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West BS, Darisheva M, McCrimmon T, Zholnerova N, Grigorchuk E, Starbird L, Terlikbayeva A, Primbetova S, Baiserkin B, Mussina Z, Kasymbekova S, Cordingley O, Frye VA. Scaling Up HIV Self-Testing and Linkage to Care Among Women Who Exchange Sex and/or Use Drugs in Kazakhstan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:216-228. [PMID: 38917303 DOI: 10.1521/aeap.2024.36.3.216] [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: 06/27/2024]
Abstract
HIV testing is the point of entry for linkage to treatment and prevention and is critically important to ending the HIV epidemic. HIV self-testing (HST) is an acceptable, user-controlled tool that can address testing barriers, which is especially important for populations who need to test frequently, like women who exchange or trade sex for money or other needed resources (WES) and women who use drugs. HST is feasible and acceptable among WES, but research among WES who also use drugs is limited, particularly in places like Kazakhstan, where HIV rates remain high and where scale-up of HST and pre-exposure prophylaxis (PrEP) is in process. To develop effective programming, there is a need to develop tailored services for WES and/or use drugs that address key barriers. We discuss opportunities to increase HST and linkage to services among WES and/or use drugs in Kazakhstan, with a focus on stigma reduction.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, New York, New York
| | | | - Tara McCrimmon
- Sociomedical Sciences, Columbia University, New York, New York
| | | | | | - Laura Starbird
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Baurzhan Baiserkin
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Zhannat Mussina
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | | | | | - Victoria A Frye
- School of Social Work, Columbia University, New York, New York
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Ai W, Fan C, Marley G, Tan RKJ, Wu D, Ong JJ, Tucker JD, Fu G, Tang W. Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis. HIV Med 2023; 24:1093-1105. [PMID: 37407253 PMCID: PMC10766863 DOI: 10.1111/hiv.13523] [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: 04/02/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. METHODS We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. RESULTS In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9-43%, I2 = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12-74%, I2 = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician-patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level. CONCLUSION This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.
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Affiliation(s)
- Wei Ai
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chengxin Fan
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jason J. Ong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Weiming Tang
- School of Public Health, Nanjing Medical University, Nanjing, China
- University of North Carolina Project-China, Guangzhou, China
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Mapingure M, Chingombe I, Dzinamarira T, Samba C, Moyo B, Mugurungi O, Musuka G. Diminished health and social outcomes among men who have sex with men who use drugs in Zimbabwe. South Afr J HIV Med 2023; 24:1513. [PMID: 37795428 PMCID: PMC10546898 DOI: 10.4102/sajhivmed.v24i1.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
No abstract available.
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Affiliation(s)
- Munyaradzi Mapingure
- Department of Strategic Information, ICAP at Columbia University, Harare, Zimbabwe
| | - Innocent Chingombe
- Department of Strategic Information, ICAP at Columbia University, Harare, Zimbabwe
| | - Tafadzwa Dzinamarira
- Department of Strategic Information, ICAP at Columbia University, Harare, Zimbabwe
| | | | - Brian Moyo
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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Ai W, Fan C, Marley G, Tan RKJ, Wu D, Ong J, Tucker JD, Fu G, Tang W. Disparities in healthcare access and utilization among people living with HIV in China: a scoping review and meta-analysis. RESEARCH SQUARE 2023:rs.3.rs-2744464. [PMID: 37066259 PMCID: PMC10104255 DOI: 10.21203/rs.3.rs-2744464/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Background Healthcare disparities hinder the goal of ending the HIV pandemic by 2030. This review aimed to understand the status of healthcare disparities among people living with HIV (PLWH) in China and summarize driving factors. Methods We searched six databases: PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and China Wanfang. English or Chinese articles published between January 2000 and July 2022 were included if they focused on any disparities in access to and utilization of healthcare among PLWH in China. Grey literature, reviews, conferences, and commentaries were excluded. A random effects model was used to calculate the pooled estimates of data on healthcare access/utilization and identified the driving factors of healthcare disparities based on a socio-ecological framework. Results A total of 8728 articles were identified in the initial search. Fifty-one articles met the inclusion criteria. Of these studies, 37 studies reported HIV-focused care, and 14 focused on non-HIV-focused care. PLWH aged ≥ 45 years, female, ethnic minority, and infected with HIV through sexual transmission had a higher rate of receiving antiretroviral therapy (ART). Females living with HIV have higher adherence to ART than males. Notably, 20% (95% CI, 9-43%, I 2 = 96%) of PLWH with illness in two weeks did not seek treatment, and 30% (95% CI, 12-74%, I 2 = 90%) refused hospitalization when needed. Barriers to HIV-focused care included the lack of knowledge of HIV/ART and treatment side effects at the individual level, and social discrimination and physician-patient relationships at the community/social level. Structural barriers included out-of-pocket medical costs, and distance and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from healthcare providers, distrust of healthcare services at the community/social level. Conclusion This review suggests disparities in ART access, adherence, and utilization of non-HIV-focused care among PLWH. Financial issues and social discrimination were prominent reasons for healthcare disparities in PLWH care. Creating a supportive social environment and expanding insurance policies, like covering more medical services and increasing reimbursement rates could be considered to promote healthcare equity.
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Affiliation(s)
- Wei Ai
- Nanjing Medical University
| | | | | | | | - Dan Wu
- University of North Carolina Project-China
| | | | | | - Gengfeng Fu
- Jiangsu Provincial Centre for Disease Control and Prevention
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Davis A, Mergenova G, Landers SE, Sun Y, Rozental E, Gulyaev V, Gulyaev P, Nurkatova M, Terlikbayeva A, Primbetova S, Altice FL, Remien RH. Implementation of a Dyad-Based Intervention to Improve Antiretroviral Therapy Adherence Among HIV-Positive People Who Inject Drugs in Kazakhstan: A Randomized Trial. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:313-324. [PMID: 37576461 PMCID: PMC10421639 DOI: 10.1177/10497315221117543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose HIV-positive people who inject drugs (PWID) in Kazakhstan face many challenges to antiretroviral therapy (ART) adherence. Interventions that leverage social support from an intimate partner, family member, or friend may be effective in improving ART adherence among this population. The purpose of this paper is to describe the implementation process of a dyad-based intervention among HIV-positive PWID and their treatment support partners. Method Sixty-six HIV-positive PWID and 66 of their treatment support partners will be enrolled in this pilot randomized controlled trial in Almaty, Kazakhstan, and randomized as dyads to receive an adapted version of the SMART Couples intervention or standard of care. Results Several implementation strategies were used to facilitate intervention delivery, including remote delivery, training of staff, supervision, technical assistance, quality assurance, and collection of assessments through diverse sources. Discussion This trial responds to a need for dyad-based ART adherence interventions adapted specifically for HIV-positive PWID.
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Affiliation(s)
- Alissa Davis
- School of Social Work, Columbia University, New York, United States
| | | | - Sara E. Landers
- School of Social Work, Columbia University, New York, United States
| | - Yihang Sun
- School of Social Work, Columbia University, New York, United States
| | - Elena Rozental
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Valera Gulyaev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Pavel Gulyaev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Mira Nurkatova
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | | | - Frederick L. Altice
- School of Medicine and School of Public Health, Yale University, New Haven, United States
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, New York, United States
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Lefrancois LH, Nguyen BT, Pham TTP, Le NTH, Dao HTT, Tran TH, Ngo KP, Tong HT, Phan HTT, Ait-Ahmed M, Pham TH, Nguyen TA, Taieb F, Madec Y. Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients. PLoS One 2023; 18:e0281857. [PMID: 36802388 PMCID: PMC9942987 DOI: 10.1371/journal.pone.0281857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Increasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID. METHODS Prospective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART. RESULTS Overall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001). CONCLUSIONS Despite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care. TRIAL REGISTRATION Clinical Trial Number: NCT03249493.
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Affiliation(s)
- Louise H. Lefrancois
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
| | - Binh Thanh Nguyen
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Thi Phuong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhung Thi Hong Le
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huyen Thi Thanh Dao
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tram Hong Tran
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Khanh Phuong Ngo
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ha Thi Tong
- Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Huong Thi Thu Phan
- Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Mohand Ait-Ahmed
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
| | - Thang Hong Pham
- National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Fabien Taieb
- Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France
- Department of International Affairs, Institut Pasteur, Université de Paris, Paris, France
| | - Yoann Madec
- Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France
- * E-mail:
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Ng'ong'a GO, Lwembe RM, Knight V, Randa D, Ściborski RJ, Ayodo G. Association of ART Non-adherence with Self-reported behavior and lifestyle among injecting drug users in the coastal region of Kenya. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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El-Bassel N, McCrimmon T, Wu E, Chang M, Terlikbayeva A, Hunt T, Darisheva M, Primbetova S, Davis A, Metsch LR, Feaster DJ, Baiserkin B, Abishev A, Denebayeva A, Sagimbayev B, Kurmetova K, Mashirov K, Gilbert L. Effectiveness of an Intervention to Improve HIV Service Delivery for People Who Inject Drugs in Kazakhstan: A Cluster Trial. JAMA Netw Open 2022; 5:e2244734. [PMID: 36454567 PMCID: PMC9716389 DOI: 10.1001/jamanetworkopen.2022.44734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE The increasing HIV incidence rates and suboptimal rates of testing, engagement, and retention in care for people who inject drugs (PWID) in Kazakhstan underscore the need for effective HIV care continuum interventions for PWID. OBJECTIVE To determine the effectiveness of the Bridge HIV care continuum intervention implemented in needle and syringe programs (NSPs) in Kazakhstan. DESIGN, SETTING, AND PARTICIPANTS This stepped-wedge cluster trial was conducted from February 2017 to May 2020, with implementation beginning sequentially across 3 cities (Almaty, Karaganda-Temirtau, and Shymkent) in August 2017, January 2018, and May 2019. Intervention effect sizes were estimated via population-averaged models, and hypothesis testing relied on a permutation testing approach. The primary unit of analysis was an NSP. Data analysis was performed from October 2020 to April 2022. INTERVENTIONS The intervention addresses the full HIV care continuum: identification, testing, referral to services, and linkage to HIV care. The 3 intervention components were (1) a social network strategy, a peer-driven recruitment approach for HIV testing; (2) HIV counseling, rapid testing, and referral following international and national guidelines and protocols; and (3) enhanced antiretroviral treatment and access to services. MAIN OUTCOMES AND MEASURES The primary outcomes were the effectiveness of implementing Bridge's enhanced service integration approach in increasing the number of PWID served at NSPs, increasing the number of PWID who are tested for HIV in NSPs, and improving linking HIV-positive PWID with HIV care. Secondary outcomes included numbers of clients registered for HIV care, initiation of antiretroviral therapy, and viral suppression. RESULTS Twenty-four NSPs (8 in each city) served a total of 1225 PWID (369 in Almaty, 618 in Karaganda-Temirtau, and 238 in Shymkent) at the preimplementation study step; 1015 clients (82.9%) were male, and the mean (SD) age was 36.7 (7.1) years. Compared with preimplementation study steps, during Bridge intervention implementation steps, NSPs experienced a significant increase in the number of PWID clients registered (incidence rate ratio, 2.37; 95% CI, 1.48-3.78) and the number of PWID who received rapid HIV tests (incidence rate ratio, 3.98; 95% CI, 2.30-6.90). No significant increase in referral to HIV care was observed. The study also found significant support for secondary outcomes of antiretroviral therapy initiation and the number of clients who achieved viral suppression. CONCLUSIONS AND RELEVANCE In this stepped-wedge cluster trial, the findings suggest that implementation of the Bridge intervention was associated with significant improvement in several steps in the continuum of HIV care for PWID in Kazakhstan. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02796027.
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Affiliation(s)
- Nabila El-Bassel
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | - Tara McCrimmon
- Columbia University Mailman School of Public Health, New York, New York
| | - Elwin Wu
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | - Mingway Chang
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | | | - Timothy Hunt
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | | | | | - Alissa Davis
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
| | - Lisa R Metsch
- Columbia University Mailman School of Public Health, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Baurzhan Baiserkin
- Medical and Pharmaceutical Control Committee of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan
| | - Asylkhan Abishev
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, Kazakhstan
| | - Alfiya Denebayeva
- Center for Prevention and Control of AIDS of the Almaty Health Department, Almaty, Kazakhstan
| | - Beibit Sagimbayev
- Karaganda Oblast Center for Prevention and Control of AIDS of the Health Department of Karaganda Oblast, Karaganda, Kazakhstan
| | - Kulpan Kurmetova
- Karaganda Oblast Center for Prevention and Control of AIDS of the Health Department of Karaganda Oblast, Karaganda, Kazakhstan
| | - Kozhakhmet Mashirov
- Center for Prevention and Control of AIDS of the Shymkent Health Department, Shymkent, Kazakhstan
| | - Louisa Gilbert
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, New York
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Iskakova B, Nugmanova Z, Murat Yucel R, Gamarel KE, King EJ. Re-validation and cultural adaptation of the brief, standardized assessment tool for measuring HIV-related stigma in healthcare settings in Almaty, Kazakhstan. PLoS One 2022; 17:e0276770. [PMID: 36322554 PMCID: PMC9629601 DOI: 10.1371/journal.pone.0276770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
The HIV epidemic continues to grow in Kazakhstan and HIV stigma remains a major barrier to HIV prevention and treatment in the country. HIV stigma in healthcare setting may also discourage people living with HIV (PLHIV) from getting the care needed. Therefore, studying the attitudes of healthcare workers towards PLHIV is important and requires well-constructed measurement tools adapted to the specific cultural context. In our study, we aimed to adapt and re-validate a brief questionnaire on HIV stigma among healthcare workers in Almaty, Kazakhstan. We held focus group discussions to obtain input on an existing questionnaire and surveyed 448 primary healthcare providers to psychometrically evaluate the scale. The final HIV-stigma scale consisted of 15 items, 6 of them measuring negative opinions about PLHIV and the rest assessing stigmatizing health facility policies towards PLHIV. Both HIV-stigma subscales demons6trated adequate psychometric properties (with Cronbach's alpha α = 0.57 for the first and α = 0.86 for the second subscale, and with factor loadings >0.35 within each subscale). High numbers of respondents holding negative attitudes towards PLHIV, detected in this sample (87%; n = 380), may suggest the need for immediate actions addressing HIV stigma in healthcare in Kazakhstan.
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Affiliation(s)
- Balnur Iskakova
- Department of Epidemiology, School of Public Health, Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Kazakhstan
| | - Zhamilya Nugmanova
- Department of Epidemiology, School of Public Health, Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Kazakhstan
| | - Recai Murat Yucel
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, Pennsylvania, United States of America
| | - Kristi E. Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Elizabeth J. King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
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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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Patel EU, Solomon SS, McFall AM, Prata Menezes N, Tomori C, Srikrishnan AK, Kumar MS, Celentano DD, Lucas GM, Mehta SH. Drug use stigma, antiretroviral therapy use, and HIV viral suppression in a community-based sample of people with HIV who inject drugs. AIDS 2022; 36:1583-1589. [PMID: 35730390 PMCID: PMC9391282 DOI: 10.1097/qad.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association of drug use stigma with antiretroviral therapy (ART) use and HIV viral suppression among people with HIV who inject drugs in India. DESIGN Cross-sectional biobehavioral survey. METHODS Between August 2016 and May 2017, persons aged at least 18 years who reported injection drug use in the past 2 years were recruited via respondent-driven sampling (RDS) in 12 Indian cities (approximately 1000 per city). The analysis was restricted to participants with laboratory-confirmed HIV infection who self-reported a prior HIV diagnosis and were eligible for ART per concurrent national HIV treatment guidelines. Enacted and internalized drug use stigma were each measured by five to six-item subscales. The study outcomes were HIV viral suppression (<150 copies/ml) and self-reported past 30-day ART use. RDS-II weighted multivariable logistic regression with a city-level random-intercept was used to estimate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs). RESULTS Among 971 ART-eligible participants previously diagnosed with HIV, 65.1% reported ART use and 56.1% were virally suppressed. Reporting any enacted stigma (vs. none) was associated with lower odds of ART use [aOR = 0.26 (95% CI = 0.15-0.44)] and viral suppression [aOR = 0.49 (95% CI = 0.31-0.78)]. High internalized stigma scores (>median vs. ≤median) were associated with lower odds of viral suppression among participants aged at least 35 years [aOR = 0.51 (95% CI = 0.27-0.97)] but not among participants aged less than 35 years [aOR = 1.22 (95% CI = 0.57-2.60)]. Similar associations were observed in analyses restricted to participants ever linked to HIV care. CONCLUSION Drug use stigma may be a barrier to HIV viral suppression among people with HIV who inject drugs, thereby hindering efforts to achieve HIV control.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Neia Prata Menezes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Cecília Tomori
- Johns Hopkins University School of Nursing
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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12
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Fusco FM, Sangiovanni N, Papa N, Cuomo N, Tambaro O, Iodice V, Bruner V, Carleo MA, Rizzo V, Palmiero G, Di Lorenzo M, Spatarella M, Viglietti R, Sangiovanni V, Esposito V. Adherence to antiretroviral therapy thought package-refill among HIV+ persons at "D. Cotugno" hospital, Naples, Italy. LE INFEZIONI IN MEDICINA 2022; 30:440-445. [PMID: 36148167 PMCID: PMC9448314 DOI: 10.53854/liim-3003-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A gold-standard for the measurement of adherence to antiretroviral therapy (ART) is lacking. Aim of this study is to verify the feasibility of a package-refill-based measurement of ART at "D. Cotugno" hospital, Naples, Italy, and the factors associated to adherence. METHODS In the period January 2018-August 2020, we calculated the package-refill as the ratio between ART-packages actually withdrawn, and the ART packages needed to regularly take ART. Adherence was associated, trough a univariate e multivariate logistic regression, to demographical, behavioural and clinical factors. RESULTS 1140 HIV+ subjects were included. At univariate logistic regression inadequate package-refill-based adherence is associated with HIV-RNA higher than 50 copies/mmL (OR 3.77-IC95% 2.76-5.13) and with HIVRNA higher than 200 copies/mmL (OR 3.98-IC95% 2.69-5.90). Being not-Italian and Injective-drug-user are associated with low adherence, having HIV/AIDS for more than 8 years is associated with better adherence. CONCLUSIONS Package-refill is a suitable method for measuring adherence and is associated with the condition of viral failure.
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Affiliation(s)
| | | | - Nunzia Papa
- "D. Cotugno" Hospital, AOS dei Colli, Naples, Italy
| | - Nunzia Cuomo
- "D. Cotugno" Hospital, AOS dei Colli, Naples, Italy
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13
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Beichler H, Grabovac I, Leichsenring B, Dorner TE. Involvement, Perception, and Understanding as Determinants for Patient-Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10314. [PMID: 36011949 PMCID: PMC9408219 DOI: 10.3390/ijerph191610314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The relationship between patients and healthcare professionals (physicians) is the cornerstone of successful long-term antiretroviral therapy for people living with human immunodeficiency virus (HIV). PURPOSE This study aimed to investigate the connection between involvement, perception, and understanding as the basis for the patient-physician relationship and drug adherence, measured as the probability of non-adherence. METHODS In an online survey, people with HIV were asked about their relationship with their physicians and the extent to which they felt involved in treatment-related decisions. A statistical analysis was conducted to determine whether a better patient-physician relationship was associated with higher adherence to therapy. This was performed by univariate group comparison (Mann-Whitney-U, Fishers Exact Test) and logistic regression. RESULTS A total of 303 persons living with HIV participated in the survey, and 257 patients were included in the analysis. Overall, 27.6% were classified as non-adherent and self-reporting based on whether an antiretroviral therapy (ART) was taken in the past or how often the ART was interrupted. This proportion was significantly higher among patients aged 50-74 years (39.7%) and those with a longer therapy duration (9-15 years: 46.6%; from 15 years on: 55.8%). Therapy-non-adherent patients showed significantly lower scores in the relationship aspects understanding (2.68 vs. 3.03), participation (2.63 vs. 3.07), and perception (3.00 vs. 3.24) compared to adherent patients. Logistic regression analysis confirms that higher scores for understanding, involvement, and perception are strongly associated with a reduction in the risk of becoming non-adherent. This was true for all examined regression models, regardless of whether they were adjusted for the length of therapy and socio-demographic characteristics. CONCLUSION The results reinforce the need for awareness among health care professionals (HCP) regarding understanding, involvement, and perception as important aspects to improve the quality of the patient-physician relationship for high adherence levels with maximized non-adherence in ART management by PLWH.
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Affiliation(s)
- Helmut Beichler
- General Hospital, Nursing School, Medical University Vienna, 1090 Wien, Austria
| | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, 1090 Wien, Austria
| | | | - Thomas Ernst Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Unite Lifestyle and Prevention, Medical University of Vienna, 1090 Wien, Austria
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14
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Smith LR, Shumskaia N, Kurmanalieva A, Patterson TL, Werb D, Blyum A, Algarin AB, Yeager S, Cepeda J. Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study. Harm Reduct J 2022; 19:53. [PMID: 35614508 PMCID: PMC9131652 DOI: 10.1186/s12954-022-00633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/12/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In Kyrgyzstan and other Eastern European and Central Asian countries, injection drug use and HIV-related intersectional stigma undermines HIV prevention efforts, fueling a rapidly expanding HIV epidemic. The Kyrgyzstan InterSectional Stigma (KISS) Injection Drug Use Cohort is the first study designed to assess the impact of drug use, methadone maintenance treatment (MMT) and HIV stigma experiences among people who inject drugs (PWID) on HIV prevention service utilization. METHODS Adult PWID were recruited from Bishkek city and the surrounding rural Chuy Oblast region in northern Kyrgyzstan via modified time location sampling and snowball sampling. All participants completed a baseline rapid HIV test and interviewer-administered survey. A subsample of participants were prospectively followed for three months and surveyed to establish retention rates for future work in the region. Internal reliability of three parallel stigma measures (drug use, MMT, HIV) was evaluated. Descriptive statistics characterize baseline experiences across these three stigma types and HIV prevention service utilization, and assess differences in these experiences by urbanicity. RESULTS The KISS cohort (N = 279, 50.5% Bishkek, 49.5% Chuy Oblast) was mostly male (75.3%), ethnically Russian (53.8%), median age was 40 years old (IQR 35-46). Of the 204 eligible participants, 84.9% were surveyed at month 3. At baseline, 23.6% had a seropositive rapid HIV test. HIV prevention service utilization did not differ by urbanicity. Overall, we found 65.9% ever utilized syringe service programs in the past 6 months, 8.2% were utilizing MMT, and 60.8% met HIV testing guidelines. No participants reported PrEP use, but 18.5% had heard of PrEP. On average participants reported moderate levels of drug use (mean [M] = 3.25; α = 0.80), MMT (M = 3.24; α = 0.80), and HIV stigma (M = 2.94; α = 0.80). Anticipated drug use stigma from healthcare workers and internalized drug use stigma were significantly higher among PWID from Bishkek (p < 0.05), while internalized HIV stigma among PWID living with HIV was significantly greater among PWID from Chuy Oblast (p = 0.03). CONCLUSION The KISS cohort documents moderate levels of HIV-related intersectional stigma and suboptimal engagement in HIV prevention services among PWID in Kyrgyzstan. Future work will aim identify priority stigma reduction intervention targets to optimize HIV prevention efforts in the region.
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Affiliation(s)
- Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA.
| | - Natalia Shumskaia
- AIDS Foundation-East West in the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
- Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Anna Blyum
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Samantha Yeager
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Ha TV, Hoffman IF, Miller WC, Mollan KR, Lancaster KE, Richardson P, Zeziulin O, Djoerban Z, Sripaipan T, Chu VA, Guo X, Hanscom B, Go VF. Association between drug use and ART use among people living with HIV who inject drugs in Vietnam, Ukraine and Indonesia: results from HPTN 074. JOURNAL OF SUBSTANCE USE 2022; 27:648-657. [PMID: 36742268 PMCID: PMC9897261 DOI: 10.1080/14659891.2021.1989509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and objective Drug use type and frequency may affect Anti-Retroviral Therapy (ART) uptake for HIV-infected people who inject drugs (PWID). This paper assesses the association between self-reported baseline drug use and ART among HIV-infected PWID in Indonesia, Ukraine and Vietnam. Methods Data on self-reported baseline drug use and ART among HIV-infected PWID at the 26- and 52-week follow-ups were extracted from the HIV Prevention Trials Network (HPTN) 074, a randomized, controlled vanguard study to facilitate HIV treatment for PWID in Indonesia, Ukraine, and Vietnam. Multivariable logistic regression models were fit by study site and the whole HPTN 074 sample, using a 0.5 type I error rate. Results The response rate were 83.3% and 77.0% at 26th and 52th weeks. At 26-week, baseline use of over one non-opiate/non-stimulant drug was associated with lower odds of ART use among Indonesian participants (OR = 0.21, 95%CI: 0.05-0.82); and baseline injecting drugs for over 20 days in the previous month was associated with lower odds of ART use among all HPTN 074 sample (OR = 0.59, 95% CI: 0.36-0.97). Conclusion The association of a specific drug use pattern with later ART uptake implies the importance of medication-assisted treatment to enhance ART uptake and adherence among participants.
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Affiliation(s)
- Tran Viet Ha
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Irving F. Hoffman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William C. Miller
- Department of Epidemiology, The Ohio State of University, Columbus, Ohio, USA
| | - Katie R. Mollan
- UNC CFAR, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul Richardson
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Teerada Sripaipan
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Viet Anh Chu
- The University of North Carolina, Hanoi, Vietnam
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Vivian F. Go
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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16
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The impact of social capital and mental health on medication adherence among older people living with HIV (PLWH). BMC Public Health 2021; 21:2252. [PMID: 34895198 PMCID: PMC8665618 DOI: 10.1186/s12889-021-12251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The number of older people living with HIV (PLWH) is increasing. Although there are many studies affecting medication adherence, research on the impact of social capital and mental health on medication adherence in this particular population is limited. Method Data were collected from an ongoing observational prospective cohort study, starting from November 2018, among older PLWH in Sichuan province, China. Five hundred twenty-one participants were interviewed. Social capital consists of the individual and family (IF) scale, and the community and society (CS) scale. The presence of probable depression and probable anxiety were assessed using the CES-D-10 and GAD-7 scales. Adherence was defined as taking ≥80% of prescribed HIV medication in 4 days prior to the interview. Two sets of Firth’ penalized regression analyses were used to estimate the association between social capital, mental health, and medication adherence. Results The prevalence of non-adherence was 18.2% (95/521) among older PLWH in this study. After adjusting for significant factors, the CS social capital (OR: 0.92, 95%CI:0.85–0.99, p < 0.05) and probable anxiety (OR:1.73, 95%CI:1.07–2.80, p < 0.05) were associated with non-adherence. Conclusion This study highlighted that the effects of social capital and mental health on older PLWH’s adherence, which implied that the need to develop interventions to concern for mental health and enhance CS social capital to help the older PLWH better manage HIV medication adherence.
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17
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Borda JP, Friedman HL, Castaño GA, Rodríguez HA, Muñoz CF, Tofighi B. Barriers to HIV and Hepatitis C care for people who inject drugs in Colombia. AIDS Care 2021; 34:633-638. [PMID: 33615915 DOI: 10.1080/09540121.2021.1889952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People who inject drugs (PWIDs) are a key population targeted in global efforts to increase HIV and Hepatitis C virus (HCV) diagnosis, linkage to care, and treatment retention. Colombia has experienced a significant increase in the incidence of HIV and HCV attributed to the alarming rise in injection drug use. The primary aim of this study was to identify factors influencing access to HIV and HCV care among PWIDs. Survey domains consisted of (1) sociodemographic characteristics; (2) history of HIV-HCV testing and infection status; (3) the 13-item questionnaire developed by Awad and colleagues to explore barriers to HIV and HCV testing, (4) the Barriers to Medical Care questionnaire; and (5) the Risk Assessment Battery. A total of 171 subjects completed the survey. A high proportion of participants reported past year testing for HIV (87%) and HCV (72.8%). However, most respondents elicited numerous barriers to obtaining information, referrals, and insurance coverage for accessing HIV and/or HCV care. Further studies are needed to identify scalable public health measures to overcome these barriers.
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Affiliation(s)
- Juan P Borda
- Facultad de Medicina, Universidad Alexander von Humboldt, Armenia, Colombia
| | | | | | - Henry A Rodríguez
- Facultad de Medicina, Universidad Alexander von Humboldt, Armenia, Colombia
| | - Carlos F Muñoz
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia
| | - Babak Tofighi
- School of Medicine, New York University, New York, USA.,Department of Population Health, New York University Langone Medical Center, New York, USA
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18
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Saleem HT, Likindikoki S, Silberg C, Mbwambo J, Latkin C. Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania: A time geography perspective. Soc Sci Med 2021; 268:113379. [PMID: 32979773 PMCID: PMC7755686 DOI: 10.1016/j.socscimed.2020.113379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
Timely initiation and sustained adherence to antiretroviral therapy (ART) are essential to improving the health outcomes of people living with HIV and preventing onward HIV transmission. However, women who use heroin often face challenges to initiating and adhering to ART. In this paper we identify spatial, temporal, and social factors that affect HIV treatment engagement among women who use heroin, drawing from a time geography framework. We conducted in-depth interviews with 30 heroin-using women living with HIV in Dar es Salaam, Tanzania between January and March 2019. We found that unstable housing, high mobility, HIV-related stigma, and unpredictable daily paths due to heroin use and involvement in sex work spatially and temporally constrained women who use heroin from incorporating HIV treatment behaviors into daily routines. Some women, however, were able to overcome these time-space constraints to HIV treatment engagement through social support and social role performance. Time geography, including concepts of time-space constraints and daily paths, is a useful framework for identifying barriers to ART engagement. Structural, relational, and individual interventions aimed at eliminating time-space constraints hold the potential to improve HIV treatment engagement among particularly vulnerable and mobile populations.
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Affiliation(s)
- Haneefa T Saleem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5033, Baltimore, MD, USA, 21205.
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Claire Silberg
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA, 21205.
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, School of Medicine, Muhmbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway Avenue, Hampton House Room 737, Baltimore, MD, USA, 21205.
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Davis A, Pala AN, Nguyen N, Robbins RN, Joska J, Gouse H, Mellins CA, Myer L, Henry M, Leu CS, Remien RH. Sociodemographic and psychosocial predictors of longitudinal antiretroviral therapy (ART) adherence among first-time ART initiators in Cape Town, South Africa. AIDS Care 2020; 33:1394-1403. [PMID: 32698680 DOI: 10.1080/09540121.2020.1798336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
First-time antiretroviral therapy (ART) initiators may be more vulnerable to poor ART adherence because they may be coping with a new HIV diagnosis, facing logistical challenges to accessing and adhering to ART for the first time, and have not yet developed support networks or the skills to support long-term adherence. We recruited 324 participants in two HIV clinics near Cape Town, South Africa. Sociodemographic/psychosocial factors were measured at baseline and self-reported adherence at the 6 month follow-up. We conducted multivariable regression to determine which baseline factors were associated with 6-month adherence. A better patient-clinic relationship score (OR: 1.08 [95% CI: 1.05-1.11]) was associated with higher adherence. A drug use problem (0.51 [0.29-0.87]), higher social isolation (0.93 [0.87-0.99]), and greater number of years living with HIV before initiating ART (0.92 [0.86-1.00]) were associated with adherence levels below 90%. Patient-clinic relationships and social support are key psycho-social factors in early adherence behavior. Reducing drug use problems through targeted screening and early intervention may improve ART adherence.
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Affiliation(s)
- Alissa Davis
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - John Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Landon Myer
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michelle Henry
- Numeracy Centre, Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - Cheng Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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20
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Optimizing HIV prevention and treatment outcomes for persons with substance use in Central Asia: what will it take? Curr Opin HIV AIDS 2020; 14:374-380. [PMID: 31219889 PMCID: PMC6688715 DOI: 10.1097/coh.0000000000000565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose of review To summarize the status of HIV and substance use in Central Asia and discuss potential ways to move forward to effective epidemic control among people who inject drugs (PWID) in the region and beyond. Recent findings PWID and their partners remain the population most affected by HIV in Central Asia. Lack of effective substance use prevention and treatment options and limited involvement of PWID-led community-based organizations in HIV programs, combined with the requirement for official registration, stigma and discrimination of PWID, and criminalization of drug use remain key barriers to effective HIV prevention and treatment. Summary Sustainable HIV epidemic control among PWID will not be feasible without decriminalization of drug use, addressing stigma and discrimination and policy changes to enhance uptake of HIV-related prevention, treatment and support services by PWID. It is also critical to ensure adoption of innovations, particularly those that combine evidence-based biomedical, behavioral and structural interventions tailored to the needs of the PWID.
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21
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If You Build It, Will They Use It? Preferences for Antiretroviral Therapy (ART) Adherence Monitoring Among People Who Inject Drugs (PWID) in Kazakhstan. AIDS Behav 2019; 23:3294-3305. [PMID: 30741397 DOI: 10.1007/s10461-019-02421-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adherence to antiretroviral therapy (ART) is an important predictor of long-term treatment success and is associated with optimal individual and public health outcomes. Novel technologies, such as electronic monitoring devices (EMDs) or pharmacokinetic testing, provide more objective measures of ART adherence than traditional measures of adherence (e.g., self-report) and may facilitate improved adherence through the provision of patient feedback. This study examines preferences for ART adherence monitoring among people who inject drugs (PWID) in Kazakhstan. In-depth interviews were conducted with 20 HIV-positive PWID, 18 of their intimate partners, and 7 AIDS Center healthcare providers in Almaty, Kazakhstan. Results indicated that patients varied in their preferences of which strategies would be most effective and acceptable to use in monitoring their adherence. Overall, patients were highly enthusiastic about the potential use of pharmacokinetic testing. Many participants supported the use of EMDs, though some were concerned about having their adherence tracked. Other participants thought reminders through text messaging or smart phone applications would be helpful, though several had concerns about confidentiality and others worried about technological difficulties operating a smart phone. Future studies should evaluate the feasibility and impact of providing quantitative drug levels as feedback for ART adherence using biomarkers of longer-term ART exposure, (i.e., hair sampling or dried blood spot testing).
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22
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Mitchell E, Lazuardi E, Rowe E, Anintya I, Wirawan DN, Wisaksana R, Subronto YW, Prameswari HD, Kaldor J, Bell S. Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:538-552. [PMID: 31815531 DOI: 10.1521/aeap.2019.31.6.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Transgender women (waria) in Indonesia have high rates of HIV and experience barriers accessing HIV services. This qualitative research explored barriers and facilitators to HIV care among waria in Indonesia. Between 2015 and 2016, 42 participants were involved in focus group discussions and in-depth interviews across three urban sites in Indonesia to examine participants' experiences and views on HIV prevention, testing, treatment initiation, and treatment adherence. Data were analyzed thematically. Barriers to accessing HIV care services included perceptions of health and HIV treatment, confidentiality and stigma concerns, and poor access to health insurance. Facilitators to HIV care included recognition of health and perceived susceptibility, perceptions of treatment benefits and consequences of non-adherence, access to social support, and patient-friendly services. Research findings highlight the importance of improving HIV treatment literacy, safeguarding community responses to addressing HIV vulnerability, addressing confidentiality and stigma issues, ensuring services are transgender-friendly, and increasing health insurance coverage.
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Affiliation(s)
| | - Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Denpasar, Indonesia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hellen Dewi Prameswari
- HIV AIDS and STI Subdirectorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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23
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Riley ED, Vittinghoff E, Koss CA, Christopoulos KA, Clemenzi-Allen A, Dilworth SE, Carrico AW. Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco. AIDS Behav 2019; 23:2326-2336. [PMID: 31324996 PMCID: PMC7478361 DOI: 10.1007/s10461-019-02601-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine A Koss
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Samantha E Dilworth
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Abstract
Purpose of Review To update clinicians on the field of psychoneuroimmunology with respect to depression. Recent Findings A significant subset of patients with depression may have illness to which dysfunction of the immune system, typically viewed as inflammation, makes a significant contribution. Normal sickness behavior may sometimes manifest abnormally as mood episodes. Early evidence suggests that interventions that reduce inflammation may improve symptoms in these patients and that they may also respond differently to standard pharmacotherapy. Summary Treatment of patients with depression should consider inflammatory status, as part of medical and psychiatric health. Recommendations for healthy diet and exercise are important for all patients but may be more important for patients who have clinical evidence of inflammation. Methods of identifying patients in the inflammatory subgroup and treating them with therapy targeted specifically at the immune system are still experimental but likely to impact care for depression in the future.
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Affiliation(s)
- Marisa Toups
- University of Texas Dell Medical School, Department of Psychiatry, 1701 Trinity Street, Austin Tx 78712
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25
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Davis A, McCrimmon T, Dasgupta A, Gilbert L, Terlikbayeva A, Hunt T, Primbetova S, Wu E, Darisheva M, El-Bassel N. Individual, social, and structural factors affecting antiretroviral therapy adherence among HIV-positive people who inject drugs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:43-50. [PMID: 30359872 DOI: 10.1016/j.drugpo.2018.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND HIV-infected people who inject drugs (PWID) are particularly vulnerable to suboptimal ART adherence. The fastest-growing HIV epidemics globally are driven by injection drug use, but only a small percentage of HIV-positive PWID have achieved viral suppression. Virally suppressed individuals have better HIV-related health outcomes and effectively no risk of transmitting HIV to others. Hence, ART adherence is important for both HIV treatment and HIV prevention. There is a paucity of data on barriers and facilitators of ART adherence among PWID in low and middle income countries, which is problematic given the growing HIV epidemics among PWID in these countries. METHODS Using the Theory of Triadic Influence, this paper examines individual, interpersonal, and structural barriers and facilitators of ART adherence among HIV-positive PWID in four cities in Kazakhstan. Eight focus groups were conducted (two in each city) with a total of 57 participants. Data were coded and analyzed by three researchers. RESULTS We found a number of barriers and facilitators to ART adherence among PWID at the individual, interpersonal, and structural levels. Individual barriers to ART adherence include misperceptions about ART, forgetfulness due to the effects of illicit drug use, and medication side effects. Interpersonal facilitators of ART adherence include social support and good relationships with healthcare providers. Structural barriers include poverty, legal challenges, disruptions in the ART supply, and stigma and discrimination. CONCLUSION The paper highlights important factors related to ART adherence for HIV-positive PWID and identifies potential strategies for intervention efforts, including couple-based interventions, electronic reminders, linkage to drug treatment services, and patient navigation. Effectively enhancing adherence to ART among PWID will likely require multi-level approaches and strategies. Further research should be conducted on potential methods and interventions for improving ART adherence among this vulnerable population.
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Affiliation(s)
- Alissa Davis
- Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States.
| | - Tara McCrimmon
- Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Anindita Dasgupta
- Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Louisa Gilbert
- Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, 38B Shashkina Street, 3rd Floor, Almaty, 050040, Kazakhstan
| | - Timothy Hunt
- Columbia University Global Health Research Center of Central Asia, 38B Shashkina Street, 3rd Floor, Almaty, 050040, Kazakhstan
| | - Sholpan Primbetova
- Columbia University Global Health Research Center of Central Asia, 38B Shashkina Street, 3rd Floor, Almaty, 050040, Kazakhstan
| | - Elwin Wu
- Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
| | - Meruyert Darisheva
- Columbia University Global Health Research Center of Central Asia, 38B Shashkina Street, 3rd Floor, Almaty, 050040, Kazakhstan
| | - Nabila El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, United States
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