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Olashore AA, Chiliza B, Paruk S. Antiretroviral therapy non-adherence and its relationship with cognitive impairment, alcohol use disorder, and depression in adolescents living with HIV. BMC Psychiatry 2023; 23:532. [PMID: 37488527 PMCID: PMC10367307 DOI: 10.1186/s12888-023-05000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE We aimed to compare antiretroviral non-adherence in the behaviourally infected (BIAs) and congenitally infected adolescents (CIAs) and explore its associations with depression, cognitive impairment, and alcohol use disorder (AUD) in adolescents living with HIV(ALWHIV) in Botswana. METHODS This study was a cross-sectional, comparative, multi-center research that involved collecting samples from different HIV clinics in Botswana. Of the 622 ALWHIV, 223 were identified as BIAs and 399 as CIAs. They were evaluated using various tools such as MINI-KID for psychiatric disorders, DSM-5 for AUD, CAT-rapid for cognitive assessment, and Visual Analogue Scale (VAS) for non-adherence (the outcome). The data were analysed using both bivariate and multivariate regression analyses. RESULTS The participants' mean age (SD) was 17.7(1.60). The CIAs were more likely to have cognitive impairment (t -7.25; p < 0.01), while the BIAs had more depression (χ2 = 5.86; p = 0.016) and AUD (χ2 = 4.39; p = 0.036) and were more likely to be non-adherent (t = 3.14; p = 0.002). In the CIA group, cognitive impairment (AOR = 2.86; 95% CI:1.77-4.64) (AOR = 2.79; 95%CI:1.73-4.48) and depression (AOR = 2.69; 95%CI:1.48-4.90 were associated with ART non-adherence. In the BIA group, depression (AOR = 2.55; 95%CI:1.27-5.16), AUD (AOR = 2.58; 95%CI:1.21-5.49) and struggling to accept status (AOR = 2.54; 95%CI:1.41-4.56) predicted non-adherence to treatment. CONCLUSION The two groups of adolescents differ regarding ART non-adherence and associated psychosocial issues, indicating the need for differentiated care to address non-adherence in the ALWHIV, especially in high-burden, resource-constrained settings, such as Botswana.
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Affiliation(s)
- Anthony A Olashore
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Ma H, Hu Z, Wang Z, Ma Y, Zhai H, Li J. Development and Validation of a New Comprehensive Assessment Scale of HIV-Related Psychological Distress in China: A Methodological Study. J Assoc Nurses AIDS Care 2023; 34:292-306. [PMID: 37067998 DOI: 10.1097/jnc.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
ABSTRACT Instruments evaluating HIV-related psychological distress (HRPD) in people living with HIV may lack sensitivity to capture patients' psychological burden. We developed a comprehensive scale measuring HRPD and evaluated its psychometric properties. A mixed-method study was conducted from July 2021 to April 2022; it involved a literature review, semistructured interviews (n = 15), three rounds of panel discussions, two rounds of Delphi studies (n = 20), a pilot test (n = 20) to generate new scale items, and a cross-sectional survey (n = 659) to evaluate the psychometric properties of the HIV-related psychological distress scale. The scale contains 22 items across 4 subscales (i.e., disease-related distress, treatment adherence distress, identity distress, and disclosure distress). The confirmatory factor analysis revealed high goodness of fit (χ2/df = 2.412, comparative fit index = 0.916, incremental fit index = 0.917, and Tucker‒Lewis index = 0.902), showing that the HIV-related psychological distress scale is a reliable (Cronbach's α = 0.871 overall) and valid scale for evaluating HRPD in China and can be used to dynamically evaluate and monitor HRPD levels during patient follow-up.
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Affiliation(s)
- Haiqi Ma
- Haiqi Ma, MSN, RN, is a Graduate Student, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China. Zhiguang Hu, BA, is a General Practitioner, Hongshan Street Community Health Service Center, Huangpu District, Guangzhou, Guangdong, China. Zhongqing Wang, MSN, is a Social Worker, University of Chinese Academy of Sciences Education Foundation, Beijing, China. Yue Ma, MSN, RN, is a Lecturer, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China. Huimin Zhai, MSN, RN, is a Professor, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China. Juan Li, MSN, RN, is a Lecturer, School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Mundamshimu JS, Malale K, Kidenya BR, Gunda DW, Bwemelo L, Mwashiuya M, Omar SS, Mlowe N, Kiyumbi M, Ngocho JS, Balandya E, Sunguya B, Mshana SE, Mteta K, Bartlett J, Lyamuya E, Mmbaga BT, Kalluvya S. Failure to Attain HIV Viral Suppression After Intensified Adherence Counselling-What Can We Learn About Its Factors? Infect Drug Resist 2023; 16:1885-1894. [PMID: 37020794 PMCID: PMC10069435 DOI: 10.2147/idr.s393456] [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: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment. Purpose We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions. Patients and Methods This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure. Results This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18-25 years (AOR = 5.6, 95% CI, 1.1-29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13-0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3-12.3) remained the main predictors of virological failure after IAC intervention. Conclusion Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.
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Affiliation(s)
| | - Kija Malale
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson R Kidenya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Daniel W Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Logious Bwemelo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Neema Mlowe
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Magwa Kiyumbi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Kilimanjaro Christian Medical University College, Mosh, Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Samuel Kalluvya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Perrone V, Dovizio M, Sangiorgi D, Andretta M, Bartolini F, Cavaliere A, Ciaccia A, Chinellato A, Costantini A, Dell’Orco S, Ferrante F, Gentile S, Lavalle A, Moscogiuri R, Mosele E, Procacci C, Re D, Santoleri F, Roccia A, Maggiolo F, Degli Esposti L. Healthcare Resource Consumption and Related Costs in Patients on Antiretroviral Therapies: Findings from Real-World Data in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3789. [PMID: 36900813 PMCID: PMC10000772 DOI: 10.3390/ijerph20053789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This real-world analysis conducted on administrative databases of a sample of Italian healthcare entities was aimed at describing the role of therapeutic pathways and drug utilization in terms of adherence, persistence, and therapy discontinuation in HIV-infected patients under antiretroviral therapies (ART) and Tenofovir Alafenamide (TAF)-based regimens on healthcare resource consumption and related direct healthcare costs. Between 2015 and 2019, adults (≥18 years) prescribed with TAF-based therapies were identified and characterized in the year prior to the first prescription (index-date) for TAF-based therapies and followed-up until the end of data availability. Overall, 2658 ART-treated patients were included, 1198 of which were under a TAF-based regimen. TAF-based therapies were associated with elevated percentages of adherence (83.3% patients with proportion of days covered, PDC > 95% and 90.6% with PDC > 85%) and persistence (78.5%). The discontinuation rate was low in TAF-treated patients, ranging from 3.3% in TAF-switchers to 5% in naïve. Persistent patients had lower overall mean annual healthcare expenditures (EUR 11,106 in persistent vs. EUR 12,380 in non-persistent, p = 0.005), and this trend was statistically significant also for costs related to HIV hospitalizations. These findings suggest that a better therapeutic management of HIV infection might result in positive clinical and economic outcomes.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | | | | | | | - Andrea Ciaccia
- Servizio Farmaceutico Territoriale ASL Foggia, 71121 Foggia, Italy
| | | | | | | | | | - Simona Gentile
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | - Antonella Lavalle
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | | | - Elena Mosele
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 7 Pedemontana, 36061 Bassano del Grappa, Italy
| | | | | | | | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
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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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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: 2] [Impact Index Per Article: 0.5] [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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Chen C, Zhang X, Tang C, Xiao X, Tao Z, Wang H. Psychometric properties of the Chinese Version of the Readiness for Hospital Discharge Scale for people living with HIV. Int J Nurs Sci 2020; 7:220-227. [PMID: 32685620 PMCID: PMC7355158 DOI: 10.1016/j.ijnss.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/04/2019] [Accepted: 12/25/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The study was conducted to validate the reliability and factor structure of the Chinese version of the Readiness for Hospital Discharge Scale (RHDS-CH) for people living with HIV (PLWH). Methods From May 2017 to November 2017, a cross-sectional survey was performed in two AIDS inpatient departments located in two cities in Hunan, China. Reliability was evaluated by examining the internal consistency and split-half reliability of the items. A confirmatory factor analysis was performed to assess the factor structure of the RHDS-CH, and the model was revised according to the modification index. Results Cronbach’s α for the RHDS-CH was 0.912, and the split-half reliability of the total scale was 0.831. Initially, the results of the confirmatory factor analysis indicated that the sample did not fit this four-factor model and its 23 items well (χ2/df = 3, GFI =0.772, TLI = 0.823, CFI = 0.844, RMSEA = 0.100). To improve the model fit indices, we performed model modification with the guidance of modification indices. Finally, the model fit indices showed an acceptable fit to the data (χ2/df = 2.141, GFI = 0.844, TLI = 0.899, CFI = 0.915, RMSEA = 0.075). Coefficients of corrected item-total correlation of the RHDS-CH ranged from 0.435 to 0.726. Conclusion This study is the first to examine the psychometric properties of the RHDS-CH for PLWH. Our findings showed good reliability and confirmed the four-factor structure model for PLWH.
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Affiliation(s)
- Chen Chen
- School of Nursing, Central South University, Hunan, China
| | - Xiaoxia Zhang
- Nursing Faculty, Henan Medical College, Henan, China
| | - Chulei Tang
- School of Nursing, Central South University, Hunan, China
| | - Xueling Xiao
- School of Nursing, Central South University, Hunan, China
| | - Zirong Tao
- Nursing Department, Xiangya Hospital, Central South University, Hunan, China
| | - Honghong Wang
- School of Nursing, Central South University, Hunan, China
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