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Sanders R, Dombrowski JC, Hajat A, Buskin S, Erly S. Associations between adverse childhood experiences, viral suppression, and quality of life among persons living with HIV in Washington state. AIDS Care 2024; 36:937-945. [PMID: 38176057 PMCID: PMC11222305 DOI: 10.1080/09540121.2023.2299339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
Adverse childhood experiences (ACEs) have been linked to numerous negative health outcomes in adulthood and have been recognized as a hurdle to participating in HIV care. However, few studies have examined the cumulative impact that different types of childhood trauma have on HIV care engagement and HIV outcomes. This study characterized the relationship between ACEs, viral suppression, and health-related quality of life (HRQOL) among persons living with HIV (PLWH). We used HIV surveillance data and self-reported information on ACEs and HRQOL from PLWH in Washington State from 2018-2020. Logistic regression was used to assess the relationship between the quantity and type of ACEs and viral suppression. We used Poisson regression to examine the relationship between ACEs and HRQOL as measured by unhealthy days. The majority of PLWH experienced ≥1 ACE (86.8%). ACEs were not significantly associated with the likelihood of viral suppression (OR ≥4 vs 0 ACEs: 0.49, 95% CI: 0.12-2.09), but ACEs were associated with more unhealthy days experienced in a 30-day period (RR ≥4 vs 0 ACEs: 3.19, 95% CI: 1.59-6.40). These findings provide support that trauma is common among PLWH, and efforts to address the impact of childhood trauma may work to improve quality of life.
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Affiliation(s)
- Rachel Sanders
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Susan Buskin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Steven Erly
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Office of Infectious Disease, Washington State Department of Health, Tumwater, WA, USA
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2
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Zeleke TA, Alemu K, Ayele TA, Denu ZA, Mwanri L, Azale T. Systematic review and meta-analysis on the effect of depression on ART adherence among women living with HIV. PLoS One 2024; 19:e0300106. [PMID: 38900748 PMCID: PMC11189173 DOI: 10.1371/journal.pone.0300106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/21/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Depression is a very common psychiatric disorder in worldwide. Globally, Human Immunodeficiency Virus (HIV) is highly prevalent among women, and are disproportionately affected by depression. Antiretroviral Therapy (ART) adherence which could highly be affected by depression is yet to be explored effectively. Depression affects overall poor HIV clinical outcomes, socioeconomic and social interactions. However, it is not well understood specifically how depression affects ART adherence in women living with HIV (WLWHIV). Investigating the effects of depression on ART adherence is critical in order to develop nuanced new evidence to address non-adherence in WLWHIV. OBJECTIVE To conduct a meta-analysis on the correlation between depression and adherence to antiretroviral therapy among women living with HIV in the globe. METHOD Using population, exposed and outcome approach, we searched Scopus, PubMed, EMBASE, Cochrane Library, Psych info, Web of science and google scholar for cohort and cross-sectional studies globally. The search strategy was structured comprising terms associated with antiretroviral therapy and adherence, women living with HIV and depression. We evaluated the paper quality, using the Newcastle-Ottawa Scales (NOS). The fixed effect model was used to analysis the effect of depression on ART adherence. RESULT A total of 8 articles comprise 6474 participants were included in this study. There were controversial findings related to the effect of depression to ART adherence. Among three cross-sectional study, one article demonstrating, depression was associated with ART adherence. Of the five cohort studies, four cohort studies reported association. The overall pooled estimated effect of depression on ART adherence was 1.02 [RR = 1.015 with 95% CI (1.004, 1.026)] with a p-value of 0.005. CONCLUSION AND RECOMMENDATION Depression was the risk factor for ART adherence among women living with HIV. It is therefore, necessary for clinician to note this and perform screening for ART adherence. TRIAL REGISTRATION The review protocol was developed with prospero registration: CRD42023415935.
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Affiliation(s)
- Tadele Amare Zeleke
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewditu Abdissa Denu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide, Australia
| | - Telake Azale
- Department of Health Promotion and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Addo PNO, Brown MJ, Nkwonta CA, Kaur A, James T, Qiao S. "I Don't Believe That One": A Qualitative Study of Undetectable = Untransmittable Views Among Older Adults Living With HIV in South Carolina. J Assoc Nurses AIDS Care 2024; 35:135-143. [PMID: 38949907 PMCID: PMC11217588 DOI: 10.1097/jnc.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT Undetectable = Untransmittable (U = U) means that people with HIV who achieve and maintain an undetectable viral load have effectively zero risk of sexually transmitting the virus to others. However, research on how U = U is perceived by older adults living with HIV (OAH) is currently lacking. This study explored U = U views among OAH. From October 2019 to February 2020, we conducted open-ended interviews with 24 OAH recruited at an HIV clinic in South Carolina. Interviews were audio-recorded and transcribed. We employed thematic analysis in this study. Three themes emerged from the analysis: (a) Conflicting beliefs in U = U; (b) Use condoms regardless; and (c) Fear of HIV reinfection. Despite strong scientific evidence supporting U = U, some OAH do not believe in U = U. This lack of belief could deprive OAH of the benefits U = U offers. Therefore, it is vital to educate OAH about U = U to enhance their understanding and belief in U = U.
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Affiliation(s)
- Prince Nii Ossah Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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4
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Yuan GF, Zhang R, Qiao S, Li X, Zhou Y, Shen Z. Longitudinal Analysis of the Relationship Between Internalized HIV Stigma, Perceived Social Support, Resilience, and Depressive Symptoms Among People Living with HIV in China: A Four-Wave Model. AIDS Behav 2024; 28:645-656. [PMID: 38091128 DOI: 10.1007/s10461-023-04251-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 02/20/2024]
Abstract
Depression is one of the most common mental health problems among people living with HIV (PLWH). However, the longitudinal psychological mechanism underlying the link of internalized HIV stigma and depressive symptoms remains a research gap. This study attempted to articulate how and to what extent perceived social support and resilience mediate the longitudinal associations between internalized HIV stigma and depressive symptoms. A sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval and four waves of follow-up was used in the current study. Participants were asked to complete self-report questionnaires. The associations among main study variables were examined via a complete longitudinal mediation approach. Results indicated that the linkage between internalized HIV stigma at T1 and depressive symptoms at T4 was serially mediated by perceived social support at T2 and resilience at T3, and perceived social support at T2 and depressive symptoms at T3 serially mediated the relationship between resilience at T1 and internalized HIV stigma at T4. Depressive symptoms at a previous time point consistently predicted the levels of internalized HIV stigma at subsequent time points. The study highlights the complex interplay between internalized HIV stigma, mental health problems, and protective factors in a longitudinal context. The findings suggest the need to incorporate interventions aimed at enhancing social support and resilience in mental health programs for PLWH, as these factors may interrupt the pathway from internalized HIV stigma to depressive symptoms and potentially improve the overall psychological well-being of this population.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China.
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Ran Zhang
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
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5
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Brown MJ, James T, Kaur A, Addo PNO, Nkwonta CA, Hansen NB, Onwuegbuzie AJ. Childhood sexual abuse and antiretroviral therapy adherence among older adults living with HIV: a mixed methods study. AIDS Care 2024; 36:17-25. [PMID: 37666211 PMCID: PMC10841262 DOI: 10.1080/09540121.2023.2254036] [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: 02/06/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
Findings on the association between childhood sexual abuse (CSA) and antiretroviral therapy (ART) adherence have been varied, with some studies showing a relationship, or a lack thereof. However, to our knowledge, no study has examined this association among older adults living with HIV (OALH). Therefore, the purpose of this study was to examine the association between CSA and ART adherence among OALH using a mixed methods approach. This study, which involved a concurrent design, had two phases. The first phase comprised in-depth, semi-structured interviews of 24 adults aged 50 and older living with HIV in South Carolina. The second phase included data from 91 OALH. Thematic analysis and multivariable regression models, adjusting for age, gender, race, and income, were used to determine the association between CSA and ART adherence. The main theme emerging from the qualitative data was that CSA was not linked with ART adherence. However, contrastingly, quantitative analyses revealed a negative statistically significant association between CSA and ART adherence (adjusted β: -3.35; 95% CI: -5.37, -1.34). This difference in findings could be due to the hidden impact of trauma and/or the use of different study populations. Future research should assess mediating pathways between CSA and ART adherence.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Prince Nii Ossah Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Nathan B. Hansen
- Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Anthony J. Onwuegbuzie
- Faculty of Education, University of Cambridge, Cambridge, England
- Faculty of Education, University of Johannesburg, Johannesburg, South Africa
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O'Grady T, Inman N, Younger A, Huang B, Bouton TO, Kim H, DeLorenzo E. The Characteristics and HIV-Related Outcomes of People Living with Co-occurring HIV and Mental Health Conditions in the United States: A Systematic Review of Literature from 2016 to 2021. AIDS Behav 2024; 28:201-224. [PMID: 37563293 PMCID: PMC10803443 DOI: 10.1007/s10461-023-04150-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
Considering advances in HIV prevention and treatment, jurisdictional efforts to end the HIV/AIDS epidemic, and reduced stigma towards people living with HIV infection and mental health conditions, the authors systematically reviewed studies published between 2016 and 2021 and identified 45 studies that met the eligibility criteria. The review found that stigma towards mental health conditions still acts as a barrier to accessing HIV treatment, which impacts treatment outcomes. Additionally, social determinants of health, such as housing instability and poverty, appear to impact mental health and, therefore, HIV-related outcomes. The review also highlighted the mutually reinforcing effects of HIV, mental health, and substance use conditions, providing valuable insights into the syndemic effects of these co-occurring conditions. Overall, the review highlights the need to address stigma and social determinants of health in HIV prevention and treatment efforts and to integrate mental health services into HIV care to improve outcomes for people living with both HIV and mental health conditions.
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Affiliation(s)
- Thomas O'Grady
- New York State Department of Health, AIDS Institute, Albany, NY, USA.
- New York State Department of Health, Corning Tower, ESP, Room 760, Albany, NY, 12237-0627, USA.
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Pl, Rensselaer, NY, 12144, USA.
| | - Nina Inman
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Alitasha Younger
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Bishan Huang
- New York State Department of Health, AIDS Institute, Albany, NY, USA
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Pl, Rensselaer, NY, 12144, USA
| | | | - Heeun Kim
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Emily DeLorenzo
- New York State Department of Health, AIDS Institute, Albany, NY, USA
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7
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Musanje K, Kamya MR, Kasujja R, Vanderplasschen W, Sinclair DL, Baluku MM, Odokonyero RF, Namisi CP, Mukisa J, White RG, Camlin CS. The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial. J Int Assoc Provid AIDS Care 2024; 23:23259582241236260. [PMID: 38446992 PMCID: PMC10919136 DOI: 10.1177/23259582241236260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | | | | | - Martin M. Baluku
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | | | - Charles P. Namisi
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
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8
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Yuan GF, Tam CC, Yang X, Qiao S, Li X, Shen Z, Zhou Y. Associations Between Internalized and Anticipated HIV Stigma and Depression Symptoms Among People Living with HIV in China: A four-wave Longitudinal Model. AIDS Behav 2023; 27:4052-4061. [PMID: 37392272 DOI: 10.1007/s10461-023-04119-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
Previous research has documented that HIV-related stigma (e.g., internalized and anticipated stigma) is detrimental to the mental health of people living with HIV (PLWH). However, longitudinal data on the bidirectional relationship between HIV-related stigma and depression symptoms are limited. The purpose of this study was to examine the bidirectional association among internalized and anticipated HIV stigma and depression symptoms among Chinese PLWH. A four-wave longitudinal design (6 months intervals) was employed among 1,111 Chinese PLWH (Mage = 38.58, SD = 9.16, age range: 18-60 years; 64.1% men). The bidirectional model was examined using a random-intercept cross-lagged panel model (RI-CLPM), which evaluated the within- and between-person effects of study variables. At the within-person level, results indicated that depression symptoms at T2 mediated the linkage between internalized HIV stigma at T1 and anticipated HIV stigma at T3, and that anticipated HIV stigma at both T2 and T3 mediated the relationship between depression symptoms at the previous time point and internalized HIV stigma at the subsequent time point. Furthermore, a bidirectional association was found between anticipated HIV stigma and depression symptoms across four waves. At the between-person level, internalized and anticipated HIV stigma were significantly associated with depression symptoms. This study highlights the complex interplay between different forms of HIV-related stigma and mental health problems among PLWH and underscores the importance of considering the bidirectional relationship between the development of psychopathology and stigmatization process in clinical practice.
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Affiliation(s)
- Guangzhe Frank Yuan
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Cheuk Chi Tam
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xueying Yang
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China
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Poxon A, Leis M, McDermott M, Kariri A, Kaul R, Kimani J. Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya. Int J Emerg Med 2023; 16:47. [PMID: 37537558 PMCID: PMC10399019 DOI: 10.1186/s12245-023-00516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/02/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused. Emergency medicine is a rapidly expanding field in Kenya and may provide a novel venue for initiating or optimizing HIV prevention services. This study examined the characteristics of FSW from Nairobi, Kenya, who had utilized an emergency department (ED) during the past year to broaden our understanding of the patient factors related to usage. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019. The participants were categorized into those who attended an ED over the past year (acute care users) and clinic-only users (control). A modified version of the WHO Violence Against Women Instrument assessed gender-based violence. Multivariable negative binomial logistic regressions evaluated predictors of health care use among these populations. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 101 and 116 were acute care and control populations, respectively. Acute care users had 12.7 ± 8.5 healthcare visits over a 12-month period, and the control population had 9.1 ± 7.0 (p < 0.05). ED attendance did not improve the PrEP usage, with 48.5%, and 51% of acute care and clinic users indicated appropriate PrEP use. Patient factors that correlated with health care utilization among acute care users included client sexual violence (OR 2.2 [1.64-2.94], p < 0.01), PrEP use (OR 1.54 (1.25-1.91), < 0.01), and client HIV status (OR 1.35 (1.02-1.69), p < 0.01). CONCLUSIONS Many FSW at high risk for HIV were not accessing HIV prevention tools despite attending a dedicated FSW clinic offering such services. FSW who had attended an ED over the past year had a higher prevalence of HIV risk factors, demonstrating that emergency departments may be important acute intervention venues to prevent HIV transmission in this population. These results can guide policy design, health care provider training, and facility preparedness to support strategies aimed at improving HIV prevention strategies for FSW in Kenyan ED's.
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Affiliation(s)
- Amanda Poxon
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada.
| | - Maria Leis
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada
| | - Miranda McDermott
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada
| | - Antony Kariri
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Rupert Kaul
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada
| | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology, University of Manitoba, Manitoba, Canada
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10
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Jones MC, Byun JY, Billings R, Shorten A, Kempf MC, Vance DE, Puga F. Tools for Screening and Measuring Anxiety Among Women Living with HIV of Reproductive Age: A Scoping Review. AIDS Behav 2023:10.1007/s10461-023-03990-9. [PMID: 36757556 DOI: 10.1007/s10461-023-03990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
Emerging evidence suggests that women living with HIV (WLWH) may experience higher rates of anxiety than men living with HIV and women living without HIV. To date, relatively little knowledge exists on valid anxiety screening and diagnostic tools and how they are used among WLWH, specifically WLWH of reproductive age. Thus, the purpose of this scoping review was to describe what is known in the published literature about anxiety among WLWH and the tools used to measure and screen for anxiety in clinical and research contexts. The Arksey and O'Malley methodological framework was used to guide a scoping review of published articles in PsycINFO, Scopus, Sociological Abstracts, and PubMed databases. Twenty-one measures of anxiety were used across the 52 articles identified in the search. Most measures used were self-report. Inconsistencies in standardized screening tools and cutoff scores were observed across studies. Further, measures to assess anxiety varied among studies focused on WLWH. Based on the results from this review, there is a need for consistent, valid measures of anxiety to advance research and clinical practice to support the well-being of WLWH.
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Affiliation(s)
- Meghan C Jones
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA.
| | - Jun Y Byun
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
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11
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Traynor SM, Schmidt RD, Gooden LK, Matheson T, Haynes L, Rodriguez A, Mugavero M, Jacobs P, Mandler R, Del Rio C, Carrico AW, Horigian VE, Metsch LR, Feaster DJ. Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions. J Clin Med 2022; 12:114. [PMID: 36614917 PMCID: PMC9820894 DOI: 10.3390/jcm12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network's CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals' experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.
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Affiliation(s)
- Sharleen M. Traynor
- Clinical Trials Research Associate Program, Durham Technical Community College, Durham, NC 27703, USA
| | - Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lauren K. Gooden
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd # 229, Birmingham, AL 35233, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, MD 20892, USA
| | - Raul Mandler
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, GA 30322, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lisa R. Metsch
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
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Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders. SSM - MENTAL HEALTH 2022; 2:100112. [PMID: 36688232 PMCID: PMC9792377 DOI: 10.1016/j.ssmmh.2022.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/28/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023] Open
Abstract
Background Antiretroviral therapy (ART) has potential to eliminate perinatal HIV infections, but adherence to ART in late pregnancy and postpartum is often suboptimal. Intimate partner violence (IPV) may influence non-adherence among perinatal women living with HIV (WWH), but few quantitative studies have examined this over time or explored mechanisms for this association. Methods We used secondary data from a parent trial in Johannesburg comprising WWH from the control arm (n=63) and WWH ineligible for the trial (n=133). Trained nurse researchers administered questionnaires at first antenatal visit on past-year psychological, physical, and/or sexual IPV (WHO instrument), socio-demographics (age, food security, education), and perinatal common mental symptoms of depression (Hospital Anxiety and Depression Screener-d); anxiety (HADS-a); post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire). At endline visit 2-4 months postpartum, nurse researchers assessed self-reported ART adherence using a visual analog scale (with ≥95% considered "good"). We fitted structural equation models (SEM) in MPlus to explore direct and indirect effects of IPV on ART adherence. Results Of 196 perinatal WWH, 53.1% reported IPV exposure at baseline. The majority of participants (85.7%) had good perinatal ART adherence. In adjusted models, IPV at baseline was associated with halved odds of good adherence (aOR=0.51, 95%CI=0.20-0.96). IPV was associated with higher adjusted odds of probable depression (aOR=4.64), anxiety (aOR=2.85), and PTSD (aOR=3.42). In SEM, IPV had a direct (standardized coef=-0.22) and indirect effect (coef=-0.05) on ART via common mental disorders. The total effect of IPV on perinatal adherence was of moderate size (coef= -0.27) and the model had good fit (CFI=0.972; TLI=0.969; RMSEA=0.045; SRMR=0.076). Conclusion IPV was longitudinally associated with perinatal ART non-adherence in part due to its relationship with mental health symptomology. Addressing IPV within clinical care has potential to improve perinatal mental health, maternal HIV outcomes, and HIV-free infant survival.
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Brown MJ, Nkwonta CA, Kaur A, James T, Haider MR, Weissman SB, Hansen NB, Heckman TG, Li X. Intervention program needs for older adults living with HIV who are childhood sexual abuse survivors. Aging Ment Health 2022; 26:2195-2201. [PMID: 34766546 PMCID: PMC9095752 DOI: 10.1080/13607863.2021.1998358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/17/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Childhood sexual abuse (CSA) prevalence estimates range from 8-11% among older adults and may range from 16 to 22% among older adults living with HIV (OALH). CSA experiences can still impact the quality of life of older adults. To the best of our knowledge, however, there are no CSA-focused interventions tailored for OALH. Using a qualitative approach, this study characterized the desired components of a trauma-focused intervention for OALH who are CSA survivors. METHODS Twenty-four (24) adults aged 50 years of age or older who were living with HIV and had experienced CSA were recruited from a large HIV immunology center in South Carolina. Participants completed in-depth, qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis. RESULTS Three main themes emerged: program format and modality, program content, and program coordinator. Most participants expressed a desire for a trauma-focused intervention program in which the CSA experience was addressed and they could talk to someone either individually, as a group, and/or both. CONCLUSION A trauma-focused intervention addressing CSA may be helpful for OALH who are CSA survivors. Future research should focus on designing and implementing age-appropriate interventions addressing the CSA experience, increasing resilience, and developing adaptive coping skills.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mohammad Rifat Haider
- Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Sharon B. Weissman
- School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Nathan B. Hansen
- Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Timothy G. Heckman
- Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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14
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Haller K, Fritzsche S, Kruse I, O’Malley G, Ehrenthal JC, Stamm T. Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study. Front Psychol 2022; 13:913081. [PMID: 35814056 PMCID: PMC9260657 DOI: 10.3389/fpsyg.2022.913081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAlthough treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.Methods194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.ResultsNon-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p < 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.ConclusionIn cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.
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Affiliation(s)
- Karl Haller
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Hematology, Oncology, and Tumor Immunology, Charité – University Medicine Berlin, Berlin, Germany
- *Correspondence: Karl Haller, ,
| | | | - Irina Kruse
- Cardiology Department, Schlosspark-Klinik, Berlin, Germany
| | - Grace O’Malley
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – University Medicine Berlin, Berlin, Germany
| | | | - Thomas Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Germany
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15
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Sangaramoorthy T, Haddix M, Agopian A, Yellin H, Mouhanna F, Abdi H, Dorsey K, Peterson J, Kharfen M, Castel AD. Measuring Unmet Needs among Persons Living with HIV at Different Stages of the Care Continuum. AIDS Behav 2021; 25:1954-1967. [PMID: 33537918 DOI: 10.1007/s10461-020-03125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Unmet needs can impede optimal care engagement, impacting the health and well-being of people living with HIV (PLWH); yet, whether unmet needs differ by care engagement status is not well understood. Using surveys and qualitative interviews, we examined and compared unmet needs for PLWH (n = 172) at different levels of care engagement. Unmet needs varied only slightly by care status. Survey findings revealed that provision of housing, emergency financial assistance, employment assistance, and food security were the greatest unmet need; for those in care, housing was the greatest unmet need, whereas for those sporadically in care or out of care, employment assistance was the greatest unmet needs. Qualitative interviews likewise illustrated that a lack of financial resources including insurance, housing, employment, and transportation presented barriers to care engagement across all care groups. Our findings indicate that unmet needs among PLWH are complex and multi-faceted across care engagement status.
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Affiliation(s)
| | - Meredith Haddix
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anya Agopian
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hannah Yellin
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Farah Mouhanna
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hibo Abdi
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Kerri Dorsey
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - James Peterson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - Amanda D Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
- Department of Epidemiology, The Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, Washington, DC, 20052, USA.
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16
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Leis M, McDermott M, Koziarz A, Szadkowski L, Kariri A, Beattie TS, Kaul R, Kimani J. Intimate partner and client-perpetrated violence are associated with reduced HIV pre-exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross-sectional study of female sex workers from Nairobi, Kenya. J Int AIDS Soc 2021; 24 Suppl 2:e25711. [PMID: 34164924 PMCID: PMC8222843 DOI: 10.1002/jia2.25711] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION UNAIDS has identified female sex workers (FSW) as a key HIV at-risk population. FSW disproportionately experience gender-based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre-exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client-perpetrated violence against FSW, mental health outcomes and PrEP use. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client-perpetrated violence, and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 56.8% (125/220) reported depression (PHQ-9 ≥ 10) and 39.1% (86/220) reported anxiety (GAD-7 ≥ 10). Only 41.4% (91/220) reported optimal use of PrEP (taken correctly six to seven days/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12 months (90%, 198/220). Any recent IPV was frequent (78.7%, 129/164), particularly emotional IPV (66.5%, 109/164), as was any client-perpetrated violence in the past 12 months (80.9%, 178/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, p = 0.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, p = 0.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client-perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, p = 0.01) was associated with decreased PrEP use, whereas client-perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, p = 0.02). CONCLUSIONS There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client-perpetrated emotional violence was associated with PrEP non-use. Interventions to reduce gender-based violence may independently enhance HIV prevention and reduce the mental health burden in this community.
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Affiliation(s)
- Maria Leis
- Department of MedicineUniversity of TorontoTorontoCanada
| | | | - Alex Koziarz
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Leah Szadkowski
- Biostatistics Research UnitUniversity Health NetworkTorontoCanada
| | - Antony Kariri
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
| | - Tara S Beattie
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonEngland
| | - Rupert Kaul
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Joshua Kimani
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
- Department of Medical MicrobiologyUniversity of ManitobaManitobaCanada
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"Todo se trata de a quién conoces": Social Networks and Drug Use Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2021; 25:1276-1289. [PMID: 33201429 DOI: 10.1007/s10461-020-03094-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 12/30/2022]
Abstract
The purpose of this study was to characterize the social networks of female sex workers (FSWs) living with HIV in the Dominican Republic (DR) and to examine the association between daily drug use and network risk profile. The study employed a micro-longitudinal observational design using a 7-day mobile health (mHealth) daily diary to collect daily substance use behaviors and social network data was collected at study enrollment. A series of crude and adjusted modified log-Poisson repeated measures regression models with generalized estimating equations (GEE), clustering by individual with a compound symmetry working correlation structure were fit to estimate the relative risks and 95% confidence intervals. Controlling for individual level factors, findings revealed that FSWs with more network members who were drug users (≥ 3) and more network members who were sexual partners and also drugs users (≥ 2) were 8.89 (95% CI 2.62, 30.22) and 6.08 (95% CI 1.20, 30.92) times more likely to engage in daily drug use compared to women with small drug and sex and drug networks. Study findings demonstrate the role high risk networks have on risk behaviors. Results may be used to inform interventions that focus on modifying negative social ties, creating and/or improving existing positive support relationships, and integrating drug use harm reduction promotion within HIV treatment programs.
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18
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Santos WND, Silva RSD, Souza FMDLC, Santos RSDC, Oliveira ICD, Silva RARD. Ineffective health control: concept analysis. Rev Bras Enferm 2021; 74:e20190158. [PMID: 33787772 DOI: 10.1590/0034-7167-2019-0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/05/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to identify and synthesize the concept of Ineffective Health Control. METHODS Concept Analysis from the perspective of Walker and Avant, operationalized by an integrative review in the databases Scopus, LILACS, PubMed, CINAHL, Web of Science, Science Direct e Cochrane, using the descriptors: Adhesion to Medication; Cooperation and Adherence to Treatment and Acquired Immunodeficiency Syndrome. RESULTS five critical attributes were identified for the concept, namely: patient's refusal to follow the therapeutic plan; abandoning treatment and worsening signs and symptoms; difficulty in reaching agreed goals; difficulty following health professionals' guidelines; multifactorial and dynamic process. CONCLUSIONS the concept of Ineffective Health Control is characterized by a multifactorial and dynamic process evidenced by the patient's refusal to follow a therapeutic plan, favouring the abandonment of treatment and resulting in the worsening of signs and symptoms and failure to reach goals.
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Abstract
Childhood sexual abuse (CSA) has been shown to be more prevalent among populations living with HIV. Antiretroviral therapy (ART) adherence is crucial for populations living with HIV as it significantly increases the likelihood of attaining and maintaining viral suppression. Previous findings on the association between CSA and ART adherence have been mixed. The current mixed-methods systematic review aimed to identify quantitative and qualitative studies from CINAHL, PsycInfo, PubMed, and Web of Science examining the relationship between CSA and ART adherence. Authors were also contacted if relevant data were unpublished. Studies had to be published from January 1, 2000 to April 1, 2019, written in English, and examined CSA as an exposure and ART adherence as an outcome. Four domains were combined: 1) childhood sexual abuse; 2) child; 3) antiretroviral; and 4) adherence. Eight quantitative and two qualitative studies were retained. The results showed that four quantitative studies found no association while the other four found factors such as timing of victimization, mental health and gender influenced the association between CSA and ART adherence. Themes emerging from the qualitative studies included use of ART evoking memories of CSA; CSA impacting mental health; and mental health treatment improving ART adherence. Mixed insights included the intricate links between CSA and ART adherence and the role of external factors on the relationship. ART adherence intervention programs may be needed for people who have experienced CSA. However, future studies are needed that will examine the association between CSA and ART adherence and include subgroup analyses.
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20
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Yemeke TT, Sikkema KJ, Watt MH, Ciya N, Robertson C, Joska JA. Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:4842-4862. [PMID: 29294819 PMCID: PMC5936676 DOI: 10.1177/0886260517718186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. The goal of this study was to examine the prevalence of traumatic experiences and mental health distress among women in an HIV clinic in Cape Town, South Africa, and to explore the acceptability of routine screening in this setting. Seventy HIV positive women were screened following referral from health care workers in the clinic. Among the participants, 51% reported a history of sexual abuse and 75% reported physical intimate partner violence (physical IPV). Among all participants, 36% met screening criteria for depression; among those with traumatic experiences (n = 57), 70% met screening criteria for posttraumatic stress disorder (PTSD). Compared with reporting no sexual abuse or physical IPV, having experienced both sexual abuse and physical IPV was significantly associated with higher odds of depression, while reporting either sexual abuse or physical IPV individually was not significantly associated with increased odds of depression. Among women reporting sexual abuse, 61% were disclosing their experience for the first time during the screening; 31% of women with physical IPV experience were disclosing for the first time. Overall, 98% of participants thought screening should be routine and extended to all women as part of clinic care. Screening women for sexual abuse and physical IPV may be an important component of ensuring HIV care engagement.
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21
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Parish CL, Feaster DJ, Pereyra MR, Alcaide ML, Weber KM, Cohen MH, Levin S, Gustafson D, Merenstein D, Aouizerat BE, Donohue J, Webster-Cyriaque J, Wingood G, Kempf MC, Metsch LR. Women's HIV disclosure to the dentist: Does frequent contact matter? J Public Health Dent 2020; 81:65-76. [PMID: 33049081 DOI: 10.1111/jphd.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/29/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Research has shown inconsistent patterns of patients' HIV serostatus disclosure to their dentists. Common barriers to disclosure have included confidentiality concerns, fear of treatment refusal, and discrimination. This study evaluated the prevalence of HIV serostatus disclosure to the dentist, whether the frequency of dental care utilization is associated with disclosure, and reasons for nondisclosure among women living with HIV. METHODS We administered a cross-sectional oral health survey to 1,526 women living with HIV in the Women's Interagency HIV Study including questions regarding HIV serostatus disclosure to dentists. Logistic regression models were used to analyze the association between dental care utilization (at least annually versus less than annually) and HIV serostatus disclosure to dentists. RESULTS Overall, 83 percent of women reported that they disclosed their HIV serostatus to their dentist. The most common reasons for nondisclosure were: a) the dentist did not ask, b) believing that the dentist did not need to know, and c) not having a consistent dentist. In the multivariable logistic regression model, at least annual dental care utilization, compared to less than annual, led to a 59 percent reduction in the odds of HIV nondisclosure to the dentist. DISCUSSION Study findings highlight that dentists who see their patients infrequently should consider methods for overcoming barriers to HIV nondisclosure and the possibility that their patient's HIV serostatus is undisclosed. Educating women living with HIV about how disclosure to dentists is a critical component of their dental assessment and treatment, and how preventive dental treatment can improve overall health outcomes, is important.
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Affiliation(s)
- Carrigan L Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Daniel J Feaster
- Miller School of Medicine, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Maria L Alcaide
- Miller School of Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge H Cohen
- Cook County Bureau of Health Services, Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | | | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Services University, Brooklyn, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, USA
| | - Bradley E Aouizerat
- College of Dentistry Department of Oral and Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University, New York, NY, USA
| | - Jessica Donohue
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Webster-Cyriaque
- Department of Dental Ecology, University of North Carolina, School of Dentistry, Chapel Hill, NC, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa R Metsch
- School of General Studies and Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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22
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Villalba K, Attonito J, Jean-Gilles M, Rosenberg R, Sanchez M, Devieux J. The Effects of Childhood Sexual Abuse: The Role of Anxiety and Alcohol Use among Haitian Women Living with HIV. JOURNAL OF CHILD SEXUAL ABUSE 2020; 29:788-801. [PMID: 33006528 DOI: 10.1080/10538712.2020.1801939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
Childhood abuse has been linked to problematic drinking in adulthood. It is also documented that people living with HIV have higher rates of alcohol use than the general population. In Haiti, a total of 25% of women living with HIV have experienced childhood sexual abuse (CSA), which puts them at an increased risk for alcohol abuse. CSA has also been associated with anxiety disorders in adulthood. Therefore, it is critical to understand the relationship between CSA, anxiety, and alcohol use among women living with HIV. A total of 244 women living with HIV participated in this study, with 35% reporting CSA. Alcohol abuse was measured with the AUDIT, anxiety with the State-Trait Anxiety Inventory test, and sexual abuse with the Childhood Trauma Questionnaire. Compared to participants who did not experience childhood sexual abuse, participants who experienced childhood sexual abuse reported greater levels of alcohol use [(17.0, SD = 9.1) (11.9, SD = 8.6) p =.001] and anxiety [(55.8, SD = 9.8) (48.9 SD = 8.3) p =.001] respectively. The indirect effect of anxiety on the association between CSA and alcohol use was significant [(ß =.19 p =.05) 95% bootstrap CI.019 -.13] Thus, women who reported being sexually abused as children reported anxiety, which in turn, was associated with an increased risk for alcohol abuse. Results demonstrate that alcohol may be used as a negative coping mechanism to alleviate anxiety symptoms triggered by CSA. These findings elucidate the need for further research examining the impact that sexual trauma has on mental health.
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Affiliation(s)
| | | | | | | | | | - Jessy Devieux
- Florida International University , Miami, Florida, USA
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23
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Kabapy AF, Shatat HZ, Abd El-Wahab EW. Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis. Transbound Emerg Dis 2020; 67:2372-2388. [PMID: 32396689 DOI: 10.1111/tbed.13621] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
Abstract
Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I2 statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.
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Affiliation(s)
- Ahmed F Kabapy
- Fellow of Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt
| | - Hanan Z Shatat
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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24
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Madkour AS, Felker-Kantor E, Wallace M, Ferguson T, Welsh DA, Molina PE, Theall KP. Latent Alcohol Use Typologies and Health Status Among a Cohort of Adults Living with HIV. Alcohol Alcohol 2020; 54:584-592. [PMID: 31580404 DOI: 10.1093/alcalc/agz071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To characterize latent typologies of alcohol use among persons living with human immunodeficiency virus (HIV) (PLWH) and test their relationship with physical and mental health status. METHODS Baseline data from 365 adult in-care PLWH enrolled in the New Orleans Alcohol Use in HIV study were analyzed. Indicators of current and former heavy drinking, intoxication, withdrawal and dependence symptoms, alcohol-related problems and past contact with alcohol use treatment were drawn from validated scales. Physical and mental health measures included SF-36 subscales, medication non-adherence and anxiety, depressive and post-traumatic stress disorder symptoms. Latent class analysis was conducted to characterize alcohol drinking typologies. Logistic and ordinary least-squares regression were employed to test associations between alcohol use and health status. RESULTS Four latent classes were identified: heavy drinkers (36%), former heavy drinkers (14%), heavy drinkers with problems (12%) and low-risk drinkers/abstainers (38%). Controlling for background characteristics, low-risk drinkers/abstainers showed significantly better health compared to heavy drinkers with problems across most domains. Although current and former heavy drinkers without alcohol-related problems were similar to heavy drinkers with problems in most health domains, they presented worse mental health and energy compared to low-risk drinkers/abstainers. CONCLUSIONS Heavy drinkers with alcohol-related problems evidenced the worst health status among PLWH, and should be considered for mental and physical health interventions. However, interventions to improve physical and mental health of PLWH should consider history of heavy alcohol use, as current alcohol use status alone may be insufficient for identifying groups at increased risk.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - David A Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, 1901 Perdido Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Patricia E Molina
- Department of Physiology Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
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Azhar S, Gandham S, Vaudrey J, Oruganti G, Samuel RS. "They Kept Away": Social Isolation of Cisgender Women Living with HIV in Hyderabad, India. CLINICAL SOCIAL WORK JOURNAL 2019; 48:64-76. [PMID: 32834184 PMCID: PMC7315697 DOI: 10.1007/s10615-019-00736-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Social isolation of cisgender women living with HIV has been recognized as a barrier to early detection of the virus, disclosure of HIV status to partners, and access to healthcare and social work services. The goal of this study is to explore how social isolation and depression affect cisgender women living with HIV in Hyderabad, India. Sixteen cisgender women living with HIV were asked to complete in-depth interviews regarding their experiences with HIV stigma and depression. All interviews were digitally audio-recorded in Hindi or Telugu, then translated, transcribed, and analyzed using thematic content analysis by two to three coders. Three main themes emerged from the qualitative interviews among these cisgender women living with HIV: (1) "They kept away": Experiences with social isolation; (2) "I thought people would think badly about me": Perceived experiences of discrimination; and (3) "I will live till I die": Suicidality, resilience, and gaining hope. Our findings reinforce the need for emphasis on culturally appropriate interventions for depression for cisgender women living with HIV in India, including greater access to mental health resources, greater availability of trained counselors that share the same gender and are native speakers of Hindi or Telugu, and increased family and community support for socially isolated individuals.
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Affiliation(s)
- Sameena Azhar
- Graduate School of Social Service, Fordham University, 113 W. 60th Street, New York, NY 10023 USA
| | - Sabitha Gandham
- SHARE India, MediCiti Institute of Medical Sciences Campus, Ghanpur, RangaReddy District, Medchal, Telangana 501401 India
| | - Jason Vaudrey
- Graduate School of Social Service, Fordham University, 113 W. 60th Street, New York, NY 10023 USA
| | - Ganesh Oruganti
- SHARE India, MediCiti Institute of Medical Sciences Campus, Ghanpur, RangaReddy District, Medchal, Telangana 501401 India
| | - Revina Suhasini Samuel
- SHARE India, MediCiti Institute of Medical Sciences Campus, Ghanpur, RangaReddy District, Medchal, Telangana 501401 India
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26
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Hunter-Jones JJ, Gilliam SM, Carswell AL, Hansen NB. Assessing the Acceptability of a Mindfulness-Based Cognitive Therapy Intervention for African-American Women Living with HIV/AIDS. J Racial Ethn Health Disparities 2019; 6:1157-1166. [PMID: 31332688 DOI: 10.1007/s40615-019-00617-5] [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: 03/25/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 11/24/2022]
Abstract
African-American HIV-seropositive women are at elevated risk for depressive symptoms compared to their seropositive counterparts. Depressive symptoms have been linked to HIV/AIDS-related health predictors and outcomes such as medication and care adherence, and viral load. Project UPLIFT, a mindfulness-based cognitive therapy intervention originally designed for persons with epilepsy has been shown effective to reduce depressive and anxiety symptoms. Focus groups were conducted to assess the appropriateness and acceptability of UPLIFT for African-American HIV-seropositive women and to obtain feedback on needed modifications. The focus groups, including cisgender and transgender African-American HIV-seropositive women, revealed, while well received, modifications should include lowering the reading level of content and altering specific mindfulness-based exercises to make them relevant and acceptable to the target population. This qualitative work demonstrates UPLIFT could be a promising avenue to improve the mental health of African-American HIV-seropositive women, a group for which mindfulness interventions had not been previously considered. SIGNIFICANCE: Mindfulness-based interventions have been found effective in reducing depression, anxiety, and chronic pain. Further, it has been used for groups living with chronic illness, particularly HIV/AIDS. It has helped to improve mental and behavioral health, as well as increase CD4 count and reduce viral load for some samples of people living with HIV/AIDS. African-American women living with HIV/AIDS are especially vulnerable to poor mental and behavioral health given their experience of mental illness and hesitancy to engage mental healthcare. Though used for other groups of people living with HIV/AIDS, mindfulness-based cognitive therapy has not previously been considered for this population. This study explored the acceptability and feasibility of an MBCT intervention for this group. The data suggests that this intervention could be potentially useful in improving the mental health of this population, and includes suggestions for making the intervention culturally relevant.
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Affiliation(s)
- Josalin J Hunter-Jones
- SSchool of Social Work, College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA.
| | - Shantesica M Gilliam
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
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Abstract
Although HIV diagnoses among women have declined in recent years in the United States (U.S.), women accounted for 19% of new HIV diagnoses in 2016. In addition, women comprise 24% of the 973,846 persons living with HIV infection in the U.S. However, HIV prevention interventions targeting women are limited. We performed a review on HIV infection in women to increase awareness, improve overall care, and inform intervention development. A systematic literature review was conducted using literature published in PubMed, PsychINFO (EBSCO), and Scopus from July 2000 and June 2017. We included studies that: (1) were conducted in the U.S., (2) enrolled at least 50 HIV-positive women, and (3) utilized a case-control, cohort, or surveillance study design. Of 7497 articles, 48 articles met inclusion criteria. HIV diagnoses among women declined 32% between 2001 and 2016. In 2016, 61% of diagnoses in women were among African American women, and 56% were in the South. Women reported barriers to HIV care largely due to psychosocial challenges and social/structural determinants of health (SDH) barriers. Though new diagnoses among women have declined, racial and regional disparities remain. HIV prevention and research efforts with women are vital to inform interventions and reduce disparities.
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Affiliation(s)
- Symone May
- Public Health Summer Intern Program, Leidos Inc, Atlanta, Georgia.,Emory University Rollins School of Public Health, Atlanta, Georgia.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley Murray
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mannes ZL, Hearn LE, Zhou Z, Janelle JW, Cook RL, Ennis N. The association between symptoms of generalized anxiety disorder and appointment adherence, overnight hospitalization, and emergency department/urgent care visits among adults living with HIV enrolled in care. J Behav Med 2019; 42:330-341. [PMID: 30387009 PMCID: PMC6447438 DOI: 10.1007/s10865-018-9988-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022]
Abstract
This study examined the association between generalized anxiety disorder (GAD) symptoms and healthcare utilization (HCU) among 801 people living with HIV (PLWH). Participants recruited from community health centers in Florida completed questionnaires assessing demographics, substance use, symptoms of GAD and depression, and HCU. Adjusted binary and multinomial logistic regressions assessed the association between moderate-severe GAD symptoms and past 6-month missed HIV-care appointments, overnight hospitalization, and emergency department (ED)/urgent care visits. Participants reporting moderate-severe GAD symptoms had a greater odds of missing an HIV-care appointment (AOR 2.03, 95% CI 1.28-3.24, p = 0.003), spending 2 (AOR 4.35, 95% CI 2.18-8.69, p < 0.001) or 3+ (AOR 2.79, 95% CI 1.20-6.45, p = 0.016) nights in the hospital, and visiting an ED/urgent care facility 2 (AOR 2.63, 95% CI 1.39-4.96, p = 0.003) or 3+ (AOR 2.59, 95% CI 1.27-5.26 p = 0.008) times compared to participants reporting none-mild anxiety. Depression was associated with fewer ED/urgent care visits and overnight hospitalizations, while no association was found with missed primary care appointments. The role of anxiety in illness management remains understudied among PLWH. Anxiety identification and the development of interventions for anxiety among PLWH may have important consequences for healthcare cost saving, patient retention in care, and HIV-disease management.
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Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL, 32610-0165, USA.
| | - Lauren E Hearn
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, 4237 S Pipkin Road, Bldg 2, Lakeland, FL, 33811, USA
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Jennifer W Janelle
- Department of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100289, Gainesville, FL, 32610, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL, 32610-0165, USA
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29
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Young-Wolff KC, Sarovar V, Sterling SA, Leibowitz A, McCaw B, Hare CB, Silverberg MJ, Satre DD. Adverse childhood experiences, mental health, substance use, and HIV-related outcomes among persons with HIV. AIDS Care 2019; 31:1241-1249. [PMID: 30887831 DOI: 10.1080/09540121.2019.1587372] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
While persons with HIV (PWH) have benefited from significant advances in treatment and resulting longevity, mental health problems remain elevated in this population. Adverse childhood experiences (ACEs) are common among PWH and may negatively affect mental health and HIV-related outcomes. We examined the association between ACEs, depression and anxiety symptoms, substance use, antiretroviral therapy (ART) adherence, and HIV-clinical indicators in a sample of 584 PWH at risk for unhealthy alcohol use enrolled in a primary care-based alcohol intervention study. The sample was 96.9% male, 63.0% non-Hispanic white, with an average age of 49.0 years. ACEs were highly prevalent: 82.5% reported ≥1 ACE, including 34.2% reporting 1-2 ACEs, 25.0% reporting 3-4 ACEs, and 23.3% reporting ≥5 ACEs. Adjusting for demographics, having 1-2, 3-4 or ≥5 ACEs was significantly associated with anxiety (ORs (95%CI): 3.41 (1.13-10.33), 4.36 (1.42-3.36), and 3.96 (1.28-12.19), respectively) and poorer mental health quality of life (Betas (SE): -3.21 (1.40), -6.23 (1.51), and -7.09 (1.54), respectively), but not with other outcomes. Trauma-informed interventions to reduce anxiety and improve mental health quality of life in PWH may reduce the negative health sequelae of ACEs.
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Affiliation(s)
- Kelly C Young-Wolff
- a Division of Research, Kaiser Permanente , Oakland , CA , USA.,b Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
| | - Varada Sarovar
- a Division of Research, Kaiser Permanente , Oakland , CA , USA
| | | | - Amy Leibowitz
- a Division of Research, Kaiser Permanente , Oakland , CA , USA
| | - Brigid McCaw
- c Family Violence Prevention Program, Kaiser Permanente , Oakland , CA , USA
| | - Charles B Hare
- d Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center , San Francisco , CA , USA
| | | | - Derek D Satre
- a Division of Research, Kaiser Permanente , Oakland , CA , USA.,b Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
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30
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CEYLAN E, KOÇ A, İNKAYA AÇ, ÜNAL S. Determination of medication adherence and related factors among people living with HIV/AIDS in a Turkish university hospital. Turk J Med Sci 2019; 49:198-205. [PMID: 30764598 PMCID: PMC7350793 DOI: 10.3906/sag-1802-137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background/aim Widespread use of antiretroviral treatment (ART) has led to decrease in the incidence of HIV/AIDS-related mortality. Besides the availability of ART, medication adherence is essential for treatment success. There is a scarcity of data reported from Turkey regarding ART adherence among people living with HIV/AIDS (PLWHA). Therefore, this study was undertaken to determine medication adherence and related factors among PLWHA in Turkey. Materials and methods The sample consisted of 158 PLWHA, who were being followed up at Infectious Diseases Outpatient Clinic of Hacettepe University Hospital. Data were collected using an individual questionnaire and the Turkish version of the Morisky Medication Adherence Scale. Results The median patient age was 38 years, 80.4% were male, and 51.3% were married. The median duration of both HIV infection and ART was 3 years. Sixty-one percent used two drug regimens. Sixty-one percent were highly adherent to ART while 37.9% were moderately adherent. The absence/presence of social support resources, disease duration, ART duration, and being informed about the ART regimen were statistically associated with medication adherence. Conclusion Our results suggest that medication adherence is excellent among Turkish PLWHA. Interventions, including effective social support, and continuous counseling about ART, might further boost the adherence of PLWHA.
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Affiliation(s)
- Erdal CEYLAN
- Department of Nursing, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Ayşegül KOÇ
- Department of Nursing, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, AnkaraTurkey
| | - Ahmet Çağkan İNKAYA
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Serhat ÜNAL
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, AnkaraTurkey
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Mao Y, Qiao S, Li X, Zhao Q, Zhou Y, Shen Z. Depression, Social Support, and Adherence to Antiretroviral Therapy Among People Living With HIV in Guangxi, China: A Longitudinal Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:38-50. [PMID: 30742482 DOI: 10.1521/aeap.2019.31.1.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Depression can result in poor adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV), and social support can help mitigate the negative relationship. However, little is known about how depression and social support synergistically influence ART adherence over time. The current study aims to explore longitudinal associations between them and examine which sources of social support can play a mediating role between depression and ART adherence over time. A randomized controlled clinical trial was conducted between 2013 and 2016 in Guangxi, China. The study sample was composed of 319 PLHIV who were randomized into control condition and provided data at baseline and at least one of the six follow-ups. The results revealed negative associations of depression with ART adherence over time, and a mediating effect of perceived support from spouse/partner or children. Interventions to promote ART adherence should focus on strengthening PLHIV's relationships with their spouse/partner and children, promoting collaborative provider-patient relationships, and enhancing peer support among PLHIV.
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Affiliation(s)
- Yuchen Mao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
- School of Law and Public Affairs, Nanjing University of Information Science and Technology, Nanjing, China
| | - Qun Zhao
- School of Law and Public Affairs, Nanjing University of Information Science and Technology, Nanjing, China
| | - Yuejiao Zhou
- Institute of HIV/AIDS Control and Prevention, Guangxi CDC, Nanning, China
| | - Zhiyong Shen
- Institute of HIV/AIDS Control and Prevention, Guangxi CDC, Nanning, China
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Chenneville T, Gabbidon K, Lynn C, Rodriguez C. Psychological factors related to resilience and vulnerability among youth with HIV in an integrated care setting. AIDS Care 2019; 30:5-11. [PMID: 30632781 DOI: 10.1080/09540121.2018.1488032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Approximately 22% of HIV diagnoses in 2015 occurred among youth aged 13-24. Much is known about the risk factors and psychopathology present in youth living with HIV (YLWH), however, relatively little is known about resiliency in this population. The current study sought to assess factors related to resilience and vulnerability among YLWH as well as the impact of psychosocial factors on these constructs using existing clinical data from an integrated care clinic serving YLWH in the southeastern United States. Data included findings from mental health screeners administered as part of the standard protocol of care for youth aged 13-24 including information about anxiety (GAD-7), post-traumatic stress disorder (PC-PTSD), depression (PHQ-A or PHQ-9), substance use (CRAFFT), and medication adherence (BEHKA-HIV Action subscale) as well as viral load and demographic variables. Hierarchical linear regression was used to determine factors related to biological (viral load) and behavioral indicators of resilience and vulnerability (BEHKA-HIV Action subscale and CRAFFT). Results showed that anxiety was a significant covariate of both biological and behavioral indicators of resilience while gender was a significant factor associated with behavioral indicators of vulnerability. None of the psychological or demographic factors examined in this study were associated with substance use, a behavioral indicator of vulnerability and resilience. Our results support the need for clinicians to screen for and monitor anxiety symptoms among YLWH in integrated care settings in an effort to promote resilience and minimize vulnerability. Practical, evidence-based strategies should be applied in clinical settings to address medication adherence and anxiety among YLWH.
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Affiliation(s)
- Tiffany Chenneville
- a Department of Psychology , University of South Florida St. Petersburg , St. Petersburg , FL , USA
| | - Kemesha Gabbidon
- a Department of Psychology , University of South Florida St. Petersburg , St. Petersburg , FL , USA
| | - Courtney Lynn
- b Educational and Psychological Services , University of South Florida , Tampa , FL , USA
| | - Carina Rodriguez
- c Department of Pediatrics , University of South Florida , Tampa , FL , USA
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Ingram L, Qaio S, Li X, Deal M. The Inner Working of Trauma: A Qualitative Assessment of Experiences of Trauma, Intergenerational Family Dynamics, and Psychological Well-Being in Women With HIV in South Carolina. J Psychosoc Nurs Ment Health Serv 2018; 57:23-31. [PMID: 30376586 DOI: 10.3928/02793695-20181023-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/22/2018] [Indexed: 12/31/2022]
Abstract
Women with HIV are more likely to have a history of traumatic and stressful life experiences. The current study examines experiences of traumatic and stressful life events, issues co-occurring with experiences of trauma, and intergenerational family dynamics regarding trauma and psychological well-being in women with HIV. The study was guided by the theoretical approach of an integrative translational model that incorporates trauma-related factors into a psychosocial framework. Data were collected from interviews with 20 women with HIV and analyzed for thematic categories. Thematic analysis indicated that traumatic life events of women with HIV included experiences of loss, sexual assault, and homelessness. Women with HIV also experienced issues co-occurring with trauma, including substance use and mental illness. The current study adds to the existing body of research by including an analysis of intergenerational family dynamics and psychological well-being. Implications for health care professionals and recommendations for translating research into practice are also discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 23-31.].
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Motazedian N, Sayadi M, Firoozbakhtian A. Non-adherence to anti-retroviral medication in Shiraz, 2014: a cross sectional study. Afr Health Sci 2018; 18:384-393. [PMID: 30602966 PMCID: PMC6306967 DOI: 10.4314/ahs.v18i2.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Medication adherence is a dynamic and complex behavioral process, which is strongly influenced by personal, social and environmental factors. Objectives To determine the prevalence and factors affecting non-adherence to medication among HIV-infected patients. Methods and materials Design A cross-sectional study. Setting Voluntary Counseling and Testing Center (VCT), Shiraz, Fars province, in the South of Iran. Patients Among HIV-positive patients who received anti-retroviral therapy, 214 adult patients were selected through convenience sampling. Their medication adherence was checked by interview and counting the pills on visits during two months. Clinical and laboratory data were obtained from the patients' records. Results Non-adherence and adherence groups included 30.4% (65) and 69.6% (149) of the patients, respectively. The mean age of patients was 40.80±7.77 years, and ranged from 20 to 65 years. Majority of cases (65%) were male. A significant relationship was found between non-adherence to medications and the variables of transmission method, marital status, housing status, and CD4, but there was no significant relationship with gender. Conclusion The prevalence of medication adherence was similar to other regions with limited financial resources. To increase patient's medication adherence, they should be exposed to motivational interventions to promote their drug consumption, social and occupational support.
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Affiliation(s)
- Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Student Research Committee, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Firoozbakhtian
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Theall KP, Felker-Kantor E, Wallace M, Zhang X, Morrison CN, Wiebe DJ. Considering high alcohol and violence neighborhood context using daily diaries and GPS: A pilot study among people living with HIV. Drug Alcohol Depend 2018; 187:236-241. [PMID: 29684891 PMCID: PMC5959796 DOI: 10.1016/j.drugalcdep.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 02/07/2023]
Abstract
Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation's highest, and to examine how such activity spaces are associated with daily mood and health behaviors. In this small, pilot study, 11 participants were tracked with a global positioning system (GPS)-enabled application on their smartphones for 2 weeks. Activity spaces were created by connecting GPS points sequentially and adding buffers. Contextual exposure data (e.g., alcohol outlets) were connected to activity spaces. Participants also completed daily diary entry through texts 3 times per day regarding outcomes of substance use behaviors, mood, and medication adherence. This yielded a total of 18,007 GPS polyline records that we aggregated into 258 person-days that captured discrete occasions of exposure to contextual factors and subjects' behaviors and moods. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Exposure to social and built environment factors such as alcohol outlets was greater when participants were outside versus inside their residential census tract. Exposures on daily routes were also significantly associated with ART adherence, alcohol consumption, and mood. Findings suggest substantial differences between activity spaces and residential contexts. Activity spaces are relevant for PLWH and may impact HIV care and behavioral outcomes such as ART adherence and substance use.
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Affiliation(s)
- Katherine P Theall
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center Comprehensive Alcohol Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA.
| | - Erica Felker-Kantor
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center Comprehensive Alcohol Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Xiao Zhang
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA
| | - Christopher N Morrison
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Douglas J Wiebe
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
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Ajema C, Mbugua C, Memiah P, Wood C, Cook C, Kotut R, Digolo L. Addressing the dual health epidemics of HIV and sexual abuse among children and adolescents in Kenya: uptake of HIV counseling and post-exposure prophylaxis. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 9:1-9. [PMID: 29296104 PMCID: PMC5741064 DOI: 10.2147/ahmt.s149416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose Child sexual abuse and HIV are key health challenges in Kenya. In 2015, LVCT Health conducted a study aimed at assessing the quality of HIV-related services offered to child survivors of sexual violence in public health facilities. Materials and methods A qualitative data collection approach was utilized. Qualitative data were collected through in-depth interviews with 31 providers. Quantitative methods included a retrospective review of 164 records of child survivors of rape who had accessed services 6 months prior to the commencement of the study. SPSS Version 22 was used in the descriptive analysis of the medical records. Client exit interviews and observation data were analyzed using MS Excel. In-depth interviews were analyzed using a thematic analytical approach. Results Twenty-seven percent (n=164) survivors were documented to have received the first dose of postexposure prophylaxis (PEP). Providers did not conduct HIV pre- and posttest counseling for the survivors. There were no longitudinal follow-up mechanisms to ensure child survivors initiated on PEP adhered to the treatment plan. Less than 30% of survivors returned to the facility for PEP adherence counseling and follow-up HIV testing. Twenty providers cited capacity gaps in undertaking HIV risk assessment for child survivors. Limited availability of PEP is a barrier to HIV prevention, as most departments only offer services between 8 am and 5 pm. HIV tests were only available on weekdays before 5 pm. PEP being out of stock remains a barrier to HIV prevention. Conclusion Existing post-rape care services are not adequately structured to facilitate delivery of quality HIV-related services to child survivors. Health provider capacity in the management of children remains weak due to lack of skill-based training on the dynamics of responding to the needs of child survivors. There is a need for standard operating procedures and training modules on the prevention of HIV in the context of child sexual abuse.
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Affiliation(s)
- Carolyne Ajema
- Research and Strategic Information Department, LVCT Health, Nairobi, Kenya
| | | | - Peter Memiah
- Department of Public Health, University of West Florida, University Parkway, Pensacola, FL, USA
| | - Camille Wood
- Department of Public Health, University of West Florida, University Parkway, Pensacola, FL, USA
| | - Courtney Cook
- Biology Department, University of West Florida, University Parkway, Pensacola, FL, USA
| | - Ronald Kotut
- Post Rape Care Department, LVCT Health, Nairobi, Kenya
| | - Lina Digolo
- Research and Strategic Information Department, LVCT Health, Nairobi, Kenya
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Scott-Sheldon LAJ, Carey KB, Johnson BT, Carey MP. Behavioral Interventions Targeting Alcohol Use Among People Living with HIV/AIDS: A Systematic Review and Meta-Analysis. AIDS Behav 2017; 21:126-143. [PMID: 28831609 PMCID: PMC5660648 DOI: 10.1007/s10461-017-1886-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Alcohol use is often reported among people living with HIV/AIDS (PLWHA) and is associated with increased sexual risk and poor medication adherence. This meta-analysis evaluated the efficacy of behavioral interventions addressing alcohol use among PLWHA. Twenty-one studies (N = 8461 PLWHA) that evaluated an individual-level intervention addressing alcohol use alone or as part of a more comprehensive alcohol/HIV intervention, included a control condition, and were available through December 2016 were included. Independent raters coded study, sample, and intervention content. Weighted mean effect sizes, using random-effects models, were calculated. Results indicate that interventions reduced alcohol consumption, increased condom use, and improved medication adherence relative to controls (d +s = 0.10-0.24). Plasma viral load was also reduced in intervention versus control participants (d + = 0.14, 95% CI = 0.02, 0.26; k = 7). These findings show that behavioral interventions addressing alcohol use can successfully reduce alcohol consumption and also improve HIV-related outcomes among PLWHA.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.
| | - Kate B Carey
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, RI, USA
| | - Blair T Johnson
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
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Madhombiro M, Dube-Marimbe B, Dube M, Chibanda D, Zunza M, Rusakaniko S, Stewart D, Seedat S. A cluster randomised controlled trial protocol of an adapted intervention for alcohol use disorders in people living with HIV and AIDS: impact on alcohol use, general functional ability, quality of life and adherence to HAART. BMC Psychiatry 2017; 17:44. [PMID: 28129756 PMCID: PMC5273845 DOI: 10.1186/s12888-017-1208-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/17/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interventions for alcohol use disorders (AUDs) in HIV infected individuals have been primarily targeted at HIV risk reduction and improved antiretroviral treatment adherence. However, reduction in alcohol use is an important goal. Alcohol use affects other key factors that may influence treatment course and outcome. In this study the authors aim to administer an adapted intervention for AUDs to reduce alcohol use in people living with HIV/AIDS (PLWHA). METHODS This study is a cluster randomised controlled trial at 16 HIV care clinics. A motivational interviewing and cognitive behavioural therapy based intervention for AUDs, developed through adaptation and piloted in Zimbabwe, will be administered to PLWHA with AUDs recruited at HIV clinics. The intervention will be administered over 16 sessions at 8 HIV clinics. This intervention will be compared with an equal attention control in the form of the World Health Organization Mental Health Gap Action Programme (WHO mhGAP) guide, adapted for the Zimbabwean context. General function, quality of life, and adherence to highly active antiretroviral treatment (HAART) will be secondary outcomes. Booster sessions will be administered to both groups at 3 and 6 months respectively. The primary outcome measure will be the Alcohol Use Disorder Identification Test (AUDIT) score. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), World Health Organisation Quality of Life (WHOQoL) HIV, viral load, and CD4 counts will be secondary outcome measures. Outcome assessments will be administered at baseline, 3, 6, and 12 months. Moderating factors such as perceived social support, how people cope with difficult situations and post-traumatic exposure and experience will be assessed at baseline. Trained research assistants will recruit participants. The outcome assessors who will be trained in administering the outcome and moderating tools will be blinded to the treatment arms allocated to the participants. However, the principal investigator, participants and intervention staff will be unblinded. Data will be analysed using STATA Version 14. Primary and secondary outcomes will be measured at four time points that is; at baseline, 3, 6, and 12 months respectively. All participants will be included in the analysis of primary and secondary outcome measures. The mean AUDIT scores will be compared between groups using student t-tests. Multilevel logistic regression analysis will be performed for binominal variables and multilevel linear regression for continuous variables. Descriptive statistics will be computed for baseline and follow-up assessments. DISCUSSION The study will be the first to address problematic alcohol use in PLWHA in Zimbabwe. It seeks to use local resources in delivering a modified, brief, evidence-based, and culturally contextualised intervention. The study results will determine the effectiveness of adapting psychological interventions for AUDs in HIV infected adults using a task-sharing framework. TRIAL REGISTRATION Pan African Clinical Trial Registry, PACTR201509001211149 . Registered 22 July 2015.
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare, Zimbabwe. .,Harare Central Hospital, Psychiatric Unit, Southerton, Harare, Zimbabwe.
| | - Bazondlile Dube-Marimbe
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - Michelle Dube
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - Dixon Chibanda
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe ,Harare Central Hospital, Psychiatric Unit, Southerton, Harare Zimbabwe
| | - Moleen Zunza
- 0000 0001 2214 904Xgrid.11956.3aStellenbosch University, Faculty of Medicine and Health Sciences, Biostatistics Unit, Tygerberg Campus, Parow, Cape Town, South Africa
| | - Simbarashe Rusakaniko
- 0000 0004 0572 0760grid.13001.33Department of Community Medicine Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - David Stewart
- Department of Psychology, Seattle Pacific University, 3rd Avenue W Seattle 206-281-2000, Washington, 3307 USA
| | - Soraya Seedat
- 0000 0001 2214 904Xgrid.11956.3aDepartment of Psychiatry, Stellenbosch University, Faculty of Medicine and Health Sciences, Tygerberg Campus, Parow, Cape Town, South Africa
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Anxiety and Depressive Symptoms Among People Living with HIV and Childhood Sexual Abuse: The Role of Shame and Posttraumatic Growth. AIDS Behav 2016; 20:1609-20. [PMID: 26837633 DOI: 10.1007/s10461-016-1298-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a critical need to examine protective and risk factors of anxiety and depressive symptoms among people living with HIV in order to improve quality of life. Structural equation modeling was used to examine the associations between HIV-related shame, sexual abuse-related shame, posttraumatic growth, and anxiety and depressive symptoms among a cohort of 225 heterosexual women and men who have sex with men (MSM) living with HIV who have experienced childhood sexual abuse (CSA). Higher sexual abuse-related shame was related to more anxiety and depressive symptoms for heterosexual women. Higher posttraumatic growth predicted less anxiety symptoms for only heterosexual women. Higher posttraumatic growth predicted less depressive symptoms for heterosexual women and MSM, but the magnitude of this effect was stronger for heterosexual women than MSM. Psychosocial interventions may need to be tailored to meet the specific needs of heterosexual women and MSM living with HIV and CSA.
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Betancourt TS, Brennan RT, Vinck P, VanderWeele TJ, Spencer-Walters D, Jeong J, Akinsulure-Smith AM, Pham P. Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone. PLoS Med 2016; 13:e1002073. [PMID: 27505186 PMCID: PMC4978463 DOI: 10.1371/journal.pmed.1002073] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/31/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Little attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors. METHODS AND FINDINGS Using survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January-April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach's α = 0.84) and EVD prevention behaviors (16 items, Cronbach's α = 0.88). Main predictors comprised war exposures (8 items, Cronbach's α = 0.85), anxiety (10 items, Cronbach's α = 0.93), depression (15 items, Cronbach's α = 0.91), and PTSD symptoms (16 items, Cronbach's α = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = -0.04; 95% CI -0.08, -0.00; p = 0.036), and war exposures (b = -0.09; 95% CI -0.17, -0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = -0.24; 95% CI -0.43, -0.06; p = 0.009). CONCLUSIONS In post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa.
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Affiliation(s)
- Theresa S. Betancourt
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Robert T. Brennan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Patrick Vinck
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Emergency Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Dayo Spencer-Walters
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Phuong Pham
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Emergency Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Bhatti AB, Usman M, Kandi V. Current Scenario of HIV/AIDS, Treatment Options, and Major Challenges with Compliance to Antiretroviral Therapy. Cureus 2016; 8:e515. [PMID: 27054050 PMCID: PMC4818110 DOI: 10.7759/cureus.515] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/01/2016] [Indexed: 11/08/2022] Open
Abstract
The discovery of the human immunodeficiency virus (HIV) as the causative organism of acquired immunodeficiency syndrome (AIDS) and the inability of modern medicine to find a cure for it has placed HIV as one of the most dreaded pathogens of the 21(st) century. With millions of people infected with HIV, it was once thought to result in "medical apocalypse". However, with the advent of antiretroviral therapy (ART), it is now possible to control HIV. Adherence to ART helps to keep the viral load under control and prolong the time of progression to AIDS, resulting in near normal life expectancy. Even with the introduction of ART, a substantial number of patients fail to adhere due to a variety of reasons, including adverse side effects, drug abuse, mental disorders, socioeconomic status, literacy, and social stigma. With the availability of so many options for HIV treatment at each stage of the disease progression, physicians can switch between the treatment regimens to avoid and/or minimize the adverse effects of drugs. Close monitoring, major social reforms, and adequate counselling should also be implemented to circumvent other challenges.
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Affiliation(s)
- Adnan Bashir Bhatti
- Department of Medicine, Capital Development Authority Hospital, Islamabad, Pakistan
| | - Muhammad Usman
- Department of Medicine, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, Pakistan
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