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Mwangwa F, Charlebois ED, Ayieko J, Olio W, Black D, Peng J, Kwarisiima D, Kabami J, Balzer LB, Petersen ML, Kapogiannis B, Kamya MR, Havlir DV, Ruel TD. Two or more significant life-events in 6-months are associated with lower rates of HIV treatment and virologic suppression among youth with HIV in Uganda and Kenya. AIDS Care 2023; 35:95-105. [PMID: 35578398 PMCID: PMC9666617 DOI: 10.1080/09540121.2022.2052260] [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: 07/19/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
Youth living with HIV in sub-Saharan Africa have poor HIV care outcomes. We determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15-24 years living with HIV in rural Kenya and Uganda. This was a cross-sectional analysis of 995 youth enrolled in the SEARCH Youth study. At baseline, providers assessed recent (within 6 months) life-events, defined as changes in schooling/employment, residence, partnerships, sickness, incarceration status, family strife or death, and birth/pregnancy, self-reported alcohol use, being a parent, and HIV-status disclosure. We examined the frequencies of events and their association with ART status and HIV viral suppression (<400 copies/ul). Recent significant life-events were prevalent (57.7%). Having >2 significant life-events (aOR = 0.61, 95% CI:0.45-0.85) and consuming alcohol (aOR = 0.61, 95% CI:0.43-0.87) were associated with a lower odds of HIV viral suppression, while disclosure of HIV-status to partner (aOR = 2.39, 95% CI:1.6-3.5) or to family (aOR = 1.86, 95% CI:1.3-2.7), being a parent (aOR = 1.8, 95% CI:1.2-2.5), and being single (aOR = 1.6, 95% CI:1.3-2.1) had a higher odds. This suggest that two or more recent life-events and alcohol use are key barriers to ART initiation and achievement of viral suppression among youth living with HIV in rural East Africa.Trial registration: ClinicalTrials.gov identifier: NCT03848728..
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Affiliation(s)
| | - Edwin D. Charlebois
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Winter Olio
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Douglas Black
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Peng
- University of California, San Francisco, San Francisco, California, United States of America
| | | | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Laura B. Balzer
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Maya L. Petersen
- University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health, Bethesda, Maryland, United States of America
| | - Moses R. Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V. Havlir
- University of California, San Francisco, San Francisco, California, United States of America
| | - Theodore D. Ruel
- University of California, San Francisco, San Francisco, California, United States of America
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Ashaba S, Cooper-Vince C, Maling S, Satinsky EN, Baguma C, Akena D, Nansera D, Bajunirwe F, Tsai AC. Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100094. [PMID: 34841384 PMCID: PMC8623847 DOI: 10.1016/j.jadr.2021.100094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Childhood trauma is associated with mental health problems among adolescents living with HIV (ALHIV) in sub-Saharan Africa, but little is known about potential moderating factors. METHODS We enrolled 224 ALHIV aged 13-17 years and collected information on childhood trauma, major depressive disorder, and suicidality. We used modified multivariable Poisson regression to estimate the association between the mental health outcome variables and childhood trauma, and to assess for effect modification by social support. RESULTS Major depressive disorder had a statistically significant association with emotional abuse (adjusted relative risk [ARR] 2.57; 95% CI 1.31-5.04; P=0.006) and physical abuse (ARR 2.16; 95% CI 1.19-3.89; P=0.01). The estimated association between any abuse and major depressive disorder was statistically significant among those with a low level of social support (ARR 4.30; 95% CI 1.64-11.25; P=0.003) but not among those with a high level of social support (ARR 1.30; 95% CI 0.57-2.98; P=0.52). Suicidality also had a statistically significant association with emotional abuse (ARR 2.03; 95% CI 1.05-3.920; P=0.03) and physical abuse (ARR 3.17; 95% CI 1.60-6.25.; P=0.001), but no differences by social support were noted. LIMITATIONS Corporal punishment is used widely in schools and homes as a form of discipline in Uganda; this cultural practice could have biased reporting about physical abuse. CONCLUSIONS Childhood trauma is associated with poor mental health among ALHIV, but its effects may be moderated by social support. More research is needed to develop social support interventions for ALHIV with adverse childhood experiences for improved mental health outcomes.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | | | - Samuel Maling
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Emily N. Satinsky
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Charles Baguma
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere College of Health Sciences, Makerere, Uganda
| | - Denis Nansera
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Psychiatry, Mbarara University Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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3
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Adeyemo S, Adeosun II, Ogun OC, Adewuya A, David AN, Adegbohun AA, Adejumo O, Ogunlowo OA, Adeyemo OO. Depression and suicidality among adolescents living with human immunodeficiency virus in Lagos, Nigeria. Child Adolesc Psychiatry Ment Health 2020; 14:31. [PMID: 32818041 PMCID: PMC7427997 DOI: 10.1186/s13034-020-00337-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nigeria is considered to have the second highest number of people living with human immunodeficiency virus (HIV) worldwide with a national HIV infection prevalence of 5.2% in children and adolescents. Adolescents with HIV-infection have been reported to be more prone to developing comorbid emotional difficulties including depression and suicidality compared to those without HIV-infection. This study is aimed at determining the prevalence and correlates of depression and suicidality in adolescents living with HIV infection. METHODS Through a consecutive sampling method, two hundred and one adolescents attending HIV outpatient clinics in two tertiary hospital (Lagos state University Teaching Hospital and Nigerian Institute of Medical Research) were recruited. Confidentiality was assured and maintained. Suicidality and Depression were assessed with their corresponding modules in Mini International Neuropsychiatric Interview for children and adolescents (MINI-Kid) by researcher, while the independent variables were assessed using self-administered questionnaires. Data was analyzed with Statistical Package for Social Science version 20. RESULT The prevalence of current and lifetime major depressive episode, and suicidality were 16.9%, 44.8% and 35.3% respectively. Female gender, decreased cluster of differentiation 4 (CD4) count and high adverse childhood experience (ACE), were significantly associated with current depressive episode, while poor social support, high ACE, physical abuse, contacting HIV infection after birth and disclosure of status, were associated with lifetime major depressive episode. Factors associated with suicidality were high ACE score, physical abuse, and emotional abuse. After logistic regression analysis; gender, high ACE and CD4 level were independently associated with current major depression, while only poor social support and contracting HIV infection after birth, were independently associated with lifetime major depression. There was a positive correlation between suicidality and depression. CONCLUSION The presence of high rate of depression and suicidality among adolescents living with HIV-infection in the current study clearly shows the need for regular psychological assessment in these group of adolescents, and thus a strong indication for a multidisciplinary management in them.
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Affiliation(s)
- Suraju Adeyemo
- Synapse Services, Number 60 Babapomile Street, Onipetesi Estate, Mangoro, Lagos, Nigeria
| | - Increase I. Adeosun
- grid.442581.e0000 0000 9641 9455Department of Medicine Benjamin Carson Snr. School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | | | - Abiodun Adewuya
- grid.411276.70000 0001 0725 8811Department of Behavioral Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Agatha Nkiru David
- grid.416197.c0000 0001 0247 1197Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Olurotimi Adejumo
- grid.412438.80000 0004 1764 5403University College Hospital Ibadan, Lagos, Nigeria
| | | | - Oluwatosin Oluwaseun Adeyemo
- grid.411276.70000 0001 0725 8811Department of Hematology, Lagos State University College of Medicine, Lagos, Nigeria
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4
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Moitra E, Anderson BJ, Herman DS, Hayaki J, Pinkston MM, Kim HN, Stein MD. Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C. AIDS Care 2020; 32:1238-1245. [PMID: 32098484 DOI: 10.1080/09540121.2020.1734177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Lifespan Physicians Group, Providence RI, USA
| | - H Nina Kim
- Department of Global Health, University of Washington, Seattle WA, USA.,Department of Medicine, University of Washington, Seattle WA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
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5
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Armistead LP, Marelich WD, Schulte MT, Gilbert M, Murphy DA. HIV and Mother-Child Conflict: Associations with Mother's Mental and Physical Health. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2019; 36:621-629. [PMID: 31673198 PMCID: PMC6822983 DOI: 10.1007/s10560-019-00601-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Maternal illness is a stressor that can disrupt family processes and contribute to negative child outcomes, and researchers have considered family variables that mediate or moderate the maternal illness-child outcome relationship. Through reliance on a diverse sample (ethnically and racially, as well as geographically), the current study expands prior literature with a focus on parent-child conflict. Specifically, associations between aspects of HIV positive mothers' illness and mother-child conflict were explored. One goal of the study was to determine if there were direct or indirect associations with aspects of mothers' HIV and mother-child conflict. HIV-positive mothers (N = 136) provided CD4 count and completed measures assessing their perceived level of physical functioning, depressive symptoms, HIV health-related anxiety, and mother-child conflict with their healthy school-age children. Path analysis considered the pattern of relationships across variables. Results showed maternal vitality and depressive symptoms were directly associated with mother-child conflict. CD4 cell count and health-related anxiety operated indirectly through maternal depressive symptoms. Mediation analyses further assessed the influence of maternal CD4 cell count on mother-child conflict behavior; results indicated an indirect effect was mediated by vitality. HIV health-related anxiety and vitality separately showed indirect effects on mother-child conflict, mediated by maternal depressive symptoms. These findings are the first to focus on mother-child conflict among children affected by maternal HIV and highlight the need for screening and intervention to address depressive symptoms among HIV-positive mothers.
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Affiliation(s)
- Lisa P Armistead
- 100 Auburn Avenue, Suite 308, Georgia State University, 404.413.2091, , Telephone: 404.413.2091
| | | | | | | | - Debra A Murphy
- Univ. of California-Los Angeles, , Telephone: 619.955.8433
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6
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Ogbonna IF, Emodi IJ, Ikefuna AN, Ojinnaka NC. Prevalence and Pattern of Psychosocial Disorders among Caregivers of HIV-infected Children in Enugu, South-Eastern Nigeria. J Trop Pediatr 2019; 65:107-113. [PMID: 29912465 DOI: 10.1093/tropej/fmy019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nigeria has the highest burden of paediatric HIV in the world. HIV infection may result in significant life stressors, on both the infected children and their caregivers. METHODS This included a hospital-based cross-sectional and comparative study. Subjects and controls who met the inclusion criteria were enrolled consecutively. Their socio-demographic variables were obtained and GHQ-28 was used to assess their psychosocial status. RESULTS A total of 154 caregivers of HIV-infected children (subjects) and 154 caregivers of HIV-negative children (controls) were enrolled into this study. In total, 42 (27.3%) and 112 (72.7%) of the subjects were males and females, respectively, compared with 37 (24.0%) and 117 (76.0%) of the controls, respectively. The prevalence of psychosocial disorders among the subjects and controls was 39 and 2.6%, respectively (p < 0.001; odds ratio: 23.936). The patterns of psychosocial disorders among the caregivers of HIV-infected children were somatic symptoms (85%), anxiety/insomnia (80%), social dysfunction (63.3%) and severe depression (48.3%). CONCLUSION There is a high prevalence of psychosocial disorders among caregivers of HIV-infected children.
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Affiliation(s)
- I F Ogbonna
- Department of Paediatrics, Federal Medical Centre, Umuahia, Nigeria
| | - I J Emodi
- Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - A N Ikefuna
- Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - N C Ojinnaka
- Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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7
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Youth-friendly services and differentiated models of care are needed to improve outcomes for young people living with HIV. Curr Opin HIV AIDS 2019; 13:249-256. [PMID: 29432230 DOI: 10.1097/coh.0000000000000454] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Outcomes among young people living with HIV (YPLWH) remain disturbingly poor. We summarize recent research on youth-friendly services (YFS) and adolescent-specific differentiated care models, which may improve outcomes across the HIV care continuum for this vulnerable population. We further emphasize unique complexities that characterize the transition from childhood through adolescence to adulthood which must be considered when caring for YPLWH. RECENT FINDINGS Studies suggest that YFS may improve outcomes in some but not all steps of the HIV care continuum. However, generalizability is compromised by the limited numbers of studies, frequent use of nonequivalent comparison groups, small sample sizes and/or short follow-up. Reproducibility and scale-up are further hindered by lack of insufficient details on operational aspects of YFS, an effective minimum package of YFS and contextual factors that may facilitate adoption of YFS. Differentiated models of care for YPLWH are in very early stages of development with positive preliminary outcomes, but most pilot models focus only on stable patients on antiretroviral therapy. SUMMARY YFS and adolescent-specific differentiated models of care are needed to improve health outcomes among YPLWH, but scale-up should be guided by rigorous research and address the unique complexities that characterize the vulnerable period of adolescence.
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8
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Bergamaschi A, d'Arripe-Longueville F, Gray LL, Colson SS, Goujard C, Ferez S, Rouanet I, Durant J, Rosenthal E, Pradier C, Duracinsky M, Schuft L. Perceived HIV-related physical fatigue, sociodemographic characteristics and physical activity: A cross-sectional study. J Clin Nurs 2019; 28:2147-2156. [PMID: 30667107 DOI: 10.1111/jocn.14793] [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] [Received: 02/02/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To get a deeper understanding of correlates of perceived HIV-related fatigue by exploring its associations with sociodemographic characteristics and physical activity level of HIV-infected people. BACKGROUND Previous studies on HIV-related fatigue have mainly focused on physiological and psychological characteristics, but few have considered its associations with sociodemographic variables. In addition, while physical activity has been found to reduce acute fatigue among HIV-infected people, its links with chronic HIV-related fatigue remain to be explored. DESIGN The study employed an observational and cross-sectional survey design. The manuscript was organised according to STROBE guidelines. METHOD A total of 560 people living with HIV in France completed a measure of perceived physical fatigue using the Fatigue Intensity Scale. The predictors targeted sociodemographic characteristics and two measures of individuals' reported level of physical activity. Data were analysed by a stepwise multiple regression model. RESULTS The results showed that lower age, higher physical activity level and socio-economic status were significantly associated with reduced perceived physical fatigue, explaining 25% of the variance. CONCLUSIONS The results highlighted the importance of considering sociodemographic and lifestyle characteristics to better characterise HIV-related fatigue, in particular in an era where HIV as a chronic illness challenges questions of quality of life throughout increasingly longer lifespans. RELEVANCE TO CLINICAL PRACTICE The results of this study have implications for HIV care professionals in terms of improving strategies for managing chronic fatigue or promoting physical activity according to more specific profiles of HIV-infected people.
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Affiliation(s)
| | | | | | | | - Cecile Goujard
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France
| | - Sylvain Ferez
- Laboratory Health, Education, Handicap Situations (EA 4614 SANTESIH), University of Montpellier, Montpellier, France
| | - Isabelle Rouanet
- Department of Infectious Diseases, Hospital of Nîmes, Nîmes, France
| | - Jacques Durant
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Eric Rosenthal
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Christian Pradier
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Public Health, Université Côte d'Azur, CHU, Nice, France
| | - Martin Duracinsky
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France.,Patient-Centered Outcomes Research (EA 7334 REMES), University of Paris-Diderot, Paris, France
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9
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Smith R, Huo Y, Tassiopoulos K, Rutstein R, Kapetanovic S, Mellins C, Kacanek D, Malee K, Yogev R, Ann Sanders M, Malee K, Hunter S, Shearer W, Paul M, Cooper N, Harris L, Purswani M, Baig MM, Villegas A, Puga A, Navarro S, Garvie PA, Blood J, Burchett SK, Karthas N, Kammerer B, Wiznia A, Burey M, Shaw R, Auguste R, Dieudonne A, Bettica L, Johnson J, Chen JS, Bulkley MG, Ivey L, Grant M, Knapp K, Allison K, Wilkins M, Russell-Bell J, Acevedo-Flores M, Rios H, Olivera V, Silio M, Gabriel M, Sirois P, Spector SA, Norris K, Nichols S, McFarland E, Cagwin E, Barr E, Katai A, Scott G, Alvarez G, Fernandez G, Cuadra A. Mental Health Diagnoses, Symptoms, and Service Utilization in US Youth with Perinatal HIV Infection or HIV Exposure. AIDS Patient Care STDS 2019; 33:1-13. [PMID: 30601062 DOI: 10.1089/apc.2018.0096] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Youth perinatally HIV infected (PHIV) or HIV exposed, but uninfected (PHEU), are aging into adolescence and adulthood with multiple complex risk factors for mental health (MH) problems and poor MH treatment utilization. Our aims were to estimate prevalence of MH diagnoses, clinically significant symptoms, and MH treatment utilization among youth with PHIV and among PHEU youth, 10-22 years old. We also aimed to identify correlates of diagnoses and treatment utilization. Analyses of data from standardized interviews, behavioral assessments, and chart review of 551 youth revealed that 36% had a previous or current MH diagnosis, with no significant HIV status group differences. Prevalence of clinically significant symptoms was 15% for both groups, of whom a third had no diagnosis, and half were not receiving treatment. Among youth with a current MH diagnosis, those with PHIV had greater utilization of services than PHEU youth (67% vs. 51%; p = 0.04). Factors associated with MH diagnoses and/or treatment utilization included caregiver characteristics, age and sex of child, HIV status, and stressful life events. Prevalence of MH diagnoses was higher than in the general population, but lower than in similar perinatally HIV-exposed cohorts, with some unmet service needs, particularly in PHEU youth. Family characteristics warrant careful consideration in early diagnosis and treatment of MH problems among youth affected by HIV.
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Affiliation(s)
- Renee Smith
- Department of Pediatrics, University of Illinois at Chicago Children's Hospital, Chicago, Illinois
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suad Kapetanovic
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California
| | - Claude Mellins
- Department of Psychiatry and Sociomedical Sciences, Columbia University, New York, New York
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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10
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Biraguma J, Mutimura E, Frantz JM. Health-related quality of life and associated factors in adults living with HIV in Rwanda. SAHARA J 2018; 15:110-120. [PMID: 30200815 PMCID: PMC6136357 DOI: 10.1080/17290376.2018.1520144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In Rwanda, as in other sub-Saharan African (SSA) countries, life expectancy of people living with HIV (PLWH) has increased dramatically as a result of combined antiretroviral therapy (cART). People living with HIV can now live longer but with increasing rates of non-communicable diseases (NCDs). Thus, prevention of NCD comorbidities in PWLHI is crucial to maintain and gain health-related benefits and to maximise the health-related quality of life (HRQOL) in the long-term management of PLWH. This study determines the association between physical and mental health-related dimensions of quality of life (QOL) with behavioural and biological risk factors, after controlling socio-demographic and HIV-related factors in adults living with HIV in Rwanda. A cross-sectional study using the WHO STEPwise approach and Kinyarwanda version of the MOS-HIV Health Survey, risk factors for NCDs and HRQOL were analysed for 794 PLWH, both HIV+ on ART and ART-naïve. Multiple regression analysis was used to examine the relationship between CMD risk factors and physical health and mental health summary scores. A total of 794 participants were interviewed. The mean age of the sample was 37.9 (±10.8) years and the majority of the participants were women (n = 513; 64.6%). About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits while 26.1% reported being physically inactive. 18.4% were overweight 43.4% had abdominal obesity, i.e. waist-hip-ratio (WHR) ≥0.95 in males and 0.85 in females. High blood pressure (HBP), i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. The results reveal that mean physical health summary and mental health summary score values were 63.96 ± 11.68 and 53.43 ± 10.89, respectively. While participants indicated that tobacco users and those who had abdominal obesity reported poor mental HRQOL, physical inactivity and hypertension have a negative impact on physical HRQOL. In addition, certain socio-demographic and HIV-related variables - specifically being unmarried, lack of HIV disclosure and low CD4 count (less 350 cell counts /mm3) - were associated with significantly lower mental and physical dimensions of quality of life. The results of this study reveal that behavioural and biological risk factors for NCDs were significantly associated with a lower HRQOL. These research findings also suggest that the assessment of the association between behavioural and biological risk factors for NCDs and a HRQOL provides opportunities for targeted counselling and secondary prevention efforts, so that health care providers can implement strategies that have a significant impact on the HRQOL.
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Affiliation(s)
- Juvenal Biraguma
- a College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda.,b Faculty of Community and Health Sciences , University of the Western Cape , Cape Town , South Africa
| | - Eugene Mutimura
- a College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda.,c Regional Alliance for Sustainable Development (RASD) , Kigali , Rwanda
| | - José M Frantz
- b Faculty of Community and Health Sciences , University of the Western Cape , Cape Town , South Africa
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11
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Reif LK, Rivera V, Bertrand R, Rouzier V, Kutscher E, Walsh K, Charles B, Pape JW, Fitzgerald DW, Koenig SP, McNairy ML. Outcomes across the tuberculosis care continuum among adolescents in Haiti. Public Health Action 2018; 8:103-109. [PMID: 30271725 PMCID: PMC6147066 DOI: 10.5588/pha.18.0021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) clinic, Port-au-Prince, Haiti. Objective: To evaluate tuberculosis (TB) care continuum outcomes among adolescents. Design: Among a retrospective cohort of 10-24 year olds diagnosed with active TB, we report completion of the following steps of the TB care continuum stratified by human immunodeficiency virus (HIV) status: diagnosis of microbiologically confirmed TB, initiation of anti-tuberculosis treatment, retention in care at 2 months on anti-tuberculosis treatment, and TB treatment success. Factors associated with attrition at each step were identified using multivariable regression. Results: A total of 1005 adolescents were diagnosed with active TB; 74 (7%) were HIV-positive at the time of TB diagnosis. HIV-positive patients had poorer outcomes than non-HIV-infected patients: 73% vs. 85% initiated anti-tuberculosis treatment (P < 0.01), 46% vs. 74% were retained in care at 2 months (P < 0.01), and 41% vs. 68% achieved TB treatment success (P < 0.01). Among those who initiated treatment, same-day initiation resulted in less treatment failure. Attrition before treatment initiation was associated with female sex and HIV coinfection. Attrition after treatment initiation was associated with age ⩾16 years and HIV coinfection. Conclusion: Outcomes across the TB care continuum are suboptimal among adolescents, with only two thirds of patients achieving treatment success. Interventions tailored to adolescents are needed to improve retention in care, particularly for those who are co-infected with HIV.
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Affiliation(s)
- L K Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - V Rivera
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - R Bertrand
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - V Rouzier
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - E Kutscher
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - K Walsh
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - B Charles
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - J W Pape
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - D W Fitzgerald
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
| | - S P Koenig
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M L McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Schulte MT, Marelich WD, Payne DL, Tarantino N, Armistead LP, Murphy DA. Validation of a brief measure of HIV health-related anxiety among women living with HIV. Res Nurs Health 2018; 41:10.1002/nur.21876. [PMID: 29862527 PMCID: PMC6557685 DOI: 10.1002/nur.21876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/21/2018] [Indexed: 11/08/2022]
Abstract
Anxiety symptoms related to health are often present in populations coping with chronic illness, and among women living with HIV (WLWH), anxiety has been linked to a range of negative outcomes. This paper describes the validation of a four-item instrument designed to measure health-related anxiety (HRA) in WLWH by assessing the impact of thinking about HIV status and health on difficulty sleeping, lack of appetite, reduced desire to socialize, and difficulty concentrating at school or work. The scale was administered to 238 adult WLWH across three studies. Exploratory factor analysis revealed a one-factor solution; multi-group confirmatory factor invariance analyses supported the single factor model. For construct and criterion validity, correlations between the HRA scale and validated instruments measuring psychological, psychosocial, and physical distress were as predicted. Results support the validity of the HRA scale among WLWH as a brief measure of anxiety related to HIV status and health.
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Affiliation(s)
- Marya T. Schulte
- University of California, Integrated Substance Abuse Programs, Los Angeles, California
| | | | - Diana L. Payne
- University of California, Integrated Substance Abuse Programs, Los Angeles, California
| | | | - Lisa P. Armistead
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Debra A. Murphy
- University of California, Integrated Substance Abuse Programs, Los Angeles, California
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Brick LAD, Nugent NR, Kahana SY, Bruce D, Tanney MR, Fernández MI, Bauermeister JA. Interaction Effects of Neighborhood Disadvantage and Individual Social Support on Frequency of Alcohol Use in Youth Living with HIV. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:276-284. [PMID: 29400400 DOI: 10.1002/ajcp.12227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Youth living with HIV (YLH) experience multiple disease-related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual- and neighborhood-level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood-specific data were compiled from the 2010 U.S. Census Bureau and matched with individual-level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non-Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross-level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.
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Affiliation(s)
- Leslie Ann D Brick
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole R Nugent
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL, USA
| | - Mary R Tanney
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Isabel Fernández
- College of Osteopathic Medicine, Nova Southeastern University, Davis, FL, USA
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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14
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Xu JF, Ming ZQ, Zhang YQ, Wang PC, Jing J, Cheng F. Family support, discrimination, and quality of life among ART-treated HIV-infected patients: a two-year study in China. Infect Dis Poverty 2017; 6:152. [PMID: 29157301 PMCID: PMC5697335 DOI: 10.1186/s40249-017-0364-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background By September 2016, approximately 653,865 people in China were living with HIV/AIDS (PLWHA) and 492,725 people were receiving antiretroviral therapy (ART). PLWHA frequently experience discrimination in all domains of their personal and social lives. The World Health Organization includes discrimination in its list of social determinants of health factors that have been linked to poor physical and psychological health. This paper identifies the family support enjoyed and discrimination faced by people infected with HIV and examines the effect they have on patients’ quality of life (QOL) as they undergo ART in China. Methods We conducted this observational cohort study of ART-treated patients with HIV in Guangxi Province using a questionnaire survey at baseline, 6, 12, and 24 months, starting in 2010. Descriptive analysis was used to describe the demographic characteristics (e.g., age, sex, educational level, marital status, and employment status) of participants. Generalized estimating equations (GEE) were employed to examine the relationships between family support, discrimination, and QOL. Results In the study, 90.4% (n = 281) of patients received family support at baseline, here defined as the initiation of ART, 91.8% (n = 244) received family support 6 months into ART, 95.5% (n = 220) at 12 months, and 94.3% (n = 230) at 24 months. The proportion of patients who did not feel discriminated against by their families was 87.2% (n = 274) at baseline, 90.4% (n = 229) 6 months into ART, 90.0% (n = 210) at 12 months, and 94.5% (n = 219) at 24 months. Patients’ overall QOL scores were positively associated with having received family support (OR = 2.74, P = 0.040, 95% CI: 1.68–4.47), not feeling discriminated against by their families (OR = 1.3, P = 0.041, 95% CI: 1.07–1.59) or discrimination from patients themselves, including never experiencing fear of abandonment by family (OR = 2.05, P = 0.025, 95% CI: 1.49–2.82). Conclusions Family support along with no or minimal discrimination was found to contribute to QOL among people infected with HIV. Their overall QOL tended to improve significantly as ART continued. This suggests that strategies meant to improve and strengthen family support, care for PLWHA, and promote HIV screening among high-risk populations should be explored by both policy makers and researchers. Electronic supplementary material The online version of this article (10.1186/s40249-017-0364-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Fang Xu
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Zhong-Qiang Ming
- Fukangda Health International Science & Technology, Beijing, China
| | - Yu-Qian Zhang
- The Paul H. Nitze School of Advanced International Studies, The Johns Hopkins University, Baltimore, USA
| | - Pei-Cheng Wang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China.,Department of Sociology, Tsinghua University, Beijing, China
| | - Feng Cheng
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China. .,Center for Global Health and Infectious Diseases of Tsinghua University, Beijing, China.
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15
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Folayan MO, Cáceres CF, Sam-Agudu NA, Odetoyinbo M, Stockman JK, Harrison A. Psychological Stressors and Coping Strategies Used by Adolescents Living with and Not Living with Hiv Infection in Nigeria. AIDS Behav 2017; 21:2736-2745. [PMID: 27605363 DOI: 10.1007/s10461-016-1534-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Little is known about stressful triggers and coping strategies of Nigerian adolescents and whether or not, and how, HIV infection modulates these sources of stress and coping. This study evaluated differences in stressors and coping strategies among Nigerian adolescents based on HIV status. We analysed the data of six hundred 10-19 year old adolescents recruited through a population-based survey from 12 States of Nigeria who self-reported their HIV status. Data on stressors and coping strategies were retrieved by self-report from participants, using a validated structured questionnaire. We compared results between adolescents with and without HIV with respect to identification of specific life events as stressors, and use of specific coping strategies to manage stress. Logistic regression analysis adjusted for age and sex. Adolescents living with HIV (ALHIV) had significantly increased odds of identifying 'having to visit the hospital regularly' (AOR: 5.85; 95 % CI: 2.11-16.20; P = 0.001), and 'having to take drugs regularly' (AOR: 9.70; 95 % CI: 4.13-22.81; P < 0.001) as stressors; and 'Seeking social support' (AOR: 3.14; 95 % CI: 1.99-4.93; p < 0.001) and 'using mental disengagement' (OR: 1.64; 95 % CI: 0.49-1.84; p = 0.001) as coping strategies. Adolescents not living with HIV had significantly increased odds of identifying 'argument with a friend or family member' as a stressor (AOR: 6.59; 95 % CI: 3.62-11.98; P < 0.001). Life events related to adolescents' HIV positive status were significant stressors for ALHIV. Providing targeted psychosocial support could help reduce the impact of such HIV status-related stressors on ALHIV.
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Affiliation(s)
- Morenike O Folayan
- Institute of Public Health and Department of Child Dental Health, Obafemi Awolowo University, 22005, Ile-Ife, Nigeria.
| | - Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nadia A Sam-Agudu
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland Baltimore, Baltimore, USA
| | | | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, La Jolla, San Diego, CA, 92093, USA
| | - Abigail Harrison
- Population Studies and Training Center, and Department of Behavioral and Social Sciences, Public Health Program, Brown University, Providence, RI, 02912, USA
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16
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McCullagh C, Quinn K, Voisin DR, Schneider J. A longitudinal examination of factors associated with social support satisfaction among HIV-positive young Black men who have sex with men. AIDS Care 2017. [PMID: 28631491 DOI: 10.1080/09540121.2017.1332333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the long-term predictors of social support satisfaction among HIV-positive young Black men who have sex with men (YBMSM). Data were collected across three waves between October 2012 and November 2014 as part of the baseline assessment from Project nGage, a preliminary efficacy randomized control study examining the role of social support in improving HIV care among YBMSM. The sample included 92 YBMSM aged 18-29. Major results controlling for age, education and intervention effects indicated that psychological health, social network size, and education at baseline predicted differences in social support satisfaction at Wave 3, with no significant effects based on length of HIV diagnosis. Therefore, interventions that are intended to promote the quality of life for YBMSM and their engagement and retention in HIV care must focus on their psychological health concerns and network size.
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Affiliation(s)
| | - Katherine Quinn
- b Department of Psychiatry and Behavioral Medicine , Center for AIDS Intervention Research, Medical College of Wisconsin , Milwaukee , WI , USA.,c STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA
| | - Dexter R Voisin
- a School of School Work , Columbia University , New York , NY , USA.,c STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA.,d School of Social Service Administration , University of Chicago , Chicago , IL , USA.,e Third Coast Center for AIDS Research , University of Chicago and Northwestern University , Chicago , IL , USA.,f Chicago Center for HIV Elimination , University of Chicago , Chicago , IL , USA
| | - John Schneider
- c STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA.,e Third Coast Center for AIDS Research , University of Chicago and Northwestern University , Chicago , IL , USA.,f Chicago Center for HIV Elimination , University of Chicago , Chicago , IL , USA.,g Department of Medicine , University of Chicago , Chicago , IL , USA.,h Department of Public Health Sciences , University of Chicago , Chicago , IL , USA
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Abstract
The paper utilizes data collected at three time points in a longitudinal study of perinatally HIV-infected (PHIV+) and a comparison group of perinatally exposed but HIV-uninfected (PHEU) youths in the United States (N = 325). Using growth curve modeling, the paper examines changes in substance use symptoms among PHIV+ and PHEU youths as they transition through adolescence, and assesses the individual and contextual factors associated with the rate of change in substance use symptoms. Findings indicate that substance use symptoms increased over time among PHIV+ youths, but not among PHEU youths. The rate of change in these symptoms was positively associated with an increasing number of negative life events. Study findings underscore the need for early, targeted interventions for PHIV+ youths, and interventions to reduce adversities and their deleterious effects in vulnerable populations.
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Funck-Brentano I, Assoumou L, Veber F, Moshous D, Frange P, Blanche S. Resilience and Life Expectations of Perinatally HIV-1 Infected Adolescents in France. Open AIDS J 2016; 10:209-224. [PMID: 27990195 PMCID: PMC5120384 DOI: 10.2174/1874613601610010209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Resilience of perinatally HIV-infected youth in European countries is poorly studied. Life satisfaction and expectations for adulthood are rarely examined. Objective: This cross-sectional, descriptive study of a French cohort of 54 perinatally HIV-infected adolescents raised in France (age 14-20 years) aimed to (1) evaluate their psychosocial adjustment, (2) identify their expectations for adulthood and (3) delineate risk and protective factors associated with mental health, life satisfaction, and HIV-1 viral load level. Method: Medical evaluation, psychological semi-structured interview, and self-report questionnaires were used. Results: All the adolescents had been receiving Highly Active Anti-Retroviral Therapy (HAART) for 9 to 11 years and 2/3 were healthy with controlled viral load (<50 copies/mL). The majority had medium to high levels of life satisfaction. They viewed HIV as having only minor impact on their current daily life and had positive expectations for adulthood. However, 46% exhibited psychiatric symptomatology. Multivariable analysis showed that having a deceased parent and current worries about HIV were substantial risk factors for psychiatric symptoms. Having two living parents and being satisfied with life were protective factors for mental health. Good quality of caregiver-adolescent relationships and high life satisfaction were significant protective factors for controlled viral load. Conclusion: These data indicate psychosocial resilience among perinatally HIV-1 infected adolescents with 10 years of HAART treatment. These findings demonstrate the influence of life satisfaction, parent’s life status and quality of caregiver-adolescent relationships on resilience and health outcomes in these patients. We conclude that healthcare providers should attend to these factors.
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Affiliation(s)
- Isabelle Funck-Brentano
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Lambert Assoumou
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 45 Boulevard de l'Hôpital, 75013 Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 101 rue de Tolbiac, 75013 Paris, France
| | - Florence Veber
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Despina Moshous
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Institut IMAGINE, 24 Boulevard du Montparnasse, 75015 Paris, France
| | - Pierre Frange
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France; AP-HP, Hôpital Necker-Enfants Malades, Laboratoire de Microbiologie Clinique; Université Paris Descartes, Sorbonne Paris-Cité, EA 7327, 149 rue de Sèvres 75743 Paris cedex 15, France
| | - Stéphane Blanche
- AP-HP, Hôpital Necker-Enfants Malades, Unité d'Immunologie-hématologie et rhumatologie pédiatriques, 149 rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, Institut IMAGINE, 24 Boulevard du Montparnasse, 75015 Paris, France
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Bozzoli CG. Orphanhood and fertility in young adults: Evidence from South Africa. ECONOMICS AND HUMAN BIOLOGY 2016; 22:190-200. [PMID: 27239730 DOI: 10.1016/j.ehb.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
I study the relation between orphanhood and fertility patterns in young adults using a longitudinal survey from the city of Cape Town, South Africa. The data set combines two survey waves with a year-by-year life history calendar that records key outcomes (e.g., schooling, work, fertility). It also provides information on so-called 'parental investments' (time and material support), family background, and literacy and numeracy test scores. I find that orphans exhibit significantly higher rates of teenage pregnancy. In particular, teenage motherhood is 19% points more likely among (female) orphans. These results suggest that orphanhood may leave a long-lasting 'imprint' in terms of premature fertility, especially in teenage females.
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Affiliation(s)
- Carlos G Bozzoli
- Facultad de Administración y Empresa, Universidad de Santiago de Chile, Chile.
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20
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Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children - a Retrospective Cohort Study. J Int AIDS Soc 2016; 19:20694. [PMID: 27341885 PMCID: PMC4920943 DOI: 10.7448/ias.19.1.20694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022] Open
Abstract
Objective To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence). Methods We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs). Results During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1) and self-esteem (β=−4.3, 95% CI: −6.7, −1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may improve PA and quality of life in these vulnerable groups.
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Folayan MO, Harrison A, Brown B, Odetoyinbo M, Stockman JK, Ajuwon AJ, Cáceres CF. Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria. PLoS One 2016; 11:e0155210. [PMID: 27163436 PMCID: PMC4862679 DOI: 10.1371/journal.pone.0155210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/26/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. METHODS We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. RESULTS Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83). CONCLUSION History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Institute of Public Health and Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Brandon Brown
- Division of Clinical Sciences, Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, California, United States of America
| | | | - Jamila K. Stockman
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Ademola J. Ajuwon
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Carlos F. Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, S.M.P. Lima, Peru
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Murphy DA, Marelich WD, Rappaport NB, Hoffman D, Farthing C. Results of an Antiretroviral Adherence Intervention: STAR (Staying Healthy: Taking Antiretrovirals Regularly). ACTA ACUST UNITED AC 2016; 6:113-24. [PMID: 17538003 DOI: 10.1177/1545109707301243] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A randomized 2-group medication adherence intervention is evaluated with HIV-infected adults (N = 141) assessed at baseline, 3-, and 9-month follow-ups. Cognitive (self-efficacy, behavioral intent), mental health (depression, well-being), and substance use indicators were the outcome measures. In addition, a posttest-only analysis from 3 to 9 months evaluates intervention impact on antiretroviral adherence, measured through Medication Event Monitoring System and pill counts. Compared to the standard care group, the intervention group showed significant increases in adherence self-efficacy and behavioral intent at 3 and 9 months and marginal improvements in mental health. Although the standard care group had higher adherence at 3 months (no baseline data were available prior to intervention), intervention group patients showed significant increases in adherence from 3 to 9 months. Although adherence levels achieved by intervention patients may not be sufficient for virological control, this is one of the first studies to provide promising results of longer term effectiveness of a behavioral adherence intervention.
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Affiliation(s)
- Debra A Murphy
- Health Risk Reduction Projects, Integrated Substance Abuse Programs, Department of Psychiatry, University of California, Los Angeles, CA 90025-7539, USA.
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Mutumba M, Bauermeister JA, Harper GW, Musiime V, Lepkowski J, Resnicow K, Snow RC. Psychological distress among Ugandan adolescents living with HIV: Examining stressors and the buffering role of general and religious coping strategies. Glob Public Health 2016; 12:1479-1491. [PMID: 28278753 DOI: 10.1080/17441692.2016.1170871] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV infection increases the risk of psychological distress among adolescents living with HIV (ALHIV), which, in turn, increases risky behaviours such as medication non-adherence, substance use, and sexual risk-taking. The majority of studies on psychological distress among ALHIV have been conducted in high-income countries; data on the prevalence and correlates of psychological distress among ALHIV in sub-Saharan Africa (SSA) are scarce, yet over two-thirds of the global population of ALHIV resides in SSA. The purpose of this study was to identify the contextually relevant correlates of psychological distress among Ugandan ALHIV. Utilizing the stress and coping framework, we explored the risk and protective factors for psychological distress in cross-sectional sample of 464 ALHIV (aged 12-19; 53% female) at a large HIV treatment centre in Kampala, Uganda. The stressors associated with psychological distress included daily hassles, major negative life events, HIV-related quality of life, and stigma. Protective factors included psychosocial resources such as religious coping, satisfaction with social support, and general coping style and behaviours. Social support and optimism were significantly associated with psychological distress. Findings underscore the need for mental health services for ALHIV in Uganda and other resource-limited settings.
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Affiliation(s)
- Massy Mutumba
- a Department of Behavioral and Biological Sciences , University of Michigan School of Nursing , Ann Arbor , MI , USA
| | - Jose A Bauermeister
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Gary W Harper
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Victor Musiime
- c Department of Pediatrics and Child Health , Makerere University College of Health Sciences , Kampala , Uganda
| | - James Lepkowski
- d Department of Biostatistics & Program in Survey Methodology , University of Michigan , Ann Arbor , MI , USA
| | - Ken Resnicow
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Rachel C Snow
- b Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
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Herzog D, Killianova T, Pauwels S, Germeys F, Gidron Y. Hemispheric Lateralization Moderates the Life Events-Distress Relationship. Stress Health 2016; 32:47-54. [PMID: 24719310 DOI: 10.1002/smi.2577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/01/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022]
Abstract
Past studies show that life events (LE) predict mental distress. This research tested whether hemispheric lateralization (HL) moderated the relationship between LE and mental distress. In studies 1 and 2, different instruments for assessing HL were used (questionnaire and neuropsychological test). In both studies, LE or daily hassles were positively correlated with distress (study 1) and with anxiety and depression (study 2), only in people with right but not left HL, controlling for effects of gender. In study 3, experimentally induced stress led to increased perceived stress, again only in participants with right but not left HL. These results show consistently that left HL may protect against adverse effects of LE, hassles or acute stress on well-being. We propose possible mechanisms and future research directions.
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Affiliation(s)
| | | | | | - Filip Germeys
- Hogeschool-Universiteit Brussel, Brussels, Belgium.,University of Leuven, Leuven, Belgium
| | - Yori Gidron
- Vrije Universiteit Brussel, Brussels, Belgium
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25
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Kajubi P, Whyte SR, Kyaddondo D, Katahoire AR. Tensions in Communication between Children on Antiretroviral Therapy and Their Caregivers: A Qualitative Study in Jinja District, Uganda. PLoS One 2016; 11:e0147119. [PMID: 26784904 PMCID: PMC4718696 DOI: 10.1371/journal.pone.0147119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction HIV treatment and disclosure guidelines emphasize the importance of communicating diagnosis and treatment to infected children in ways that are appropriate to children’s developmental stage and age. Minimal attention, however, has been given to communication challenges confronted by HIV-infected children and their caregivers. This study examined the tensions between children and their caregivers arising from differing perspectives regarding when and what to communicate about antiretroviral therapy (ART). Methods This qualitative study was conducted between November 2011 and December 2012 and involved 29 HIV-infected children aged 8–17 years on ART and their caregivers. Data were collected through observations and in-depth interviews, which took place in homes, treatment centres and post-test clubs. Children and caregivers were sampled from among the 394 HIV-infected children and (their) 393 caregivers who participated in the cross-sectional survey that preceded the qualitative study. ATLAS.ti. Version 7 was used in the management of the qualitative data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results While the children felt that they were mature enough to know what they were suffering and what the medications were for, the caregivers wanted to delay discussions relating to the children’s HIV diagnosis and medication until they felt that the children were mature enough to deal with the information and keep it a secret and this caused a lot of tension. The children employed different tactics including refusing to take the medicines, to find out what they were suffering from and what the medications were for. Children also had their own ideas about when, where and with whom to discuss their HIV condition, ideas that did not necessarily coincide with those of their caregivers, resulting in tensions. Conclusions Guidelines should take into consideration differing perceptions of maturity when recommending ages at which caregivers should communicate with their children about diagnosis and ART. Health care providers should also encourage caregivers to recognize and respect children’s efforts to learn about and manage their condition. Children’s questions and expressions of feelings should be treated as openings for communication on these issues.
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Affiliation(s)
- Phoebe Kajubi
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | | | - David Kyaddondo
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne Ruhweza Katahoire
- Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
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Mutumba M, Musiime V, Lepkwoski JM, Harper GW, Snow RC, Resnicow K, Bauermeister JA. Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV. AIDS Care 2016; 28:807-15. [PMID: 27294696 DOI: 10.1080/09540121.2015.1131966] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Psychological distress is common among adolescents living with HIV (ALHIV) worldwide, and has been associated with non-adherence to anti-retroviral therapy (ART), leading to poor virologic suppression, drug resistance, and increased risk for AIDS morbidity and mortality. However, only a few studies have explored the relationship between psychological distress and ART adherence among adolescents in sub-Saharan Africa. The paper examines the relationship between psychological distress and ART adherence, and effect of psychosocial resources on ART adherence. We conducted a cross-sectional survey of 464 ALHIV (aged 12-19; 53% female) seeking HIV care at a large HIV treatment center in Kampala, Uganda. ALHIV were recruited during routine clinic visits. Three self-reported binary adherence measures were utilized: missed pills in the past three days, non-adherence to the prescribed medical regimen, and self-rated adherence assessed using a visual analog scale. Psychological distress was measured as a continuous variable, and computed as the mean score on a locally developed and validated 25-item symptom checklist for Ugandan ALHIV. Psychosocial resources included spirituality, religiosity, optimism, social support, and coping strategies. After adjusting for respondents' socio-demographic characteristics and psychosocial resources, a unit increase in psychological distress was associated with increased odds of missing pills in past 3 days (Odds Ratio(OR) = 1.75; Confidence Interval (CI): 1.04-2.95), not following the prescribed regimen (OR = 1.63; CI: 1.08-2.46), and lower self-rated adherence (OR = 1.79; CI: 1.19-2.69). Psychosocial resources were associated with lower odds for non-adherence on all three self-report measures. There is a need to strengthen the psychosocial aspects of adolescent HIV care by developing interventions to identify and prevent psychological distress among Ugandan ALHIV.
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Affiliation(s)
- Massy Mutumba
- a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA.,b Joint Clinical Research Center , Kampala , Uganda
| | - Victor Musiime
- b Joint Clinical Research Center , Kampala , Uganda.,c Department of Pediatrics , Makerere University College of Health Sciences , Kampala , Uganda
| | - James M Lepkwoski
- d Survey Methodology Program , University of Michigan , Ann Arbor , MI , USA
| | - Gary W Harper
- a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA
| | - Rachel C Snow
- a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA
| | - Ken Resnicow
- a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA
| | - Jose A Bauermeister
- a Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , MI , USA
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Ankrah DNA, Koster ES, Mantel-Teeuwisse AK, Arhinful DK, Agyepong IA, Lartey M. Facilitators and barriers to antiretroviral therapy adherence among adolescents in Ghana. Patient Prefer Adherence 2016; 10:329-37. [PMID: 27042024 PMCID: PMC4801129 DOI: 10.2147/ppa.s96691] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) is known to be challenging among adolescents living with HIV/AIDS, notwithstanding the life-saving importance of this therapy. Of the global total number of adolescents living with HIV in 2013, 83% reside in sub-Saharan Africa. The study aimed to identify facilitators of and barriers to antiretroviral treatment adherence among adolescents in Ghana. METHODS A cross-sectional qualitative study using semi-structured interviews for data collection was carried out among adolescents (aged 12-19 years) at the adolescents HIV clinic at the Korle-Bu Teaching Hospital in Ghana. Predominantly open-ended questions relating to ART were used. Interviews were done until saturation. In total, 19 interviews were conducted. Analysis was done manually to maintain proximity with the text. FINDINGS The main facilitators were support from health care providers, parental support, patient's knowledge of disease and self-motivation, patient's perceived positive outcomes, and dispensed formulation. The identified barriers were patient's forgetfulness to take medicines, perceived stigmatization due to disclosure, financial barriers, and adverse effects of ART. Support from health care workers was the most frequently mentioned facilitator, and patient's forgetfulness and perceived stigmatization after disclosure were the most frequently mentioned barriers. Self-motivation (knowledge induced) to adhere to treatment was a specific facilitator among older adolescents. CONCLUSION Continuous information provision in addition to unflinching support from health care workers and parents or guardians may improve adherence among adolescents. Also, interventions to reduce patient forgetfulness may be beneficial. A multi-sectorial approach would be needed to address adolescent disclosure of HIV/AIDS status.
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Affiliation(s)
- Daniel NA Ankrah
- Pharmacy Department, Korle-Bu Teaching Hospital, Accra, Ghana, Accra, Ghana
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands, Accra, Ghana
- Correspondence: Daniel NA Ankrah, Pharmacy Department, Korle-Bu Teaching Hospital, PO Box 77, Korle-Bu, Accra, Ghana, Tel +233 30 263 6168, Fax +233 30 267 3729, Email
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands, Accra, Ghana
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands, Accra, Ghana
| | - Daniel K Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana (Legon), Accra, Ghana
| | - Irene A Agyepong
- Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
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Lewis JV, Abramowitz S, Koenig LJ, Chandwani S, Orban L. Negative life events and depression in adolescents with HIV: a stress and coping analysis. AIDS Care 2015; 27:1265-74. [PMID: 26313848 DOI: 10.1080/09540121.2015.1050984] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prevalence of negative life events (NLE) and daily hassles, and their direct and moderated associations with depression, were examined among HIV-infected adolescents. Specifically, we examined whether the negative association with depression of NLE, daily hassles, and/or passive coping were moderated by social support or active coping strategies. Demographic characteristics, depression, coping, social support, NLE, and daily hassles were collected at baseline as part of the Adolescent Impact intervention via face-to-face and computer-assisted interviews. Of 166 HIV-infected adolescents, 53% were female, 72.9% black, 59.6% with perinatally acquired HIV (PIY), the most commonly reported NLE were death in family (81%), violence exposure (68%), school relocation (67%), and hospitalization (61%); and for daily hassles "not having enough money (65%)". Behaviorally infected youth (BIY--acquired HIV later in life) were significantly more likely to experience extensive (14-21) lifetime NLE (38.8% vs. 16.3%, p < .012) than PIY. In multiple stepwise regression analysis, the model accounting for the greatest variability in depression scores (32%) included (in order of entry): daily hassles, low social support, behaviorally acquired HIV, minority sexual orientation, and passive coping. A significant passive coping-by-social support interaction revealed that the association between passive coping and depression was exacerbated when social support was low. Social support moderated the effect of NLE, such that NLE were associated with greater depression when social support was low, although the effect did not remain statistically significant when main effects of other variables were accounted for. Daily hassles, poor coping, and limited social support can adversely affect the psychological well-being of HIV-infected adolescents, particularly sexual minority youth with behaviorally acquired HIV. Multimodal interventions that enhance social support and teach adaptive coping skills may help youth cope with environmental stresses and improve mental health outcomes.
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Affiliation(s)
- Jennifer V Lewis
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| | - Susan Abramowitz
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| | - Linda J Koenig
- b Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Sulachni Chandwani
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
| | - Lisa Orban
- a Department of Pediatric Infectious Diseases , NYU Langone Medical Center , New York , NY , USA
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Mutumba M, Resnicow K, Bauermeister JA, Harper GW, Musiime V, Snow RC, Lepkowski JM. Development of a psychosocial distress measure for Ugandan adolescents living with HIV. AIDS Behav 2015; 19:380-92. [PMID: 25577026 DOI: 10.1007/s10461-014-0973-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress for Ugandan ALH aged 12-19 years (N = 508; 53.1 % female). Using a mixed method approach, we developed and tested a 25-item checklist with six subscales-anhedonia, depressive-anxiety, isolation, suicidal ideation, sleep problems, and somatization. We found adequate reliability for the scale (α = 0.89), and a satisfactory measurement structure in our confirmatory factor analyses (RMSEA <1.0, and CFI and TLI >0.90). We discuss the potential use of this culturally sensitive scale to examine psychological distress among ALH in Uganda.
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30
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Mutumba M, Bauermeister JA, Musiime V, Byaruhanga J, Francis K, Snow RC, Tsai AC. Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: a qualitative study. AIDS Patient Care STDS 2015; 29:86-94. [PMID: 25607900 DOI: 10.1089/apc.2014.0222] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although more than 90% of youth perinatally infected with HIV live in sub-Saharan Africa, little is known about the psychosocial factors that impact their wellbeing, or how these youth cope with these challenges. The purpose of this study was to identify the psychosocial challenges and coping strategies among perinatal HIV-infected adolescents in Uganda. In-depth interviews were conducted with a purposive sample of 38 HIV-infected adolescents aged 12-19 years at a large HIV treatment center in Kampala. Data were analyzed thematically to identify themes and domains related to stressors and specific coping strategies. Psychosocial challenges included stigma/discrimination, relationship challenges such as HIV status disclosure, and medication difficulties. Coping strategies included medication adherence, concealment or limited disclosure of HIV status, treatment optimism, social support, rationalizing, social comparison, spirituality/religiosity, avoidance, and distraction. Age and gender differences also emerged: younger participants generally lacked specific coping strategies; compared to females, male adolescents reported greater use of avoidance/distraction techniques. Findings underscore the need to address stigma within homes and schools, and to equip adolescents with the comprehensive knowledge and skills to address their varied challenges.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
- Joint Clinical Research Center, Kampala, Uganda
| | - José A. Bauermeister
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Victor Musiime
- Joint Clinical Research Center, Kampala, Uganda
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Rachel C. Snow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Center for Global Health and Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Fang X, Vincent W, Calabrese SK, Heckman TG, Sikkema KJ, Humphries DL, Hansen NB. Resilience, stress, and life quality in older adults living with HIV/AIDS. Aging Ment Health 2015; 19:1015-21. [PMID: 25633086 PMCID: PMC4520800 DOI: 10.1080/13607863.2014.1003287] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living with HIV/AIDS (OPLWHA). METHOD Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being). RESULTS SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being. CONCLUSION Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.
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Affiliation(s)
- Xindi Fang
- School of Public Health, Yale University, 60 College Street, New Haven, CT 06520
| | - Wilson Vincent
- Department of Medicine, University of California at San Francisco School of Medicine, 50 Beale Street, San Francisco, CA 94143
| | - Sarah K. Calabrese
- School of Public Health, Yale University, 60 College Street, New Haven, CT 06520
| | - Timothy G. Heckman
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 308 Ramsey Student Center, Athens, GA 30602
| | - Kathleen J. Sikkema
- Department of Psychology & Neuroscience, Duke University, 417 Chapel Drive, Durham, NC 27708
| | - Debbie L. Humphries
- School of Public Health, Yale University, 60 College Street, New Haven, CT 06520
| | - Nathan B. Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, 308 Ramsey Student Center, Athens, GA 30602
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32
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Nöstlinger C, Bakeera-Kitaka S, Buyze J, Loos J, Buvé A. Factors influencing social self-disclosure among adolescents living with HIV in Eastern Africa. AIDS Care 2015; 27 Suppl 1:36-46. [PMID: 26616124 PMCID: PMC4685614 DOI: 10.1080/09540121.2015.1051501] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 05/08/2015] [Indexed: 11/10/2022]
Abstract
Adolescents living with HIV (ALHIV) face many psychosocial challenges, including HIV disclosure to others. Given the importance of socialization during the adolescent transition process, this study investigated the psychological and social factors influencing self-disclosure of own HIV status to peers. We examined social HIV self-disclosure to peers, and its relationship to perceived HIV-related stigma, self-efficacy to disclose, self-esteem, and social support among a sample of n = 582 ALHIV aged 13-17 years in Kampala, Uganda, and Western Kenya. Data were collected between February and April 2011. Among them, 39% were double orphans. We conducted a secondary data analysis to assess the degree of social disclosure, reactions received, and influencing factors. Interviewer-administered questionnaires assessed medical, socio-demographic, and psychological variables (Rosenberg self-esteem scale; self-efficacy to disclose to peers), HIV-related stigma (10-item stigma scale), and social support (family-life and friends). Descriptive, bivariate, and logistic regression analyses were performed with social self-disclosure to peers with gender as covariates. Almost half of ALHIV had told nobody (except health-care providers) about their HIV status, and about 18% had disclosed to either one of their friends, schoolmates, or a boy- or girlfriend. Logistic regression models revealed that having disclosed to peers was significantly related to being older, being a paternal orphan, contributing to family income, regular visits to the HIV clinic, and greater social support through peers. Low self-efficacy to disclose was negatively associated to the outcome variable. While social self-disclosure was linked to individual factors such as self-efficacy, factors relating to the social context and adolescents' access to psychosocial resources play an important role. ALHIV need safe environments to practice disclosure skills. Interventions should enable them to make optimal use of available psychosocial resources even under constraining conditions such as disruptive family structures.
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Affiliation(s)
| | - Sabrina Bakeera-Kitaka
- Baylor-Uganda, Kampala, Uganda
- Department of Paediatrics, Makerere University, Kampala, Uganda
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anne Buvé
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Abstract
There is a growing evidence base on the immediate and short-term effects of adult HIV on children. We provide an overview of this literature, highlighting the multiple risks and resultant negative consequences stemming from adult HIV infection on the children they care for on an individual and family basis. We trace these consequences from their origin in the health and wellbeing of adults on whom children depend, through multiple pathways to negative impacts for children. As effective treatment reduces vertical transmission, the needs of affected children will predominate. Pathways include exposure to HIV in utero, poor caregiver mental or physical health, the impact of illness, stigma and increased poverty. We summarize the evidence of negative consequences, including those affecting health, cognitive development, education, child mental health, exposure to abuse and adolescent risk behaviour, including sexual risk behaviour, which has obvious implications for HIV-prevention efforts. We also highlight the evidence of positive outcomes, despite adversity, considering the importance of recognizing and supporting the development of resilience. This study is the first in a series of three commissioned by President's Emergency Plan for AIDS Relief (PEPFAR)/United States Agency for International Development (USAID), the summary provided here was used to inform a second study which seeks to identify insights from the broader child development field which will help us predict what long-term negative consequences children affected by HIV and AIDS are likely to experience. The third study discusses the design of a model to estimate these consequences. Although comprehensive, the review is often hampered by poor-quality research, inadequate design, small sample sizes and single studies in some areas.
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Kumar SP, Dandona R, Kumar GA, Ramgopal S, Dandona L. Depression among AIDS-orphaned children higher than among other orphaned children in southern India. Int J Ment Health Syst 2014; 8:13. [PMID: 24708649 PMCID: PMC4016624 DOI: 10.1186/1752-4458-8-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/26/2014] [Indexed: 11/11/2022] Open
Abstract
Background Systematic data on mental health issues among orphaned children are not readily available in India. This study explored depression and its associated risk factors among orphaned children in Hyderabad city in south India. Methods 400 orphaned children drawn equally from AIDS and non-AIDS orphan groups aged 12–16 years residing in orphanages in and around Hyderabad city in southern India were recruited to assess depression and associated risk factors using the Center for Epidemiologic Studies-Depression Scale (CES-DC). Variation in the intensity of depression was assessed using multiple classification analysis (MCA). Results 397 (99%) orphans provided complete interviews in the study of whom 306 (76.5%) were aged 12 to 14 years, and 206 (51.8%) were paternal orphans. Children orphaned by AIDS were significantly more likely to report being bullied by friends or relatives (50.3%) and report experiencing discrimination (12.6%) than those orphaned due to other reasons (p < 0.001). The overall prevalence of depression score >15 with CES-DC was 74.1% (95% CI 69.7-78.4) with this being significantly higher for children orphaned by AIDS (84.4%, 95% CI 79.4 – 89.5) than those due to other reasons (63.6%, 95% CI 56.9 – 70.4). Mean depression score was significantly higher for children orphaned by AIDS (34.6) than the other group (20.6; p < 0.001). Among the children orphaned by AIDS, the bulk of depression score was clustered in 12–14 years age groups whereas in the children orphaned by other reasons it was clustered in the 15–16 years age group (p = 0.001). MCA analysis showed being a child orphaned by AIDS had the highest effect on the intensity of depression (Beta = 0.473). Conclusions Children orphaned by AIDS had significantly higher depressive symptoms than the other orphaned children. These findings could be used for further planning of mental health interventions to meet the mental health needs of orphaned children, that could include preventive, diagnostic and treatment services.
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Affiliation(s)
- Sg Prem Kumar
- Public Health Foundation of India, ISID Campus, 4, Institutional Area, Vasant Kunj, New Delhi 110 070, India
| | - Rakhi Dandona
- Public Health Foundation of India, ISID Campus, 4, Institutional Area, Vasant Kunj, New Delhi 110 070, India
| | - G Anil Kumar
- Public Health Foundation of India, ISID Campus, 4, Institutional Area, Vasant Kunj, New Delhi 110 070, India
| | - Sp Ramgopal
- Public Health Foundation of India, ISID Campus, 4, Institutional Area, Vasant Kunj, New Delhi 110 070, India
| | - Lalit Dandona
- Public Health Foundation of India, ISID Campus, 4, Institutional Area, Vasant Kunj, New Delhi 110 070, India ; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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McKernan McKay M, Alicea S, Elwyn L, McClain ZRB, Parker G, Small LA, Mellins CA. The development and implementation of theory-driven programs capable of addressing poverty-impacted children's health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014; 43:428-41. [PMID: 24787707 PMCID: PMC4215567 DOI: 10.1080/15374416.2014.893519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007 ) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.
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Affiliation(s)
- Mary McKernan McKay
- a Department of Psychiatry and Community Medicine , Mount Sinai School of Medicine
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Esposito-Smythers C, Brown LK, Wolff J, Xu J, Thornton S, Tidey J. Substance abuse treatment for HIV infected young people: an open pilot trial. J Subst Abuse Treat 2013; 46:244-50. [PMID: 23988190 DOI: 10.1016/j.jsat.2013.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 07/08/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to test an integrated cognitive behavioral and contingency management (CBT/CM) intervention for young people living with HIV (YPLH) with an alcohol and/or cannabis use disorder in an open pilot trial. Seventeen participants (ages 18-24) were recruited from three HIV community clinics. Assessments were completed at pre-and post-treatment as well as 3 month follow-up. Eighty percent of participants were retained in the study. Results suggest that the CBT/CM intervention was acceptable, feasible, and could be delivered with fidelity. Further, participants reported significant reductions in alcohol use, withdrawal symptoms, dependence symptoms and related problems, as well as co-occurring depressive symptoms and delinquent behavior across assessment periods. A trend was evident for reductions in marijuana use and related problems. Overall, these preliminary results suggest that a substance abuse CBT/CM intervention tailored to YPLH is acceptable, feasible, and holds promise for symptomatic improvement. Further testing of this type of protocol is warranted.
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Abstract
HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, "treatment as prevention" for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.
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Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt School of Medicine, Nashville, TN 37203, USA.
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Betancourt TS, Meyers-Ohki SE, Charrow A, Hansen N. Annual Research Review: Mental health and resilience in HIV/AIDS-affected children-- a review of the literature and recommendations for future research. J Child Psychol Psychiatry 2013; 54:423-44. [PMID: 22943414 PMCID: PMC3656822 DOI: 10.1111/j.1469-7610.2012.02613.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To date, research on mental health in HIV-affected children (children who have an HIV-positive caregiver or live with the virus themselves) has focused on risk factors associated with the disease. However, simultaneous identification of factors that contribute to resilience in the face of risks is also needed. A greater understanding of modifiable protective processes that contribute to resilience in the mental health of children affected by HIV can inform the design of interventions that bolster naturally occurring supports and contribute to early prevention or better management of risks. METHODS We reviewed the recent literature on mental health and resilience in children and adolescents affected by HIV/AIDS. Literature searches of PsycInfo and PubMed were conducted during July-December 2011 consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Qualitative and quantitative studies were included for review if primary research questions pertained to mental health and coping or protective processes in children and families affected by HIV/AIDS. All studies subject to full review were evaluated for quality using a modified Systematic Assessment of Quality in Observational Research (SAQOR) rating system. RESULTS One hundred and seventy one unique studies were returned from online searches of the literature and bibliography mining. Of these, 29 were evaluated as pertaining directly to mental health and resilience in families and children living with HIV/AIDS. Eight studies presented qualitative analyses. Ten quantitative studies examined individual resources contributing to child resilience and four quantitative studies looked at family-level resources. Ten studies also investigated community level interactions. Four presented findings from resilience-focused interventions. CONCLUSIONS There is a clear need for rigorous research on mental health and resilience in HIV-affected children and adolescents. The evidence base would greatly benefit from more standardized and robust approaches to thinking about resilience from an ecological perspective inclusive of resources at multiple levels and their interactions.
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Affiliation(s)
- Theresa S Betancourt
- Department of Global Health and Population/François-Xavier Bagnoud Center for Health and Human Rights at Harvard University, Boston, MA 02115, USA.
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Alicea S, Pardo G, Conover K, Gopalan G, McKay M. Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools. CLINICAL SOCIAL WORK JOURNAL 2012; 40:175-186. [PMID: 23564983 PMCID: PMC3616766 DOI: 10.1007/s10615-011-0344-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.
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Affiliation(s)
- Stacey Alicea
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA
| | - Gisselle Pardo
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA,
| | - Kelly Conover
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA,
| | - Geetha Gopalan
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA,
| | - Mary McKay
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA
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Lagrange RD, Mitchell SJ, Lewis M, Abramowitz S, D'Angelo LJ. Health Protective Behaviors among Young People Living with HIV/AIDS. ACTA ACUST UNITED AC 2012; S1. [PMID: 23293748 DOI: 10.4172/2155-6113.s1-013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Young people living with HIV/AIDS (YPLH) in the post-HAART era have the potential to manage their HIV as a chronic illness rather than as an almost inevitable terminal disease. However, little is known about behaviors YPLH can engage in to promote or protect health beyond taking anti-retroviral (ARV) medicines. The current study fills an important gap in existing research by identifying correlates of Health Protective Behaviors (HPB) within an urban sample of YPLH. Participants (n=134) were recruited from two pediatric clinics serving adolescents living with HIV who met the following criteria: HIV-infected and aware of their status, 13-24 years old, residing in the Washington, DC metropolitan area, currently prescribed ARV or due to begin ARV within 3 months, and able to understand and sign a written consent form. Each participant was interviewed via Audio computer-assisted self-interview (ACASI) and reported the percentage of possible time they engaged in six HPB during the prior month using a 10-point scale (e.g., 5=50%). Results indicate that most patients engaged in the measured health protective behaviors more than half the time, although patients 18 and older engaged in all HPB less frequently than their younger counterparts. Patients with adherence > 90% were far more likely to engage in HPB than those with poorer adherence. The age differences in HPB highlight a need for broader scaffolding in the transition to independent living and adult health care. Given the relationship between adherence and HPB, the establishment and maintenance of healthy lifestyle practices early in adolescence can translate into positive long-term health outcomes.
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Affiliation(s)
- Ricardo D Lagrange
- Center for Clinical and Community Research, Children's National Medical Center, Washington, DC, USA
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Surkan PJ, Mukherjee JS, Williams DR, Eustache E, Louis E, Jean-Paul T, Lambert W, Scanlan FC, Oswald CM, Fawzi MS. Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti. AIDS Care 2011; 22:803-15. [PMID: 20635244 DOI: 10.1080/09540120903443392] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In many settings worldwide, HIV-positive individuals have experienced a significant level of stigma and discrimination. This discrimination may also impact other family members affected by the disease, including children. The aim of our study was to identify factors associated with stigma and/or discrimination among HIV-affected youth and their HIV-positive caregivers in central Haiti. Recruitment of HIV-positive patients with children aged 10-17 years was conducted in 2006-2007. Data on HIV-related stigma and/or discrimination were based on interviews with 451 youth and 292 caregivers. Thirty-two percent of caregivers reported that children were discriminated against because of HIV/AIDS. Commune of residence was associated with discrimination against children affected by HIV/AIDS and HIV-related stigma among HIV-positive caregivers, suggesting variability across communities. Multivariable regression models showed that lacking social support, being an orphan, and caregiver HIV-related stigma were associated with discrimination in HIV-affected children. Caregiver HIV-related stigma demonstrated a strong association with depressive symptoms. The results could inform strategies for potential interventions to reduce HIV-related stigma and discrimination. These may include increasing social and caregiver support of children affected by HIV, enhancing support of caregivers to reduce burden of depressive symptoms, and promoting reduction of HIV-related stigma and discrimination at the community-level.
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Affiliation(s)
- Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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L'Etang S. A Cognitive-Behavioural-Based Counselling Intervention Programme: A Rationale for the Counselling of Adolescents and Youth Living with HIV&AIDS in a Rural South African Town. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2011. [DOI: 10.1177/008124631104100210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescence, on its own, is a tremendously trying period for any young person, and having to cope with the added burden of being HIV-positive can have a devastating effect on a young person's psychological development. This is why the need for strategies and interventions aimed at the mental health of young people living with HIV&AIDS (PLWHA) is becoming increasingly critical. Despite the increased levels of psychological distress faced by HIV-positive adolescents and despite the numerous calls for counselling post-diagnosis, little has been done to meet the psychosocial needs of South African adolescents and youth living with HIV&AIDS from a developmental point of view. This article outlines the initiatives that have been implemented to target the health of young PLWHA and makes the argument that new interventions catering for the psychosocial needs of young PLWHA, in terms of managing the virus, need to be developed. In conclusion, the Cognitive-behavioural-based Counselling Intervention Programme is introduced as one possible means of meeting the psychosocial needs of young PLWHA.
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Affiliation(s)
- Shlaine L'Etang
- School of Education Sciences, North-West University (Vaal Triangle Campus), Vanderbijlpark, South Africa
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Gibson K, Rueda S, Rourke SB, Bekele T, Gardner S, Fenta H, Hart and the OHTN Cohort Study TA. Mastery and coping moderate the negative effect of acute and chronic stressors on mental health-related quality of life in HIV. AIDS Patient Care STDS 2011; 25:371-81. [PMID: 21492004 DOI: 10.1089/apc.2010.0165] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Acute and chronic life stressors have a detrimental effect on the health of people living with HIV. Psychosocial resources such as mastery, coping, and social support may play a critical role in moderating the negative effects of stressors on health-related quality of life. A total of 758 participants provided baseline enrolment data on demographics (age, gender, ethnicity, sexual orientation, education, employment, income), clinical variables (CD4 counts, viral load, AIDS-defining condition, time since HIV diagnosis), psychosocial resources (mastery, coping, social support), life stressors (National Population Health Survey [NPHS] Stress Questionnaire), and health-related quality of life (SF-36). We performed hierarchical multivariate regression analyses to evaluate the potential moderating effects of psychosocial resources on the relationship between stressors and health-related quality of life. The top three stressors reported by participants were trying to take on too many things at once (51%), not having enough money to buy the things they needed (51%), and having something happen during childhood that scared them so much that they thought about it years later (42%). Life stressors were significantly and inversely associated with both physical and mental health-related quality of life. Mastery and maladaptive coping had significant moderating effects on mental health but not on physical health. These results suggest that developing interventions that improve mastery and reduce maladaptive coping may minimize the negative impact of life stressors on the mental health of people with HIV. They also highlight that it is important for clinicians to be mindful of the impact of life stressors on the health of patients living with HIV.
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Affiliation(s)
- Katherine Gibson
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sergio Rueda
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sean B. Rourke
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Research on Inner City Health and The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tsegaye Bekele
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Sandra Gardner
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Haile Fenta
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Sopena S, Evangeli M, Dodge J, Melvin D. Coping and psychological adjustment in adolescents with vertically acquired HIV. AIDS Care 2011; 22:1252-8. [PMID: 20640957 DOI: 10.1080/09540121003668110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with vertically acquired HIV face the challenges of adolescence in addition to the demands of coping with their illness. The relationship between coping and psychological adjustment has been widely studied in adults and children with chronic diseases but it is poorly understood in adolescents with HIV. This study aimed to identify whether a UK sample of adolescents with vertically acquired HIV had poor psychological adjustment and to clarify the relationship between coping and psychological adjustment in this sample. Thirty adolescents with vertically acquired HIV (aged 11-17) filled in questionnaires of coping and psychological adjustment and a correlational design was used to determine if specific coping styles were related to quality of psychological adjustment. Results showed that younger children had lower levels of psychological adjustment than older adolescents, although as a group the adolescents scored within normal ranges. Psychological adjustment was significantly related to two coping styles, Ventilating feelings and Being humorous. Exploratory analysis examined the extent of HIV disclosure in this sample and the degree of satisfaction felt about the nature of communication about the diagnosis. The results showed that participants had few confidants but were satisfied with the nature of communication about their status. The level of satisfaction was not related to adjustment. On the basis of the results, potential clinical implications for adolescents with vertically acquired HIV who might be struggling not only with the challenging demands of adolescence but also with their illness are discussed. The need to adopt a developmental approach to coping and psychological adjustment is emphasized.
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Affiliation(s)
- Sara Sopena
- Department of Clinical Psychology, Royal Holloway University of London, Surrey, Egham, UK.
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VanDevanter N, Duncan A, Burrell-Piggott T, Bleakley A, Birnbaum J, Siegel K, Lekas HM, Schrimshaw E, Cohall A, Ramjohn D. The influence of substance use, social sexual environment, psychosocial factors, and partner characteristics on high-risk sexual behavior among young Black and Latino men who have sex with men living with HIV: A qualitative study. AIDS Patient Care STDS 2011; 25:113-21. [PMID: 21235387 PMCID: PMC3049423 DOI: 10.1089/apc.2010.0100] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Understanding the sexual risk behaviors of youths living with HIV/AIDS is critical to secondary prevention of HIV. As part of a larger qualitative study of youths living with HIV, in-depth interviews were conducted with 27 African American and Latino, HIV-infected young men who have sex with men, aged 16-24 years, living in New York City. The study explored the role of substance use, the social-sexual-environmental, and psychological contexts in which sexual risk behaviors occurred. Since learning of their HIV infection, the majority of participants had reduced their risky sexual behaviors; however, a subset (26%) of participants continued to have unprotected sex, in most cases with multiple partners. Substance use, the social environmental context of the sexual encounter, the psychological impact of HIV on sexual behavior, and partner characteristics were associated with high-risk sexual behaviors in this group. Among high-risk participants, factors associated with risky sexual behaviors clustered, with 57% reporting two or more factors. More intensive interventions are needed for this subset of youths living with HIV, including assessment and treatment for substance use and mental health issues, strategies for stress reduction, and partner interventions.
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Hightow-Weidman LB, Smith JC, Valera E, Matthews DD, Lyons P. Keeping them in "STYLE": finding, linking, and retaining young HIV-positive black and Latino men who have sex with men in care. AIDS Patient Care STDS 2011; 25:37-45. [PMID: 21162690 DOI: 10.1089/apc.2010.0192] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young men who have sex with men (YMSM) of color are at particularly increased risk for HIV infection compared to white MSM. National data highlight the need to link YMSM of color to care to improve their overall health and stem further infections, yet, there is limited data on interventions and clinical outcomes focused on engaging and retaining youth, specifically HIV-infected YMSM of color in care. To address the medical care needs of this underserved population, in 2005, the Health Research and Services Administration (HRSA) created the YMSM of Color Initiative. Utilizing a social marketing campaign targeting youth and members of their sexual and social networks, testing and outreach on college campuses and within the broader community, and a tightly linked medical-social support network, we created STYLE (Strength Through Youth Livin' Empowered), a novel intervention that sought to diagnose, engage, and retain HIV-positive black and Latino YMSM in HIV primary care services. Over a 3-year period, 81 men were either newly diagnosed or reengaged in care. Overall, 63% of the cohort was retained in clinical care; defined as attending at least one medical visit every 4 months. Compared to the 3 years prior to STYLE, the odds ratio for whether or not someone attended a clinic visit was 2.58 (95% confidence interval [CI] 1.34-4.98) if enrolled in STYLE. We conclude that compared to a pre-STYLE cohort, STYLE was an effective intervention that increased HIV diagnoses, provided efficient and timely engagement in care for both those newly diagnosed and those who had fallen out of care and improved overall retention.
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Affiliation(s)
- Lisa B. Hightow-Weidman
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin C. Smith
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erik Valera
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Derrick D. Matthews
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrick Lyons
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Barroso J, Hammill BG, Leserman J, Salahuddin N, Harmon JL, Pence BW. Physiological and psychosocial factors that predict HIV-related fatigue. AIDS Behav 2010; 14:1415-27. [PMID: 20352317 DOI: 10.1007/s10461-010-9691-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fatigue is one of the most common and debilitating symptoms experienced by HIV-infected people. We report the results of our longitudinal analysis of physiological and psychosocial factors that were thought to predict changes in HIV-related fatigue in 128 participants over a 1-year period, in an effort to sort out the complex interplay among a comprehensive set of physiological and psychosocial variables. Physiological measures included hepatic function (aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase, total bilirubin, hepatitis C status), thyroid function (thyroid stimulating hormone, thyroxine), HIV viral load, immunologic function (CD4, CD8, CD4/CD8 ratio, CD16, CD8CD38), gonadal function (testosterone, dehydroepiandrosterone), hematologic function (hemoglobin, hematocrit, serum erythropoietin), and cellular injury (lactic acid). Psychosocial measures included childhood and adult trauma, anxiety, depression, social support, stressful life events, and post-traumatic stress disorder (PTSD). Unemployment, not being on antiretroviral therapy, having fewer years since HIV diagnosis, more childhood trauma, more stressful life events, less social support, and more psychological distress (e.g., PTSD, anxiety and depression) put HIV-infected persons at risk for greater fatigue intensity and fatigue-related impairment in functioning during 1-year follow-up. Physiological variables did not predict greater fatigue. Stressful life events had both direct and indirect effects on fatigue.
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Affiliation(s)
- Julie Barroso
- School of Nursing, Duke University, DUMC 3322, Durham, NC 27710, USA.
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Orban LA, Stein R, Koenig LJ, Conner LC, Rexhouse EL, Lewis JV, LaGrange R. Coping strategies of adolescents living with HIV: disease-specific stressors and responses. AIDS Care 2010; 22:420-30. [PMID: 20146110 DOI: 10.1080/09540120903193724] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined disease-specific stressors and coping responses employed by youth with HIV. Data were analyzed from Adolescent Impact, a multi-site study of 166 adolescents infected with HIV in three major US cities. Participants identified HIV-related stressors during a face-to-face interview. Coping strategies were measured using the adolescent version of the Kidcope. Emotional and behavioral functioning were assessed with the Youth or Adult Self Report symptom checklists. Medication-related stressors were most common (30%) and reported more often by perinatally infected youth, whereas youth infected through risk behaviors reported more disclosure-related stressors. Passive emotional regulation was perceived as the most used and most helpful coping strategy overall. Youth reporting medication adherence-related stressors used resignation most frequently. A two-factor model (Passive and Active Coping) emerged. The Passive Coping factor included strategies that do not directly approach the problem, whereas Active Coping included strategies that involve an active approach. Youth with moderately advanced disease (CD4 200-500 cells/mm(3)) used a Passive Coping style more often than healthier youth (CD4 > 500 cells/mm(3)). Additionally, Passive Coping was associated with greater emotional and behavioral problems. Youth infected with HIV may benefit from interventions promoting adaptive coping responses to HIV-specific stressors, particularly medication adherence.
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Abstract
PURPOSE The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research. DESIGN A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological. METHODS A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables. FINDINGS Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination. CONCLUSIONS Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being. CLINICAL RELEVANCE Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.
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Affiliation(s)
- Carolyn Garcia
- University of Minnesota School of Nursing, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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Meade CS, Wang J, Lin X, Wu H, Poppen PJ. Stress and coping in HIV-positive former plasma/blood donors in China: a test of cognitive appraisal theory. AIDS Behav 2010; 14:328-38. [PMID: 19127424 DOI: 10.1007/s10461-008-9494-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 11/06/2008] [Indexed: 11/27/2022]
Abstract
Throughout the 1990s, many villagers in rural China were infected with HIV through commercial plasma/blood donation. These former plasma/blood donors (FPDs) experienced many HIV-related stressors. This study tested a cognitive appraisal model of stress and coping in a sample of HIV-positive adult FPDs. Participants (N = 207) from multiple villages completed a battery of questionnaires assessing HIV-related stress, HIV symptoms, cognitive appraisal, coping behaviors, and psychological distress. Participants reported high levels of HIV-related stress, depression, and anxiety. In a structural equation model, greater HIV-related stress, HIV symptoms, and threat appraisal were directly associated with psychological distress. HIV-related stress was also indirectly associated with psychological distress through threat appraisal. In a second model, coping was found to mediate the relationship between challenge appraisal and psychological distress. Results support the utility of cognitive appraisal theory. Stress management interventions targeting HIV-positive FPDs in China are indicated.
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Affiliation(s)
- Christina S Meade
- Department of Psychiatry, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA.
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