinic and CM procedures), and facilitation (feasibility outside the research setting). RESULTS Several major themes were identified. Regarding the evidence, participants lacked prior experience with CM, but the intervention was well received and, by some, perceived to lead to lasting behavior change. Regarding the clinical context for the reward schedule, the use of biochemical testing, specifically fingerstick phosphatidylethanol testing, and the reward process were perceived to be engaging and gratifying for both staff and patients. Participants indicated that the intervention was enhanced by its co-location within the HIV clinic. Regarding facilitation, participants suggested addressing the intervention's feasibility for non-research use, simplifying the reward structure, and rewarding non-abstinence in alcohol use. CONCLUSIONS Among patients and staff involved in a clinical trial, CM was viewed as a helpful, positive, and feasible approach to addressing unhealthy alcohol use and related conditions. To enhance implementation, future efforts may consider simplified approaches to the reward structure and expanding rewards to non-abstinent reductions in alcohol consumption.
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Affiliation(s)
- Shawn M. Cohen
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
| | - Dominick DePhilippis
- Veterans Affairs Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, D.C. 20420, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, USA
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Yale School of Public Health, New Haven, CT 06510, USA
- Veterans Affairs Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, USA
| | | | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical Center, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30033, USA
| | - Patricia Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine
| | | | - Michael Simberkoff
- Veterans Affairs NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, USA
| | - Nancy M. Petry
- Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT
| | - David A. Fiellin
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
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Lesko CR, Gnang JS, Fojo AT, Hutton HE, McCaul ME, Delaney JA, Cachay ER, Mayer KH, Crane HM, Batey DS, Napravnik S, Christopoulos KA, Lau B, Chander G. Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019. Ann Epidemiol 2023; 85:6-12. [PMID: 37442307 PMCID: PMC10538410 DOI: 10.1016/j.annepidem.2023.07.002] [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: 09/23/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death. METHODS We followed a cohort of 1781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy). RESULTS Our sample (86% male, 54% White) had median age of 35 years. Over 102 months, people with no, moderate, and unhealthy alcohol use averaged 62.3, 61.1, and 59.5 months virally suppressed, respectively. People who reported unhealthy or moderate alcohol use spent 5.1 (95% confidence intervals (CI): 0.8, 9.3) and 7.6 (95%CI: 3.1, 11.7) more months lost to care than nondrinkers. Compared to no use, unhealthy alcohol use was associated with 3.4 (95%CI: -5.6, -1.6) fewer months in care, not virally suppressed. There were no statistically significant differences after adjustment for demographic and clinical characteristics. CONCLUSIONS Moderate or unhealthy drinking at enrollment in HIV care was associated with poor retention in care. Alcohol use was not associated with time spent virally suppressed.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Jeanine S Gnang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mary E McCaul
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Joseph A Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Epidemiology, University of Washington, Seattle, WA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA
| | - Sonia Napravnik
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Geetanjali Chander
- School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Medicine, School of Medicine, University of Washington, Seattle, WA
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Reddon H, Fairbairn N, Grant C, Milloy MJ. Experiencing homelessness and progression through the HIV cascade of care among people who use drugs. AIDS 2023; 37:1431-1440. [PMID: 37070552 PMCID: PMC10330029 DOI: 10.1097/qad.0000000000003570] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between periods of homelessness and progression through the HIV cascade of care among people who use drugs (PWUD) with universal access to no-cost HIV treatment and care. DESIGN Prospective cohort study. METHODS Data were analysed from the ACCESS study, including systematic HIV clinical monitoring and a confidential linkage to comprehensive antiretroviral therapy (ART) dispensation records. We used cumulative link mixed-effects models to estimate the longitudinal relationship between periods of homelessness and progression though the HIV cascade of care. RESULTS Between 2005 and 2019, 947 people living with HIV were enrolled in the ACCESS study and 304 (32.1%) reported being homeless at baseline. Homelessness was negatively associated with overall progression through the HIV cascade of care [adjusted partial proportional odds ratio (APPO) = 0.56, 95% confidence interval (CI): 0.49-0.63]. Homelessness was significantly associated with lower odds of progressing to each subsequent stage of the HIV care cascade, with the exception of initial linkage to care. CONCLUSIONS Homelessness was associated with a 44% decrease in the odds of overall progression through the HIV cascade of care, and a 41-54% decrease in the odds of receiving ART, being adherent to ART and achieving viral load suppression. These findings support calls for the integration of services to address intersecting challenges of HIV, substance use and homelessness among marginalized populations such as PWUD.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - M-J Milloy
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Taylor E, Patel D, Marconi V, Whitmire A, Hansen N, Kershaw T, Fiellin D, Lauckner C. Pilot Trial of a Smartphone-Based Intervention to Reduce Alcohol Consumption among Veterans with HIV. MILITARY BEHAVIORAL HEALTH 2023; 11:66-77. [PMID: 38405355 PMCID: PMC10888529 DOI: 10.1080/21635781.2023.2221465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Veterans engage in disproportionate levels of alcohol use, which can impact treatment outcomes among veterans with HIV. The TRAC (Tracking and Reducing Alcohol Consumption) intervention, which combines smartphones, mobile breathalyzers, and motivational interviewing (MI), was developed to help reduce alcohol use among this population. This study reports results of an 8-week pilot trial of TRAC among veterans with HIV (N = 10). Participants attended weekly MI sessions conducted via videoconferencing or phone and completed twice-daily self-monitoring of alcohol consumption using breathalyzers and surveys. They also completed pre- and post-intervention questionnaires and a qualitative interview. Analyses explored adherence to self-monitoring tasks, perceptions of the intervention, and preliminary effects of TRAC on alcohol use and readiness to change drinking behavior. Participants completed 76% of breathalyzer readings and 73% of surveys and completed more daytime than evening monitoring tasks. AUDIT hazardous drinking scores significantly decreased between baseline and post-test. Qualitative interviews revealed positive attitudes toward the technologies and MI sessions. Overall, this pilot demonstrated that the TRAC intervention has potential to reduce alcohol use among veterans with HIV, though additional effort is needed to improve adherence to mobile monitoring. Results were used to refine the intervention in preparation for a randomized controlled trial.
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Affiliation(s)
- Erica Taylor
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Darshti Patel
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Vincent Marconi
- Atlanta VAMC, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David Fiellin
- Program in Addiction Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Medicine, Yale School of Public Health, New Haven, Connecticut, USA
| | - Carolyn Lauckner
- Center for Health Equity Transformation, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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29
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Beksinska A, Karlsen O, Gafos M, Beattie TS. Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001216. [PMID: 37310993 DOI: 10.1371/journal.pgph.0001216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/08/2022] [Indexed: 06/15/2023]
Abstract
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Studies were selected for inclusion that reported any measure of prevalence or incidence of alcohol use among FSWs aged 18 or older from countries defined as LMIC in accordance with the World Bank income groups 2019. The following study designs were included: cross-sectional survey, case-control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Study quality was assessed with the Center for Evidence-Based Management (CEBMa) Critical Appraisal Tool. Pooled prevalence estimates were calculated for (i) any hazardous/harmful/dependent alcohol use, (ii) harmful/dependent alcohol use only, both overall and by region and (iii) daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31-51%), and of daily alcohol use was 26% (95% CI: 17-36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01-2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15-1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24-4.80), but not with HIV, violence or mental health problems. We found a high prevalence of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with important HIV risk factors such as inconsistent condom use, STIs and other drug use. Major limitations included heterogeneity in tools and cut-off scores to measure alcohol use and other common risk factors, and a paucity of longitudinal studies. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oda Karlsen
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nguyen TT, Nguyen HT, Do HP, Ho CSH, Ho RCM. Characterizing the Development of Research Landscapes in Substance Use and HIV/AIDS During 1990 to 2021. Subst Abuse 2023; 17:11782218231177515. [PMID: 37304210 PMCID: PMC10251474 DOI: 10.1177/11782218231177515] [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: 12/20/2022] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions.
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Affiliation(s)
- Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Hien Thu Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Huyen Phuc Do
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Cyrus SH Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger CM Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
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31
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Smith MK, Latkin CA, Hutton HE, Chander G, Enns EA, Ha TV, Frangakis C, Sripaipan T, Go VF. Longitudinal Trajectories of Alcohol Use in Vietnamese Adults with Hazardous Alcohol Use and HIV. AIDS Behav 2023; 27:1972-1980. [PMID: 36409386 DOI: 10.1007/s10461-022-03930-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
A three-armed drinking cessation trial in Vietnam found that both a brief and intensive version of an intervention effectively reduced hazardous drinking in people living with HIV. We used group-based trajectory modeling (GBTM) to assess the extent to which findings may vary by latent subgroups distinguished by their unique responses to the intervention. Using data on drinking patterns collected over the 12 months, GBTM identified five trajectory groups, three of which were suboptimal ["non-response" (17.2%); "non-sustained response" (15.7%), "slow response" (13.1%)] and two optimal ["abstinent" (36.4%); "fast response" (17.6%)]. Multinomial logistic regression was used to determine that those randomized to any intervention arm were less likely to be in a suboptimal trajectory group, even more so if randomized to the brief (vs. intensive) intervention. Older age and higher baseline coping skills protected against membership in suboptimal trajectory groups; higher scores for readiness to quit drinking were predictive of it. GBTM revealed substantial heterogeneity in participants' response to a cessation intervention and may help identify subgroups who may benefit from more specialized services within the context of the larger intervention.
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Affiliation(s)
- M Kumi Smith
- School of Public Health, University of Minnesota, Twin Cities, 1300 2Nd Ave S, Suite 300, Minneapolis, MN, USA.
| | - Carl A Latkin
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Eva A Enns
- School of Public Health, University of Minnesota, Twin Cities, 1300 2Nd Ave S, Suite 300, Minneapolis, MN, USA
| | - Tran Viet Ha
- School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Teerada Sripaipan
- School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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Lopez CM, Baker NL, Moreland AD, Bisca E, Wilson T, Slick N, Danielson CK, Eckard AR, Madisetti M, Resick PA, Safren SA. Development and feasibility testing of an integrated PTSD and adherence intervention cognitive processing therapy-life steps (CPT-L) to improve HIV outcomes: Trial protocol. Contemp Clin Trials Commun 2023; 33:101150. [PMID: 37273831 PMCID: PMC10238849 DOI: 10.1016/j.conctc.2023.101150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023] Open
Abstract
Despite high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual models posit that avoidant behavior (hallmark symptom of PTSD) demonstrated by PLWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may address internalized stigma with targeted modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. This study will be the first pilot open-label randomized control trial (RCT) to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve PTSD symptoms, adherence to ART, and retention in HIV care. Primary aims are to (1) conduct theater testing of the CPT and Lifesteps research protocol and evaluate acceptability (n = 12) and (2) deliver a modified CPT protocol (CPT-Lifesteps, or CPT-L) in 60 PLWH/PTSD exploring impact of CPT-L on PTSD symptoms and HIV outcomes compared to a Lifesteps + Standard of Care condition. This innovative research extends PTSD treatment approaches as a paradigm to reduce barriers to ART adherence. Findings of this innovative study are significant because they support the Undetectable = Untransmittable (U[bond, double bond]U) campaign and can help prevent the transmission of HIV infection through increased viral suppression.
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Affiliation(s)
- Cristina M. Lopez
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Angela D. Moreland
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Bisca
- Medical University of South Carolina, USA
| | | | - Nathalie Slick
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla K. Danielson
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Allison R. Eckard
- Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Bertholet N, Saitz R, Hahn JA, Heeren TC, Emenyonu NI, Freiberg M, Winter MR, Kim TW, Magane K, Lloyd-Travaglini C, Fatch R, Bryant K, Forman LS, Rateau L, Blokhina E, Muyindike WR, Gnatienko N, Samet JH. Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:704-712. [PMID: 36799302 PMCID: PMC10198460 DOI: 10.1111/acer.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. METHODS People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3 ) adjusting for covariates. Analyses were conducted separately by site. RESULTS The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively. CONCLUSIONS In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control.
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Affiliation(s)
- Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Richard Saitz
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith A. Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nneka I. Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Vanderbilt University Medical Center, Cardiovascular Division, Nashville, TN, USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Theresa W. Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Kara Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Lindsey Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Winnie R. Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine, Mbarara, Uganda
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
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West BS, Diaz JE, Philbin MM, Mauro PM. Past-year medical and non-medical opioid use by HIV status in a nationally representative US sample: Implications for HIV and substance use service integration. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208976. [PMID: 36827878 PMCID: PMC10100645 DOI: 10.1016/j.josat.2023.208976] [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: 05/23/2022] [Revised: 12/22/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023]
Abstract
AIM In the context of the continued overdose epidemic, recent population estimates of opioid use in highly affected groups, such as people at risk for or people living with HIV (PLWH), are essential for service planning and provision. Although nonmedical opioid use is associated with HIV transmission and with lowered adherence and care engagement, most studies rely on clinic-based samples and focus on medical use of opioids only. We examine associations between opioid-related outcomes by HIV status in a community-based nationally representative sample. METHODS The 2015-2019 National Survey on Drug Use and Health included 213,203 individuals aged 18 and older. Respondents self-reported whether a health care professional ever told them they had HIV/AIDS (i.e., HIV-positive/PLWH, HIV-negative, HIV-unknown). Opioid-related outcomes included past-year medical opioid use and past-year nonmedical (i.e., prescription opioid and heroin) use. Multinomial logistic regression estimated adjusted relative risk ratios between past-year opioid-related outcomes and HIV status, controlling for age, gender, race/ethnicity, income, population density, and year. RESULTS In 2015-2019, 0.2 % of respondents were PLWH and 0.3 % self-reported an HIV-unknown status. Past-year medical opioid use was 37.3 % among PLWH, 30.4 % among HIV-negative and 21.9 % among HIV-unknown individuals. Past-year nonmedical use was 11.1 % among PLWH, 4.2 % among HIV-negative and 7.2 % among HIV-unknown individuals. Compared to HIV-negative individuals, PLWH had 3.21 times higher risk of past-year nonmedical use vs. no use (95 % CI:2.02-5.08) and 2.02 times higher risk of past-year nonmedical vs. medical opioid use only (95 % CI:1.24-2.65). CONCLUSION Nonmedical opioid use prevalence was almost three times higher among PLWH than HIV-negative individuals. Because opioid use and its related harms disproportionately burden PLWH, integrating HIV and substance use prevention and treatment services may improve both HIV-related and opioid-related outcomes, including overdose.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, United States of America.
| | - José E Diaz
- SUNY Downstate Health Sciences University Department of Medicine, United States of America
| | - Morgan M Philbin
- University of California San Francisco School of Medicine, United States of America
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, United States of America
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Bazzi AR, Shaw LC, Biello KB, Vahey S, Brody JK. Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness. J Gen Intern Med 2023; 38:913-921. [PMID: 35614171 PMCID: PMC9132566 DOI: 10.1007/s11606-022-07672-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness. METHODS To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components. RESULTS Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships. DISCUSSION Findings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Leah C Shaw
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Seamus Vahey
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Jennifer K Brody
- Boston Healthcare for the Homeless Program, Boston, MA, USA
- Harvard Medical School, Boston, USA
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Kiyingi J, Nabunya P, Kizito S, Nabayinda J, Nsubuga E, Bahar OS, Jennings Mayo-Wilson L, Namuwonge F, Nattabi J, Magorokosho N, Tozan Y, Witte SS, Ssewamala FM. Self-Reported Adherence to Antiretroviral Therapy (ART) Among Women Engaged in Commercial Sex Work in Southern Uganda. AIDS Behav 2023; 27:1004-1012. [PMID: 36066764 PMCID: PMC9974600 DOI: 10.1007/s10461-022-03837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
We examined the correlates of self-reported adherence to antiretroviral therapy (ART) among women engaged in commercial sex work (WESW) in Uganda. We used baseline data from a longitudinal study, which recruited 542 WESW in Southern Uganda. We used nested regression models to determine the individual and family, and economic level correlates of self-reported adherence. Study findings show that older age (OR = 1.07, 95% CI = 1.013, 1.139), secondary education (OR = 2.01, 95% CI = 1.306, 3.084), large household size (OR = 1.08, 95% CI = 1.020, 1.136), high family cohesion (OR = 1.06, 95% CI = 1.052, 1.065), and high financial self-efficacy (OR = 1.07, 95% CI = 1.006, 1.130) were associated with good self-reported adherence to ART. Married women (OR=-0.39, 95% CI = 0.197, 0.774), depression (OR = 0.85, 95% CI = 0.744, 0.969), alcohol use (OR = 0.72, 95% CI = 0.548, 0.954), ever been arrested (OR = 0.58, 95% CI = 0.341, 0.997), and high household assets ownership (OR = 0.48, 95% CI = 0.313, 0.724) were associated with poor self-reported adherence to ART. Findings suggest a need to adopt a multi-level approach to address gaps in ART adherence among WESW.
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Affiliation(s)
- Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- University of North Carolina Gillings School of Global Public Health, 170 Rosenau Hall, 27599, Chapel Hill, NC, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Yesim Tozan
- New York University College of Global Public Health, 14 East 4th street, 3rd floor, 10003, New York, NY, USA
| | - Susan S Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
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Haas AD, Lienhard R, Didden C, Cornell M, Folb N, Boshomane TMG, Salazar-Vizcaya L, Ruffieux Y, Nyakato P, Wettstein AE, Tlali M, Davies MA, von Groote P, Wainberg M, Egger M, Maartens G, Joska JA. Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study. AIDS Behav 2023; 27:1849-1861. [PMID: 36592251 PMCID: PMC10149479 DOI: 10.1007/s10461-022-03916-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/03/2023]
Abstract
We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22-1.96], substance use disorders (aRR 1.53, 95% CI 1.19-1.97), serious mental disorders (aRR 1.30, 95% CI 1.09-1.54), and depression (aRR 1.19, 95% CI 1.10-1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15-19 years), and young adults (20-24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes-particularly of adolescents and young adults-and supports strengthening mental health services in HIV treatment programmes.
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Affiliation(s)
- Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
| | - Raphael Lienhard
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Christiane Didden
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Department of Sociology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Tebatso M G Boshomane
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa.,Steve Biko Academic Hospital, Pretoria, South Africa
| | - Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Patience Nyakato
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anja E Wettstein
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Hyland CJ, McDowell MJ, Bain PA, Huskamp HA, Busch AB. Integration of pharmacotherapy for alcohol use disorder treatment in primary care settings: A scoping review. J Subst Abuse Treat 2023; 144:108919. [PMID: 36332528 PMCID: PMC10321472 DOI: 10.1016/j.jsat.2022.108919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) represents the most prevalent addiction in the United States. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include pharmacotherapy (acamprosate, disulfiram, naltrexone). METHODS The team undertook a search across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science on May 21, 2021. Eligibility criteria included: patient population ≥ 18 years old, primary care-based setting, US-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies. We assessed study bias using a modified Oxford Centre for Evidence-based Medicine Rating Framework quality rating scheme. RESULTS The qualitative synthesis included forty-seven papers, representing 25 primary studies. Primary study sample sizes ranged from 24 to 830,825 participants and many (44 %) were randomized controlled trials. Most studies (80 %) included a nonpharmacologic intervention for AUD: 56 % with brief intervention, 40 % with motivational interviewing, and 12 % with motivational enhancement therapy. A plurality of studies (48 %) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acamprosate, and/or disulfiram. Of the 47 total studies included, 68 % assessed care initiation and engagement. Fewer studies (15 %) explored practices surrounding screening for or diagnosing AUD. Outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (53 % and 51 %, respectively). Many of these outcomes showed significant findings in favor of integrated care models for AUD. CONCLUSIONS The integration of AUD pharmacotherapy in primary care settings may be associated with improved process and outcome measures of care. Future research should seek to understand the varied experiences across care integration models.
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Affiliation(s)
- Colby J Hyland
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America.
| | - Michal J McDowell
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, United States of America
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States of America.
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America.
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America; McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States of America.
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39
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Hojilla JC, Sarovar V, Lam JO, Park IU, Vincent W, Hare CB, Silverberg MJ, Satre DD. Sexually Transmitted Infection Screening in Key Populations of Persons Living with HIV. AIDS Behav 2023; 27:96-105. [PMID: 35916949 PMCID: PMC9851927 DOI: 10.1007/s10461-022-03747-w] [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] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
Annual screening for bacterial sexually transmitted infections (STI), including gonorrhea/chlamydia (GC/CT) and syphilis, is recommended for persons with HIV (PWH). We used the prevention index to quantify the extent to which STI screening was completed at guideline-recommended frequency in African American and Latinx persons, women, persons with alcohol (AUD) and substance (SUD) use disorders. Data from PWH at Kaiser Permanente Northern California were collected from electronic health records. We defined receipt of GC/CT and syphilis screening consistent with recommendations as a prevention index score ≥ 75%. Among 9655 PWH (17.7% Latinx; 16.2% African American; 9.6% female; 12.4% AUD; 22.1% SUD), prevention index scores for GC/CT and syphilis increased from 2015 to 2019. African American PWH had lower odds of receiving an annual syphilis screen (aOR 0.87 [95% CI 0.79-0.97]). Female sex was associated with lower odds of GC/CT (aOR 0.30 [95% CI 0.27-0.34]) and syphilis (aOR 0.27 [95% CI 0.24-0.310) screening. AUD and SUD were not associated with differences in annual GC/CT or syphilis screening. Key PWH subgroups experience ongoing challenges to annual STI screening despite comparable healthcare access.
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Affiliation(s)
- J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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40
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Isehunwa OO, Ntinga X, Msimango L, Smith PM, van Heerden A, Matthews LT. Opportunities to leverage reproductive goals and ideals among South African men to promote HIV testing, treatment and prevention: A qualitative study. Glob Public Health 2023; 18:2173795. [PMID: 36803171 DOI: 10.1080/17441692.2023.2173795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/09/2023] [Indexed: 02/22/2023]
Abstract
Despite significant gains in HIV testing, treatment and prevention in sub-Saharan Africa, male engagement and retention in HIV care remains a challenge. We conducted in-depth interviews with 25 men with HIV (MWH) living in rural South Africa to explore how men's reproductive goals could inform approaches to engage men and their female partners in HIV care and prevention. Themes were organised into opportunities and barriers for HIV care, treatment and prevention that men articulated as important to their reproductive goals at the individual, couple and community levels. At the individual level, men are motivated to remain healthy so they can raise a healthy child. At the couple level, the importance of maintaining a healthy partner to raise children may promote serostatus-disclosure, testing and encourage men to support partners to access HIV prevention. At the community level, men described the need to be seen as fathers who provide for their families as important motivators to engage in care. Men also articulated barriers including low knowledge about antiretroviral-based HIV prevention, lack of trust within partnerships and community stigma. Addressing reproductive goals of MWH may be an untapped path for promoting male engagement in HIV care and prevention for their partners.
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Affiliation(s)
- Oluwaseyi O Isehunwa
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xolani Ntinga
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Lindani Msimango
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Patricia M Smith
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynn T Matthews
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Stanton AM, Hornstein BD, Musinguzi N, Dolotina B, Orrell C, Amanyire G, Asiimwe S, Cross A, Psaros C, Bangsberg D, Hahn JA, Haberer JE, Matthews LT. Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda. J Int Assoc Provid AIDS Care 2023; 22:23259582231161029. [PMID: 36945860 PMCID: PMC10034296 DOI: 10.1177/23259582231161029] [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: 03/23/2023] Open
Abstract
Identifying factors associated with alcohol use changes during pregnancy is important for developing interventions for people with HIV (PWH). Pregnant PWH (n = 202) initiating antiretroviral therapy in Uganda and South Africa completed two assessments, 6 months apart (T1, T2). Categories were derived based on AUDIT-C scores: "no use" (AUDIT-C = 0 at T1 and T2), "new use" (AUDIT-C = 0 at T1, >0 at T2), "quit" (AUDIT-C > 0 at T1, =0 at T2), and "continued use" (AUDIT-C > 0, T1 and T2). Factors associated with these categories were assessed. Most participants had "no use" (68%), followed by "continued use" (12%), "quit" (11%), and "new use" (9%). Cohabitating with a partner was associated with lower relative risk of "continued use." Borderline significant associations between food insecurity and higher risk of "new use" and between stigma and reduced likelihood of "quitting" also emerged. Alcohol use interventions that address partnership, food security, and stigma could benefit pregnant and postpartum PWH.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychological and Brain Sciences, 1846Boston University, Boston, USA
- 446213The Fenway Institute, Boston, USA
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, USA
| | - Benjamin D Hornstein
- Department of Medicine, 9967University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas Musinguzi
- Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda
- 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brett Dolotina
- Department of Epidemiology, 33638Mailman School of Public Health, Columbia University, New York, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gideon Amanyire
- Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda
- 560159Africa Health Research Institute, Durban, South Africa
| | - Stephen Asiimwe
- Global Health Collaborative, Mbarara, Uganda
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | - Anna Cross
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christina Psaros
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, USA
- 1811Harvard Medical School, Boston, USA
| | - David Bangsberg
- School of Public Health, Oregon Health and Science University/Portland State, Portland, USA
| | - Judith A Hahn
- Department of Medicine, 8785University of California San Francisco, San Francisco, USA
| | - Jessica E Haberer
- 1811Harvard Medical School, Boston, USA
- Center for Global Health, 2348Massachusetts General Hospital, Boston, USA
| | - Lynn T Matthews
- Department of Medicine, 9967University of Alabama at Birmingham, Birmingham, USA
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Belay DM, Bayisa B, Abera M. Association of Substance Use with Immunological Response to Antiretroviral Therapy in HIV-Positive Patients from Southwest Ethiopia: A Prospective Observational Study. Int J Gen Med 2022; 15:8437-8450. [PMID: 36483781 PMCID: PMC9724579 DOI: 10.2147/ijgm.s389010] [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: 09/07/2022] [Accepted: 11/19/2022] [Indexed: 11/03/2023] Open
Abstract
Background Use of psychoactive substances by HIV-positive patients in the course of antiretroviral drug treatment has become a public health problem globally. Substance use (alcohol, nicotine, and khat) during the course of treatment results in interactions with drugs that lead to undesired treatment outcomes. This condition is understudied, and the consequences of substance use among patients on antiretroviral treatment are not well explored. Methods A prospective observational study was conducted among people on antiretroviral therapy (ART) at Jimma University Medical Center in southwest Ethiopia from April 20 to November 27, 2019. Data were collected using the World Health Organization's alcohol, smoking, and substance involvement screening test among adults who have followed antiretroviral therapy for a minimum of 6 months. Logistic regression analysis was done to identify factors associated with immunological response. The inadequate immunological response was defined as patients who were unable to achieve or maintain a CD4 cell count of >350 cells/mm³ after the 6-months of follow-up. Results Of the 332 patients enrolled, a majority (64.2%) of the respondents were females. The mean (±SD) age of the patients was 38.5 ± 9.5 years. The proportion of participants with a high level of health risk due to alcohol use was 8.4%, while 63.8% of them were non-alcohol users with no health risk. In multivariable logistic regression analysis, moderate and high levels of health risks from alcohol use were significantly associated with increased odds of inadequate immunological response (AOR: 2.9; 95% CI, 1.1-7.4) and (AOR: 4.3; 95% CI, 1.2-14.8), respectively, but the level of health risk from khat and cigarette use showed no association with inadequate immunological response in this study. Conclusion Moderate and high levels of health risk from alcohol use were independently associated with inadequate immunological response. People living with HIV/AIDS should regularly be screened for and be educated about substance use and its potential negative impact on CD4 cell recovery.
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Affiliation(s)
- Dagmawi Mekonnen Belay
- Jimma University Medical Center, Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bodena Bayisa
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
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Richards VL, Leeman RF, Wang Y, Cook C, Prins C, Ennis N, Spencer EC, Cook RL. Identifying the best measures of alcohol consumption to predict future HIV viral suppression trajectories. AIDS Behav 2022; 26:3242-3253. [PMID: 35380289 PMCID: PMC9474662 DOI: 10.1007/s10461-022-03674-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/01/2022]
Abstract
Alcohol use is associated with poor outcomes among people living with HIV (PLWH), but it remains unclear which alcohol use measures best predict future HIV viral non-suppression over time. This study aimed to compare the ability of five alcohol use measures to predict risk of suboptimal HIV viral load trajectories over 36 months. We analyzed data from a cohort of PLWH in Florida including survey data linked to the state HIV surveillance system on prospective HIV viral loads over 36 months (n = 783; 66% male; 55% Black; Mage=46, SD = 11). Four trajectory patterns for HIV viral load were identified: consistently low (65.1%), decreasing (15.9%), increasing (10.6%), and consistently high (8.4%). Past year alcohol use frequency (OR = 2.1, CI:1.0-4.4), drinks consumed on a typical drinking day (OR = 2.2, CI:1.2-4.1), frequency of binge drinking (OR = 2.6, CI:1.3-5.2), and alcohol-related problems score (OR = 1.7, CI:1.1-2.7) were the measures predictive of the risk of future viral non-suppression above specific thresholds.
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Affiliation(s)
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Cindy Prins
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Emma C Spencer
- Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Reid R, Dale SK. Moderating effects of social support on the relationship between substance use disorders and HIV viral load and medication adherence among Black women living with HIV in the United States. AIDS Care 2022; 34:1219-1228. [PMID: 34783618 PMCID: PMC9453849 DOI: 10.1080/09540121.2021.2001415] [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: 05/12/2020] [Accepted: 10/28/2021] [Indexed: 01/26/2023]
Abstract
Substance use may predict lower rates of antiretroviral therapy (ART) adherence and viral suppression among Black Women Living with HIV (BWLWH). We assessed how perceived social support (PSS) moderates the relationship between substance use disorder (SUD) and viral load (VL) and ART adherence. 119 BWLWH provided information on PSS, SUD, alcohol use disorder (AUD) and adherence (via Wisepill). Higher PSS from friends (β = -.263, p = .008) and significant others (β = -.219, p = .025) predicted lower VL. SUD predicted low Wisepill adherence (a) in the past week (β = -.273, p = .035) and past two weeks (β = -.273, p = .033) only for women low in PSS from friends, and (b) in the past two weeks only for women low in total PSS (β = -.294, p = .024). Ironically, for women high in total PSS, SUD predicted higher adherence in the past four weeks (β = .360, p = .006). Adherence and VL may be bolstered by understanding the role of various forms of PSS and SUDs.
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Estimating the changing burden of disease attributable to alcohol use in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:662-675. [DOI: 10.7196/samj.2022.v112i8b.16487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background. Alcohol use was one of the leading contributors to South Africa (SA)’s disease burden in 2000, accounting for 7% of deaths and disability-adjusted life years (DALYs) in the first South African Comparative Risk Assessment Study (SACRA1). Since then, patterns of alcohol use have changed, as has the epidemiological evidence pertaining to the role of alcohol as a risk factor for infectious diseases, most notably HIV/AIDS and tuberculosis (TB).Objectives. To estimate the burden of disease attributable to alcohol use by sex and age group in SA in 2000, 2006 and 2012.Methods. The analysis follows the World Health Organization (WHO)’s comparative risk assessment methodology. Population attributable fractions (PAFs) were calculated from modelled exposure estimated from a systematic assessment and synthesis of 17 nationally representative surveys and relative risks based on the global review by the International Model of Alcohol Harms and Policies. PAFs were applied to the burden of disease estimates from the revised second South African National Burden of Disease Study (SANBD2) to calculate the alcohol-attributable burden for deaths and DALYs for 2000, 2006 and 2012. We quantified the uncertainty by observing the posterior distribution of the estimated prevalence of drinkers and mean use among adult drinkers (≥15 years old) in a Bayesian model. We assumed no uncertainty in the outcome measures.Results. The alcohol-attributable disease burden decreased from 2000 to 2012 after peaking in 2006, owing to shifts in the disease burden, particularly infectious disease and injuries, and changes in drinking patterns. In 2012, alcohol-attributable harm accounted for an estimated 7.1% (95% uncertainty interval (UI) 6.6 - 7.6) of all deaths and 5.6% (95% UI 5.3 - 6.0) of all DALYs. Attributable deaths were split three ways fairly evenly across major disease categories: infectious diseases (36.4%), non-communicable diseases (32.4%) and injuries (31.2%). Top rankings for alcohol-attributable DALYs for specific causes were TB (22.6%), HIV/AIDS (16.0%), road traffic injuries (15.9%), interpersonal violence (12.8%), cardiovascular disease (11.1%), cancer and cirrhosis (both 4%). Alcohol remains an important contributor to the overall disease burden, ranking fifth in terms of deaths and DALYs.Conclusion. Although reducing overall alcohol use will decrease the burden of disease at a societal level, alcohol harm reduction strategies in SA should prioritise evidence-based interventions to change drinking patterns. Frequent heavy episodic (i.e. binge) drinking accounts for the unusually large share of injuries and infectious diseases in the alcohol-attributable burden of disease profile. Interventions should focus on the distal causes of heavy drinking by focusing on strategies recommended by the WHO’s SAFER initiative.
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Gette JA, McKenna KR, McAfee NW, Schumacher JA, Parker JD, Konkle-Parker D. Users of cannabis-only are less likely to accept brief interventions than other substance use profiles in a sample of people living with HIV/AIDS. Am J Addict 2022; 31:447-453. [PMID: 35488889 DOI: 10.1111/ajad.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/21/2022] [Accepted: 04/17/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research has shown that people living with HIV/AIDS (PLWHA) engage in increased rates of substance use, which has a number of potential negative health outcomes. Increased legalization of cannabis is likely to further increase the availability and use of cannabis in this population. Efforts have been made to integrate screening and intervention resources as part of an individual's routine healthcare visits. Though brief approaches such as Screening and Brief Intervention (SBIRT) have shown promise in addressing alcohol use, results are mixed in addressing cannabis use. The present study investigated how individuals reporting cannabis use responded to an invitation to engage in a brief negotiated intervention (BNI). METHODS PLWHA participated in a self-administered tablet computer-based version of SBIRT. Patients screened as having at-risk, high-risk, or dependent substance use (N = 331) were eligible to receive the BNI. Of these patients, 101 reported cannabis-only use, with or without alcohol. RESULTS Binary logistic regressions controlling for Alcohol Use Disorders Identification Test and Drug Abuse Screening Test score and demographics, found that cannabis-only use was significantly related to declining the BNI. DISCUSSION AND CONCLUSIONS Cannabis-only engagement predicts lower BNI acceptance rates than other substance use profiles; inappropriate screening tools may be one reason for this discrepancy. Implications and directions for future research are discussed. SCIENTIFIC SIGNIFICANCE Findings are relevant in modifying SBIRT for cannabis use. To our knowledge, this is the first work to evaluate acceptance of brief interventions for cannabis as compared to other substances and brief intervention acceptance in a sample of PLWHA.
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Affiliation(s)
- Jordan A Gette
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Psychological Science, Texas Tech University, Lubbock, Texas, USA
| | - Kevin R McKenna
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Psychology, Palo Alto VA Medical Center, Palo Alto, California, USA
| | - Nicholas W McAfee
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Julie A Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jefferson D Parker
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Deborah Konkle-Parker
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
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MacDonell K, Dinaj-Koci V, Koken J, Naar S. Barriers and facilitators to scaling up Healthy Choices, a motivational interviewing intervention for youth living with HIV. BMC Health Serv Res 2022; 22:1098. [PMID: 36038882 PMCID: PMC9426253 DOI: 10.1186/s12913-022-08453-w] [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: 09/16/2021] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study included Community Health Workers and their supervisors from HIV clinical care teams who participated in the Healthy Choices intervention program. Healthy Choices is a Motivational Interviewing-based intervention aimed at improving medication adherence and reducing alcohol use for adolescents and emerging adults ages 16—24 living with HIV. In this study, the intervention was “scaled up” for delivery by local HIV care providers in real-world clinic settings. Methods Providers (N = 21) completed semi-structured interviews (N = 29) about their experiences with intervention scale-up. Rigorous thematic analyses were conducted within discussions of barriers and facilitators of intervention implementation. Results Three dominant thematic areas emerged from the data: (1) perceptions of the Healthy Choices intervention, (2) engaging high risk YLH in in-person behavior interventions, and (3) perspectives on implementation of the intervention using local staff. Results offer insights into implementation of MI-based interventions for adolescents and emerging adults in clinic settings using local clinical staff instead of dedicated research staff. Conclusions Overall, scaled-up intervention programs for youth are challenged to maintain scientific rigor, provide rigorous training and supports, and offer an attractive and engaging program. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08453-w.
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Affiliation(s)
- Karen MacDonell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA. .,Department of Health Sciences, LaGuardia Community College, CUNY, 31-10 Thomson, Avenue, E300, Long Island City, NY, 11101, USA.
| | - Veronica Dinaj-Koci
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA
| | - Juline Koken
- Department of Health Sciences, LaGuardia Community College, CUNY, 31-10 Thomson, Avenue, E300, Long Island City, NY, 11101, USA.,Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Science, Florida State University, College of Medicine, 2010 Levy Ave., Bldg. B, Suite 266G, Tallahassee, FL, 32310, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA.,Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Science, Florida State University, College of Medicine, 2010 Levy Ave., Bldg. B, Suite 266G, Tallahassee, FL, 32310, USA
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Gilmore AK, McKee G, Flanagan JC, Leone RM, Oesterle DW, Kirby CM, Short N, Gill-Hopple K. Medications at the Emergency Department After Recent Rape. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP12954-NP12972. [PMID: 33736532 PMCID: PMC9922488 DOI: 10.1177/0886260521997434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.
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Affiliation(s)
- Amanda K. Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
| | - Grace McKee
- Advanced Fellowship Program in Mental Illness Research and Treatment, Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Central Virginia VA Health Care System
- Department of Psychology, Virginia Commonwealth University
| | - Julianne C. Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
- Ralph H. Johnson VA Medical Center
| | - Ruschelle M. Leone
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
| | - Daniel W. Oesterle
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University
| | - Charli M. Kirby
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Nicole Short
- Department of Anesthesiology, University of North Carolina School of Medicine
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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The Impact of Alcohol Consumption on Cardiovascular Health: Myths and Measures. Glob Heart 2022; 17:45. [PMID: 36051324 PMCID: PMC9306675 DOI: 10.5334/gh.1132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
Over the past several decades, the prevalence of cardiovascular disease (CVD) has nearly doubled, and alcohol has played a major role in the incidence of much of it. Alcohol has also been attributed in deaths due to infectious diseases, intentional and unintentional injuries, digestive diseases, and several other non-communicable diseases, including cancer. The economic costs of alcohol-associated health outcomes are significant at the individual as well as the country level. Risks due to alcohol consumption increase for most cardiovascular diseases, including hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, and stroke. The widespread message for over 30 years has been to promote the myth that alcohol prolongs life, chiefly by reducing the risk of coronary heart disease (CHD). Lack of universal advice and stringent policy measures have contributed towards increased uptake and easy availability of alcohol. The WHO has called for a 10% relative reduction in the harmful use of alcohol between 2013–2025. However, lack of investment in proven alcohol control strategies, as well as persistence of misinformation and industry interference, have hindered the efforts of public health professionals to make sufficient progress in reducing alcohol related harms and death.
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