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The HIV Care Continuum in Small Cities of Southern New England: Perspectives of People Living with HIV/AIDS, Public Health Experts, and HIV Service Providers. AIDS Behav 2021; 25:897-907. [PMID: 33001353 DOI: 10.1007/s10461-020-03049-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
The HIV care continuum (HCC), comprised of five steps (screening, linkage to care, treatment initiation, retention, and viral suppression), is used to monitor treatment delivery to people living with HIV (PLWH). The HCC has primarily focused on large urban or metropolitan areas where the situation may differ from that in smaller cities. Three themes (i.e., knowledge, stigma, stability) that shaped HCC outcomes were identified from analysis of two qualitative studies involving HIV service providers, public health experts, and PLWH in smaller cities of southern New England. The findings suggest that enhancing HCC outcomes require a multiprong approach that targets both the individual and organizational levels and includes interventions to increase health literacy, staff communication skills, universal screening to assess patients' religiosity/spirituality and supplemental service needs. Interventions that further ensure patient confidentiality and the co-location and coordination of HIV and other healthcare services are particularly important in smaller cities.
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Hendricks L, Eshun-Wilson I, Rohwer A. A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV. Syst Rev 2021; 10:54. [PMID: 33568216 PMCID: PMC7875685 DOI: 10.1186/s13643-021-01582-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) struggle with the challenges of living with a chronic disease and integrating antiretroviral treatment (ART) and care into their daily lives. The aims of this study were as follows: (1) to undertake the first mega-aggregation of qualitative evidence syntheses using the methods of framework synthesis and (2) make sense of existing qualitative evidence syntheses that explore the barriers and facilitators of adherence to antiretroviral treatment, linkage to care and retention in care for PLHIV to identify research gaps. METHODS We conducted a comprehensive search and did all screening, data extraction and critical appraisal independently and in duplicate. We used the Kaufman HIV Behaviour Change model (Kaufman et al., 2014) as a framework to synthesise the findings using the mega-aggregative framework synthesis approach, which consists of 8 steps: (1) identify a clearly defined review question and objectives, (2) identify a theoretical framework or model, (3) decide on criteria for considering reviews for inclusion, (4) conduct searching and screening, (5) conduct quality appraisal of the included studies, (6) data extraction and categorisation, (7) present and synthesise the findings, and (8) transparent reporting. We evaluated systematic reviews up to July 2018 and assessed methodological quality, across reviews, using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. RESULTS We included 33 systematic reviews from low, middle- and high-income countries, which reported on 1,111,964 PLHIV. The methodological quality of included reviews varied considerably. We identified 544 unique third-order concepts from the included systematic reviews, which were reclassified into 45 fourth-order themes within the individual, interpersonal, community, institutional and structural levels of the Kaufman HIV Behaviour Change model. We found that the main influencers of linkage, adherence and retention behaviours were psychosocial and personal characteristics-perceptions of ART, desires, fears, experiences of HIV and ART, coping strategies and mental health issues-interwoven with other factors on the interpersonal, community, institutional and structural level. Using this approach, we found interdependence between factors influencing ART linkage, retention and adherence and identified the need for qualitative evidence that explores, in greater depth, the complex relationships between structural factors and adherence, sociodemographic factors such as community violence and retention, and the experiences of growing up with HIV in low- and middle-income countries-specifically in children, youth, women and key populations. CONCLUSIONS This is the first mega-aggregation framework synthesis, or synthesis of qualitative evidence syntheses using the methods of framework synthesis at the overview level. We found the novel method to be a transparent and efficient method for assessing the quality and making sense of existing qualitative systematic reviews. SYSTEMATIC REVIEW REGISTRATION The protocol of this overview was registered on PROSPERO ( CRD42017078155 ) on 17 December 2017.
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Affiliation(s)
- Lynn Hendricks
- Centre for Evidence-Based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Social, Methodological, Innovative, Kreative, Centre for Sociological Research, Faculty of Social Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ingrid Eshun-Wilson
- Centre for Evidence-Based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-Based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Caycho-Rodríguez T, Tomás JM, Ventura-León J, Sancho P, Cabrera-Orosco I, Barboza-Palomino M. Measurement of the will to live in older adults: Transcultural adaptation, validity and reliability of the Will-to-Live Scale. ENFERMERIA CLINICA 2020; 31:4-11. [PMID: 33012632 DOI: 10.1016/j.enfcli.2020.06.078] [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] [Received: 12/10/2019] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The Will-to-Live Scale (WTLS) is used to measure the will to live in older adults; however, there is no Spanish version. The objective of the study was to translate the WTLS into Spanish, assess its internal structure, reliability, and the correlates between WTLS and life satisfaction, resilience, and depression in older Peruvian adults. METHOD The participants were 235 Peruvian older adults (M=72.69, SD=6.68), evaluated between March to May 2019, selected through non-probability sampling. The WTLS, the Satisfaction with Life Scale (SWLS), the Brief Resilient Coping Scale (BRCS) and the Patient Health Questionnaire-2 (PHQ-2) were administered. Data analysis included reliability by internal consistency and structural equation models, specifically confirmatory factor analysis (AFC), to test the one-dimensional solution of the WTLS and the convergent validity of the WTLS at the latent level, by specifying a four-factor model (will to live, life satisfaction, resilience and depression). RESULTS Cronbach's alpha coefficient and the composite reliability index obtain values of .93 and .94, respectively. The one-dimensional structure of the WTLS was fitted to the data (χ2(5)=10,067, P=.073, CFI=.999, RMSEA=.066, SRMR=.014) and showed positive associations with the SWLS (ρ=.82), and BRCS (ρ=.86), as well as negative associations with the PHQ-2 (ρ=-.66). CONCLUSION The WTLS in Spanish presents evidence of validity and reliability to measure the will to live in Peruvian older adults.
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Affiliation(s)
| | - José M Tomás
- Departamento de Metodología de Ciencias del Comportamiento, Facultad de Psicología, Universidad de Valencia, Valencia, España
| | - José Ventura-León
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú
| | - Patricia Sancho
- Departamento de Metodología de Ciencias del Comportamiento, Facultad de Psicología, Universidad de Valencia, Valencia, España
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Hadi AM, Lee PY, Adibah HI. The implication of stigma on people living with HIV and the role of social support - A case report. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:43-45. [PMID: 32843944 PMCID: PMC7430316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.
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Affiliation(s)
- A M Hadi
- MD (UPM), MMed (Family Medicine) (UPM) Department of Family Medicine Faculty of Medicine and Health Sciences, Universiti Putra Malaysia Serdang, Selangor, Malaysia
| | - P Y Lee
- MBBS (UM), MMed (Family Medicine) (UM) Department of Family Medicine Faculty of Medicine and Health Sciences, Universiti Putra Malaysia Serdang, Selangor, Malaysia
| | - H I Adibah
- MD (USM), MMed (Family Medicine) (USM) Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Urban and Rural Differences: Unmet Needs for Symptom Management in People Living With HIV in China. J Assoc Nurses AIDS Care 2020; 30:206-217. [PMID: 30822292 DOI: 10.1097/jnc.0000000000000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Access to HIV care has increased in China, but regional disparities for the unmet symptom management needs of people living with HIV remain. Little attention has been paid to these disparities, especially in rural areas. We describe unmet symptom management needs in 1,214 people living with HIV from five HIV hospitals in the eastern coast, middle, and southern regions of China. Insomnia, abnormal dreams, and fatigue were the most common unmet needs of patients in urban China, whereas cognitive problems and blurry vision were the most common in rural China. Self-management capacity, discrimination, and symptom severity predicted more unmet symptom management needs for patients in urban areas. Medication adherence, basic function, and symptom severity predicted more unmet needs among patients in rural areas. Our results have implications for nurses in HIV care and HIV policymakers. Separate interventions targeting the urban and rural areas must be implemented to meet patient symptom management needs.
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Lee SA, Kim EY, Chang SO. A life where concealment and exposure coexist-The antiretroviral therapy adherence of people living with HIV infection: A phenomenological study. J Adv Nurs 2020; 76:1027-1036. [PMID: 32003040 DOI: 10.1111/jan.14309] [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] [Received: 11/18/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study is to identify the nature and structure of the real world experiences of people living with HIV infection and adhering to antiretroviral therapy (ART). DESIGN Giorgi's phenomenological method was applied. METHODS Data collection was conducted from 1 November 2016-1 September 2017. A total of six participants participated in the study. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this study. RESULTS The findings show that the structure of the experience of people living with HIV and adhering to ART is composed of six essential common constituents: (a) ART adherence has become a prerequisite for a normal life; (b) Endless adjustments responding to a sensitive body; (c) Dosing Time becomes the framework of the day; (d) Dosing time needing to coincide with the availability of confidential dosing space; (e) Classification of Relationships-those who know of my taking antiretroviral drugs and those who do not; and (f) Recognition of the multiple relationships affecting ART. CONCLUSION Adhering to ART is experienced by people infected with HIV not only as a process they want to hide, but also a critical lifeline that stabilizes their lives. That is, their day-to-day living is split into a double life reflecting their coexisting need for concealment and exposure. IMPACT Although much existing literature focuses on the adherence to medication, this study reveals the meaning of ART in the context of viewing the patient as an independent subject. Contrary with what people living with HIV want, they are at risk of external exposure during the process of treatment. This study highlights the need for nurses to communicate with patients about the strategies they need to meet the challenges they face.
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Affiliation(s)
- Sun-A Lee
- National Medical Center, Seoul, Republic of Korea
| | - Eun Y Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Sung O Chang
- College of Nursing, Korea University, Seoul, Republic of Korea
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Zhang C, McMahon J, Leblanc N, Braksmajer A, Crean HF, Alcena-Stiner D. Association of Medical Mistrust and Poor Communication with HIV-Related Health Outcomes and Psychosocial Wellbeing Among Heterosexual Men Living with HIV. AIDS Patient Care STDS 2020; 34:27-37. [PMID: 31755736 DOI: 10.1089/apc.2019.0200] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Studies have suggested that effective patient-provider relationships may reduce health disparities and foster engagement across the HIV care continuum among people living with HIV/AIDS. However, no studies have explored specific mechanisms between medical mistrust/poor communication and HIV-related/psychosocial health outcomes among HIV-positive men of color who have sex with women (MCSW) in the United States. From 2011 to 2012, the research team recruited 317 eligible participants in New York City. Using validated explanatory and predictive modeling strategies, we explored the associations between mistrust/poor communication and HIV-related/psychosocial health outcomes among this group. Subgroup analyses were further conducted to assess the different effects of non-Hispanic black and Hispanic men. A total of 313 males (204 black, 93 Hispanic, and 16 others) reported that valid responses were included in the current analysis. In the explanatory models, both mistrust and poor communication were negatively associated with various HIV-related and psychosocial outcomes among this group of HIV-positive MCSW. In the predictive models, predictors of mistrust for the overall sample and the black subsample were nearly the same. On the contrary, predictors of poor communication were substantially different when comparing black and Hispanic HIV-positive MCSW. Our findings confirm that patient-provider relationship quality is associated with poor HIV-related and psychosocial outcomes in black and Hispanic MCSW. A different set of multi-level predictors are associated with mistrust and poor communication comparing black and Hispanic MCSW. We call for interventions addressing patient-provider relationship quality that are tailored differently for black and Hispanic men.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Natalie Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Amy Braksmajer
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Hugh F. Crean
- School of Nursing, University of Rochester Medical Center, Rochester, New York
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Rouleau G, Richard L, Côté J, Gagnon MP, Pelletier J. Nursing Practice to Support People Living With HIV With Antiretroviral Therapy Adherence: A Qualitative Study. J Assoc Nurses AIDS Care 2019; 30:e20-e37. [PMID: 31241513 PMCID: PMC6594722 DOI: 10.1097/jnc.0000000000000103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Antiretroviral therapy (ART) management is a core competency for nursing practice in HIV as documented in best practice guidelines. Nurse-led interventions are effective in fostering ART adherence in people living with HIV (PLWH). However, these evidence-based interventions and professional expectations pertaining to these guidelines do not reflect current practice, nor do they expose the challenges faced by nurses. We conducted a qualitative exploratory study with nurses to explore their professional practices in the context of ART adherence. Sixteen nurses participated in data collection: nine in a focus group and seven in individual interviews. We identified four themes: building a therapeutic relationship with PLWH as a foundation of HIV nursing care; nursing activities to support PLWH with ART adherence; challenges faced by nurses providing ART-related care; and resource mobilization supporting nursing practice development in ART management and HIV care. Aspects of HIV nursing practice need to be strengthened to enhance best practice care, such as managing powerlessness in the context of ART nonadherence.
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Affiliation(s)
- Geneviève Rouleau
- Geneviève Rouleau, RN, MSc, is a PhD Candidate, Faculty of Nursing, Laval University, Quebec City, Quebec, Canada and is Coordinator of the Research Chair in Innovative Nursing Practices, University of Montreal Hospital Research Center, Montreal, Quebec, Canada. Lauralie Richard, RN, PhD, is a Research Fellow, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, New Zealand and an Associate Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. José Côté, RN, PhD, is the Holder of the Research Chair in Innovative Nursing Practices, Montreal; Researcher, University of Montreal Hospital Research Center, Montreal and Full Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. Marie-Pierre Gagnon, PhD, is a Full Professor, Faculty of Nursing, Laval University, Quebec City and a Researcher, University Hospital Center of Quebec-Laval University Research Center, Quebec City, Quebec, Canada. Jérôme Pelletier, RN, MSc, is a PhD Student, Faculty of Nursing, Laval University, Quebec City and Professor, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Lauralie Richard
- Geneviève Rouleau, RN, MSc, is a PhD Candidate, Faculty of Nursing, Laval University, Quebec City, Quebec, Canada and is Coordinator of the Research Chair in Innovative Nursing Practices, University of Montreal Hospital Research Center, Montreal, Quebec, Canada. Lauralie Richard, RN, PhD, is a Research Fellow, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, New Zealand and an Associate Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. José Côté, RN, PhD, is the Holder of the Research Chair in Innovative Nursing Practices, Montreal; Researcher, University of Montreal Hospital Research Center, Montreal and Full Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. Marie-Pierre Gagnon, PhD, is a Full Professor, Faculty of Nursing, Laval University, Quebec City and a Researcher, University Hospital Center of Quebec-Laval University Research Center, Quebec City, Quebec, Canada. Jérôme Pelletier, RN, MSc, is a PhD Student, Faculty of Nursing, Laval University, Quebec City and Professor, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - José Côté
- Geneviève Rouleau, RN, MSc, is a PhD Candidate, Faculty of Nursing, Laval University, Quebec City, Quebec, Canada and is Coordinator of the Research Chair in Innovative Nursing Practices, University of Montreal Hospital Research Center, Montreal, Quebec, Canada. Lauralie Richard, RN, PhD, is a Research Fellow, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, New Zealand and an Associate Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. José Côté, RN, PhD, is the Holder of the Research Chair in Innovative Nursing Practices, Montreal; Researcher, University of Montreal Hospital Research Center, Montreal and Full Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. Marie-Pierre Gagnon, PhD, is a Full Professor, Faculty of Nursing, Laval University, Quebec City and a Researcher, University Hospital Center of Quebec-Laval University Research Center, Quebec City, Quebec, Canada. Jérôme Pelletier, RN, MSc, is a PhD Student, Faculty of Nursing, Laval University, Quebec City and Professor, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Marie-Pierre Gagnon
- Geneviève Rouleau, RN, MSc, is a PhD Candidate, Faculty of Nursing, Laval University, Quebec City, Quebec, Canada and is Coordinator of the Research Chair in Innovative Nursing Practices, University of Montreal Hospital Research Center, Montreal, Quebec, Canada. Lauralie Richard, RN, PhD, is a Research Fellow, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, New Zealand and an Associate Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. José Côté, RN, PhD, is the Holder of the Research Chair in Innovative Nursing Practices, Montreal; Researcher, University of Montreal Hospital Research Center, Montreal and Full Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. Marie-Pierre Gagnon, PhD, is a Full Professor, Faculty of Nursing, Laval University, Quebec City and a Researcher, University Hospital Center of Quebec-Laval University Research Center, Quebec City, Quebec, Canada. Jérôme Pelletier, RN, MSc, is a PhD Student, Faculty of Nursing, Laval University, Quebec City and Professor, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Jérôme Pelletier
- Geneviève Rouleau, RN, MSc, is a PhD Candidate, Faculty of Nursing, Laval University, Quebec City, Quebec, Canada and is Coordinator of the Research Chair in Innovative Nursing Practices, University of Montreal Hospital Research Center, Montreal, Quebec, Canada. Lauralie Richard, RN, PhD, is a Research Fellow, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, New Zealand and an Associate Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. José Côté, RN, PhD, is the Holder of the Research Chair in Innovative Nursing Practices, Montreal; Researcher, University of Montreal Hospital Research Center, Montreal and Full Professor, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. Marie-Pierre Gagnon, PhD, is a Full Professor, Faculty of Nursing, Laval University, Quebec City and a Researcher, University Hospital Center of Quebec-Laval University Research Center, Quebec City, Quebec, Canada. Jérôme Pelletier, RN, MSc, is a PhD Student, Faculty of Nursing, Laval University, Quebec City and Professor, Université du Québec à Rimouski, Rimouski, Quebec, Canada
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Tibbels NJ, Hendrickson ZM, Naugle DA, Dosso A, Van Lith L, Mallalieu EC, Kouadio AM, Kra W, Kamara D, Dailly-Ajavon P, Cisse A, Seifert-Ahanda K, Thaddeus S, Babalola S, Hoffmann CJ. Men's perceptions of HIV care engagement at the facility- and provider-levels: Experiences in Cote d'Ivoire. PLoS One 2019; 14:e0211385. [PMID: 30897098 PMCID: PMC6428322 DOI: 10.1371/journal.pone.0211385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022] Open
Abstract
Men in sub-Saharan Africa have lower rates of HIV testing and are less likely to initiate treatment compared to women. Service delivery dimensions are a key factor in facilitating engagement along the HIV treatment continuum for men and women, yet male specific overall perceptions of the service delivery environment have received little attention in West Africa. This study draws on qualitative data collected in Côte d’Ivoire to explore provider-level and structural factors affecting men’s engagement in HIV testing and treatment through interviews and focus group discussions conducted with health workers and men living with HIV (some on ART) or whose HIV status was unknown. Factors influencing decisions to test or initiate treatment were considered in terms of perceived benefits and costs. Men described costs at the interpersonal (client-provider) level, such as unwanted disclosure or stigma, which were weighed against the potential for social support and clinical guidance. Likewise, fear of unwanted disclosure operated at the facility level, as the layout of facilities sometimes grouped clients living with HIV together. Notably, the benefits men described from engaging in HIV testing and care all operated at the interpersonal level and none at the facility level. In light of the fact that provider- and facility-level factors influenced the perceptions and experiences of men along the treatment continuum, we offer recommendations to reduce barriers to testing and engagement in care related to service delivery.
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Affiliation(s)
- Natalie Jean Tibbels
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Zoé Mistrale Hendrickson
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Danielle Amani Naugle
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Abdul Dosso
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Lynn Van Lith
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth C. Mallalieu
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anne Marie Kouadio
- Sociology Department, Félix Houphouët-Boigny University in Cocody, Abidjan, Côte d’Ivoire
| | - Walter Kra
- Sociology Department, Alassane Ouattra University, Bouaké, Côte d’Ivoire
| | - Diarra Kamara
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Patricia Dailly-Ajavon
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Adama Cisse
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Kim Seifert-Ahanda
- United States Agency for International Development, Washington, D.C., United States of America
| | - Sereen Thaddeus
- United States Agency for International Development, Abidjan, Cote d’Ivoire
| | - Stella Babalola
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Godersky ME, Saxon AJ, Merrill JO, Samet JH, Simoni JM, Tsui JI. Provider and patient perspectives on barriers to buprenorphine adherence and the acceptability of video directly observed therapy to enhance adherence. Addict Sci Clin Pract 2019; 14:11. [PMID: 30867068 PMCID: PMC6417248 DOI: 10.1186/s13722-019-0139-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/27/2019] [Indexed: 12/04/2022] Open
Abstract
Background Buprenorphine effectively reduces opioid craving and illicit opioid use. However, some patients may not take their medication as prescribed and thus experience suboptimal outcomes. The study aim was to qualitatively explore buprenorphine adherence and the acceptability of utilizing video directly observed therapy (VDOT) among patients and their providers in an office-based program. Methods Clinical providers (physicians and staff; n = 9) as well as patients (n = 11) were recruited from an office-based opioid treatment program at an urban academic medical center in the northwestern United States. Using a semi-structured guide, interviewers conducted individual interviews and focus group discussions. Interviews were digitally recorded and transcribed verbatim. Transcripts were independently coded to identify key themes related to non-adherence and then jointly reviewed in an iterative fashion to develop a set of content codes. Results Among providers and patients, perceived reasons for buprenorphine non-adherence generally fell into several thematic categories: social and structural factors that prevented patients from consistently accessing medications or taking them reliably (e.g., homelessness, transportation difficulties, chaotic lifestyles, and mental illness); refraining from taking medication in order to use illicit drugs or divert; and forgetting to take medication, especially in the setting of taking split-doses. Some participants perceived non-adherence to be less of a problem for buprenorphine than for other medications. VDOT was viewed as potentially enhancing patient accountability, leading to more trust from providers who are concerned about diversion. On the other hand, some participants expressed concern that VDOT would place undue burden on patients, which could have the opposite effect of eroding patient-provider trust. Others questioned the clinical indication. Conclusions Findings suggest potential arenas for enhancing buprenorphine adherence, although structural barriers will likely be most challenging to ameliorate. Providers as well as patients indicated mixed attitudes toward VDOT, suggesting it would need to be thoughtfully implemented.
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Affiliation(s)
- Margo E Godersky
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Andrew J Saxon
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Joseph O Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Jeffrey H Samet
- Division of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Jane M Simoni
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA.
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Arnold EM, Swendeman D, Harris D, Fournier J, Kozina L, Abdalian S, Rotheram MJ. The Stepped Care Intervention to Suppress Viral Load in Youth Living With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10791. [PMID: 30810536 PMCID: PMC6414817 DOI: 10.2196/10791] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background Among youth living with HIV (YLH) aged 12-24 years who have health care in the United States, only 30% to 40% are virally suppressed. YLH must achieve viral suppression in order to reduce the probability of infecting others as well as increasing the length and quality of their own life. Objective This randomized controlled trial aimed to evaluate the efficacy of an Enhanced Standard Care condition (n=110) compared to an Enhanced Stepped Care intervention condition (n=110) to increase viral suppression among YLH aged 12-24 years with established infection (not acutely infected). Methods YLH (N=220) who are not virally suppressed will be identified at homeless shelters, health clinics, and gay-identified community-based organizations in Los Angeles, CA, and New Orleans, LA. Informed consent will be obtained from all participants. YLH will be randomly assigned to one of two study conditions: Enhanced Standard Care, which includes standard clinical care plus an automated messaging and monitoring intervention (AMMI), or an Enhanced Stepped Care, which includes three levels of intervention (AMMI, Peer Support via social media plus AMMI, or Coaching plus Peer Support and AMMI). The primary outcome is viral suppression of HIV, and YLH will be assessed at 4-month intervals for 24 months. For the Enhanced Stepped Care intervention group, those who do not achieve viral suppression (via blood draw, viral load<200 copies/mL) at any 4-month assessment will “step up” to the next level of intervention. Secondary outcomes will be retention in care, antiretroviral therapy adherence, alcohol use, substance use, sexual behavior, and mental health symptoms. Results Recruitment for this study began in June 2017 and is ongoing. We estimate data collection to be completed by the end of 2020. Conclusions This is the first known application of an Enhanced Stepped Care intervention model for YLH. By providing the lowest level of intervention needed to achieve viral suppression, this model has the potential to be a cost-effective method of helping YLH achieve viral suppression and improve their quality of life. Trial Registration ClinicalTrials.gov NCT03109431; https://clinicaltrials.gov/ct2/show/NCT03109431 International Registered Report Identifier (IRRID) DERR1-10.2196/10791
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Affiliation(s)
- Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Harris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jasmine Fournier
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Leslie Kozina
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Susan Abdalian
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Mary Jane Rotheram
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Leblanc NM, Albuja L, DeSantis J. The Uses of Self and Space: Health Providers' Approaches to Engaging Patients into the HIV Care Continuum. AIDS Patient Care STDS 2018; 32:321-329. [PMID: 30067407 DOI: 10.1089/apc.2017.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In the context of HIV prevention, the provider-patient relationship has been found to profoundly impact HIV screening, patient initiation into HIV care, and adherence to medication following an HIV diagnosis. Given the importance of the provider-patient relationship, insight into provider approaches to cultivate such relationships is essential. Such insight could highlight considerations for provider engagement with patients that can address the current challenges in HIV prevention and treatment. This qualitative descriptive study sought to describe current health providers' approaches to engage patients into the HIV care continuum (HCC). Findings from the content and thematic analysis indicated that health providers (N = 22) used various approaches to engage patients/clients into HIV screening, and subsequent HIV care. Approaches were represented by an interpersonal process and a thematic analysis revealed the nuances in the approaches that manifested in the following themes: uses of self, normalizing disease, and engaging couples. This study demonstrated the importance for health providers to be aware of the specific context of patient's vulnerability to HIV infection and barriers to care. Self-awareness and the capability to self-reflect on one's personal practice also helped to ensure engagement of those vulnerable to infection or infected with HIV into the HCC.
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Affiliation(s)
| | - Laura Albuja
- Department of Pediatrics, School of Medicine, Pediatric Mobile Clinic, University of Miami, Miami, New York
| | - Joseph DeSantis
- School of Nursing and Health Sciences, University of Miami, Miami, New York
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13
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Engler K, Lènàrt A, Lessard D, Toupin I, Lebouché B. Barriers to antiretroviral therapy adherence in developed countries: a qualitative synthesis to develop a conceptual framework for a new patient-reported outcome measure. AIDS Care 2018; 30:17-28. [PMID: 29719990 DOI: 10.1080/09540121.2018.1469725] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Suboptimal adherence to antiretroviral therapy (ART) remains common. Patient-centered tools are needed to comprehensively assess adherence barriers in HIV clinical practice. Thus, we conducted a research synthesis to produce a conceptual framework for a new patient-reported outcome measure (PRO) for use in routine HIV care in Canada and France. A PRO's conceptual framework graphically represents the concepts to be measured and the potential relationships between them. Towards ensuring the framework's relevance to the target populations' concerns, qualitative studies with HIV-positive adults on barriers to ART adherence in developed countries were synthesized with thematic analysis, attending to the cross-study prevalence and interrelationships of barrier themes. In March 2016, searches within Medline, PsychINFO, and Embase produced 5,284 records. Two reviewers determined the final sample (n = 41). Analysis generated three levels of ART adherence barrier themes. Twenty Level 2 themes and their component subthemes (Level 3) were organized into 6 higher-order themes (Level 1): Cognitive and emotional aspects (100% of studies contributing content -prevalence), Lifestyle factors (95%), Social and material context (95%), Characteristics of ART (90%), Health experience and state (73%), and Healthcare services and system (66%). As to interrelationships, study authors articulated relationships between all higher-order themes (Level 3). Linkages between Level 2 barrier themes showed great variability, from 21% to 95%. Overall, this synthesis contributes an exceptionally detailed conceptual framework and report of ART adherence barriers, applicable to a wide range of PLHIV. It suggests that a key to understanding many barriers is through their interconnections. It also identifies gaps in barrier research. Concerning the new PRO's development, comprehensiveness will need to be weighed against other concerns (e.g., respondent burden) and the provision of barrier-specific guidance for clinically addressing its scores seems essential.
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Affiliation(s)
- Kim Engler
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - Andras Lènàrt
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - David Lessard
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - Isabelle Toupin
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada
| | - Bertrand Lebouché
- a Department of Family Medicine , McGill University , Montreal , QC , Canada.,b Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials , Montreal , QC , Canada.,c Center for Outcomes Research & Evaluation , Research Institute, McGill University Health Centre (MUHC) , Montreal , QC , Canada.,d Chronic Viral Illness Service , Royal Victoria Hospital, MUHC , Montreal , QC , Canada
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14
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Michlig GJ, Westergaard RP, Lam Y, Ahmadi A, Kirk GD, Genz A, Keruly J, Hutton H, Surkan PJ. Avoidance, meaning and grief: psychosocial factors influencing engagement in HIV care. AIDS Care 2018; 30:511-517. [PMID: 29338328 DOI: 10.1080/09540121.2018.1425366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although the introduction of antiretroviral therapy has rendered HIV a chronic illness, inconsistent engagement in HIV care by key populations limits its public health impact. Poor engagement in care is especially prevalent among vulnerable populations with mental health and substance use disorders. Beyond structural and health system considerations, psychosocial factors may present challenges to sustained engagement. We conducted a qualitative study using in-depth interviews with 31 primarily African American, urban-based individuals, many with past or current drug use and mental disorders, living with HIV. Participants identified several psychosocial barriers that detract from their motivation to attend appointments and take medication. These included mental distress or detachment over a lack of purpose in life; denial about the need to be engaged in care; insufficient trust in the efficacy of care or the health system; deaths of loved ones leading to bereavement or loss of social support; and engagement in specific avoidance behaviors like drugs and alcohol. The study findings suggest that more comprehensive HIV care, which integrates mental health and substance abuse services in order to enhance meaning and address coping and grief, may be important. Considering these services in addition to improving the logistical components of care such as cues/reminders, accessibility, and patient-provider communication may improve intervention packages.
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Affiliation(s)
- Georgia J Michlig
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ryan P Westergaard
- b University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Yukyan Lam
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Azal Ahmadi
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Gregory D Kirk
- a International Health , Johns Hopkins University , Baltimore , MD , USA.,c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Andrew Genz
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Jeanne Keruly
- c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Heidi Hutton
- c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Pamela J Surkan
- a International Health , Johns Hopkins University , Baltimore , MD , USA
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