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Chawla S, Kaida A, Brouillette MJ, Kleiner B, Dubuc D, Skerritt L, Burchell AN, Rouleau D, Loutfy M, de Pokomandy A. Mental health service use and shortages among a cohort of women living with HIV in Canada. BMC Health Serv Res 2024; 24:923. [PMID: 39135046 PMCID: PMC11321070 DOI: 10.1186/s12913-024-11396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care. METHODS Baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages. RESULTS Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03-2.77], higher education level (aOR: 1.43, 95% CI: 1.02-2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02-1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26-0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39-0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50-0.96) were associated with lower odds of reporting service shortages. CONCLUSION Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.
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Affiliation(s)
- Seerat Chawla
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Harvard Medical School, Boston, MA, USA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Marie-Josée Brouillette
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Bluma Kleiner
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danièle Dubuc
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Rouleau
- Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
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Characterizing Ryan White Part A-funded support service utilization patterns and their association with viral suppression among people with HIV in New York City. AIDS Behav 2022; 26:3254-3266. [PMID: 35389140 DOI: 10.1007/s10461-022-03642-4] [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: 03/01/2022] [Indexed: 11/01/2022]
Abstract
Use of HIV-related support services has been demonstrated to improve outcomes for people living with HIV. Further exploring patterns of use could help identify how and in what settings additional HIV care and treatment adherence support could be provided. We aimed to identify support service utilization patterns and examine their association with viral load suppression (VLS). Our sample comprised 6,581 people with HIV who received Ryan White Part A support services for basic needs (food and nutrition, legal, harm reduction, housing services) in New York City from 1/2013 to 12/2016, but had not received services specifically targeting HIV care and treatment adherence. Five support service utilization classes were identified using latent class analysis, the majority of which were characterized by the predominant use of concrete services (e.g., food assistance). Compared with the low-intensity, sporadic concrete service use class, clients in all other classes had lower odds of VLS in a 365-day follow-up period, but this disadvantage disappeared with adjustment for confounding variables indicative of need. Our findings underscore the impact of need-related barriers on VLS and suggest that long-term service utilization beyond the one year period of this study may be required to diminish their negative effect on HIV outcomes.
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Hully A, Mallah R, Villa G, Gilleece Y. Integrating services to improve quality of care for women living with HIV: A global systematic review. HIV Med 2022; 23:310-318. [PMID: 35212105 DOI: 10.1111/hiv.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to review and analyse evidence on the impact of service integration on quality of care for women living with HIV. METHODS Evidence search in September 2020 using the PICO format yielded 60 potential papers. Inclusion required evidence of measurement of an outcome associated with service delivery within a system showing clear integration of services exclusively for women living with HIV. In all, 60 papers were screened, 27 were excluded at the abstract stage, and 17 were excluded after full text review, leaving 20 final papers included in this review. RESULTS Three papers measured the impact of integrating sexual health services and all showed some measure of improved quality of care. Outcome measures considered in this paper were impact on uptake, prevention, user satisfaction, user knowledge and cost-effectiveness. Ten papers studied the impact of integrating family planning, with eight papers suggesting positive outcomes. Eleven papers studied integrated cervical cytology services with 10 able to demonstrate positive impact. Two papers assessed integrating menopause services and two looked at integration of psychological and social services. The most described positive impact was improved user knowledge and satisfaction. There were two main methods of integration demonstrated, described as 'upskilling' of staff and 'guest services'. CONCLUSIONS Integrating services can create opportunities to improve the quality of patient-centred care whilst promoting the sexual, reproductive and human rights of women living with HIV, with an emphasis on designing services to suit local contexts.
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Affiliation(s)
- Alice Hully
- University Hospitals Sussex NHS Trust, Brighton, UK
| | - Rana Mallah
- University Hospitals Sussex NHS Trust, Brighton, UK
- Croydon Health Services NHS Trust, London, UK
| | - Giovanni Villa
- University Hospitals Sussex NHS Trust, Brighton, UK
- Department of Global Health & Infection, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Yvonne Gilleece
- University Hospitals Sussex NHS Trust, Brighton, UK
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Simske NM, Rivera T, Ren BO, Benedick A, Simpson M, Kalina M, Hendrickson SB, Vallier HA. Implementation of programming for survivors of violence-related trauma at a level 1 trauma center. Trauma Surg Acute Care Open 2021; 6:e000739. [PMID: 34693023 PMCID: PMC8499348 DOI: 10.1136/tsaco-2021-000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Prior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism. Methods VOCARP was established in 2017 at our center, and all patients who engaged with programming (n=1019) were prospectively recorded. Patients are offered services in the emergency department, on inpatient floors and at outpatient clinic visits. Two control groups (patients sustaining violent injuries without VOCARP use (n=212) and patients with non-violent trauma (n=201)) were similarly aggregated. Results During 22 months, 96% of patients accepted education materials, 31% received financial compensation, 27% requested referrals, and 22% had crisis interventions. All other resources were used by <20% of patients. Patients who used VOCARP resources were substantially different from those who declined services; they were less often male (56% vs. 71%), more often single (79% vs. 51%), had greater unemployment (63% vs. 51%) and were less frequently shot (gunshot wound: 26% vs. 37%), all p<0.05. Overall recidivism rate was 9.4%, with no difference between groups. Use of mental health services was linked to lower recidivism rates (4.4% vs. 11.7%, p=0.016). While sexual assault survivors who used VOCARP resources had lower associated recidivism (2.4% vs. 12%, p=0.14), this was not statistically significant. Discussion This represents the largest violence intervention cohort reported to date to our knowledge. Despite substantial engagement, efficacy in terms of lower recidivism appears limited to specific subgroups or resource utilization. Level of evidence Level II. Therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Bryan O Ren
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Alex Benedick
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Megen Simpson
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Simske NM, Rivera T, Breslin MA, Hendrickson SB, Simpson M, Kalina M, Ho VP, Vallier HA. Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period. Trauma Surg Acute Care Open 2020; 5:e000363. [PMID: 32072016 PMCID: PMC6996789 DOI: 10.1136/tsaco-2019-000363] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources. METHODS Trauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient's medical records. RESULTS From May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had 'direct contact' (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2-15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2-10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018. CONCLUSIONS Hospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary. LEVEL OF EVIDENCE Level II therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mary A Breslin
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | | | - Megen Simpson
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Vanessa P Ho
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Flash MJE, Garland WH, Martey EB, Schackman BR, Oksuzyan S, Scott JA, Jeng PJ, Rubio M, Losina E, Freedberg KA, Kulkarni SP, Hyle EP. Cost-effectiveness of a Medical Care Coordination Program for People With HIV in Los Angeles County. Open Forum Infect Dis 2019; 6:ofz537. [PMID: 31909083 PMCID: PMC6935680 DOI: 10.1093/ofid/ofz537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background The Los Angeles County (LAC) Division of HIV and STD Programs implemented a medical care coordination (MCC) program to address the medical and psychosocial service needs of people with HIV (PWH) at risk for poor health outcomes. Methods Our objective was to evaluate the impact and cost-effectiveness of the MCC program. Using the CEPAC-US model populated with clinical characteristics and costs observed from the MCC program, we projected lifetime clinical and economic outcomes for a cohort of high-risk PWH under 2 strategies: (1) No MCC and (2) a 2-year MCC program. The cohort was stratified by acuity using social and clinical characteristics. Baseline viral suppression was 33% in both strategies; 2-year suppression was 33% with No MCC and 57% with MCC. The program cost $2700/person/year. Model outcomes included quality-adjusted life expectancy, lifetime medical costs, and cost-effectiveness. The cost-effectiveness threshold for the incremental cost-effectiveness ratio (ICER) was $100 000/quality-adjusted life-year (QALY). Results With MCC, life expectancy increased from 10.07 to 10.94 QALYs, and costs increased from $311 300 to $335 100 compared with No MCC (ICER, $27 400/QALY). ICERs for high/severe, moderate, and low acuity were $30 500/QALY, $25 200/QALY, and $77 400/QALY. In sensitivity analysis, MCC remained cost-effective if 2-year viral suppression was ≥39% even if MCC costs increased 3-fold. Conclusions The LAC MCC program improved survival and was cost-effective. Similar programs should be considered in other settings to improve outcomes for high-risk PWH.
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Affiliation(s)
- Moses J E Flash
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wendy H Garland
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Emily B Martey
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Sona Oksuzyan
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Justine A Scott
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip J Jeng
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Marisol Rubio
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Elena Losina
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kenneth A Freedberg
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sonali P Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Emily P Hyle
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, USA
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O’Brien N, Hong QN, Law S, Massoud S, Carter A, Kaida A, Loutfy M, Cox J, Andersson N, de Pokomandy A. Health System Features That Enhance Access to Comprehensive Primary Care for Women Living with HIV in High-Income Settings: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2018; 32:129-148. [PMID: 29630850 DOI: 10.1089/apc.2017.0305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Women living with HIV in high-income settings continue to experience modifiable barriers to care. We sought to determine the features of care that facilitate access to comprehensive primary care, inclusive of HIV, comorbidity, and sexual and reproductive healthcare. Using a systematic mixed studies review design, we reviewed qualitative, mixed methods, and quantitative studies identified in Ovid MEDLINE, EMBASE, and CINAHL databases (January 2000 to August 2017). Eligibility criteria included women living with HIV; high-income countries; primary care; and healthcare accessibility. We performed a thematic synthesis using NVivo. After screening 3466 records, we retained 44 articles and identified 13 themes. Drawing on a social-ecological framework on engagement in HIV care, we situated the themes across three levels of the healthcare system: care providers, clinical care environments, and social and institutional factors. At the care provider level, features enhancing access to comprehensive primary care included positive patient-provider relationships and availability of peer support, case managers, and/or nurse navigators. Within clinical care environments, facilitators to care were appointment reminder systems, nonidentifying clinic signs, women and family spaces, transportation services, and coordination of care to meet women's HIV, comorbidity, and sexual and reproductive healthcare needs. Finally, social and institutional factors included healthcare insurance, patient and physician education, and dispelling HIV-related stigma. This review highlights several features of care that are particularly relevant to the care-seeking experience of women living with HIV. Improving their health through comprehensive care requires a variety of strategies at the provider, clinic, and greater social and institutional levels.
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Affiliation(s)
- Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Quan Nha Hong
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Susan Law
- Institute for Better Health—Trillium Health Partners, Mississauga, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sarah Massoud
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Cox
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
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Adam GP, Di M, Cu-Uvin S, Halladay C, Smith BT, Iyer S, Trikalinos TA. Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map. Syst Rev 2018; 7:25. [PMID: 29391059 PMCID: PMC5796491 DOI: 10.1186/s13643-018-0684-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While in its early years the HIV epidemic affected primarily the male and the young, nowadays, the population living with HIV/AIDS is approximately 24% women, and its age composition has shifted towards older ages. Many of the older women who live with HIV/AIDS also live with the medical and social conditions that accompany aging. This work aims to identify and characterize empirical studies of strategies for the comprehensive management of women over 40, including transgender women, who live with HIV/AIDS. Forty was chosen as an operational age cutoff to identify premenopausal women who are less likely to bear children, as well as peri- and postmenopausal women. METHODS We conducted a literature search after discussions with a diverse panel of content experts and other stakeholders and developed an evidence map that identified 890 citations that address questions having to do with programs and barriers to engaging with programs, as well as the role of insurance and comorbidities, and have enrolled older women who live with HIV/AIDS. RESULTS Of these, only 37 (4%) reported results of interest for women over 40 who live with HIV/AIDS, or examined interactions between gender and older age that would allow predictions in this subgroup. Few of the 37 eligible studies focused on women facing obvious challenges, such as immigrants, transgender, physically abused, or those recently released from prison. No studies focused on women caring for dependents, including children and grandchildren, or those diagnosed after age 40. CONCLUSION The evidence base that is directly applicable to women over 40 who live with HIV/AIDS in the USA is limited, and the research need is broad. We propose research prioritization strategies for this population.
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Affiliation(s)
- Gaelen P Adam
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Mengyang Di
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Susan Cu-Uvin
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.,Department of Ob-Gyn and Medicine, Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Christopher Halladay
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Bryant T Smith
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Suchitra Iyer
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Thomas A Trikalinos
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
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Shin S, Muñoz M, Caldas A, Ying Wu, Zeladita J, Wong M, Espiritu B, Sanchez E, Callacna M, Rojas C, Arevalo J, Sebastian JL, Bayona J. Mental Health Burden Among Impoverished HIV-Positive Patients in Peru. ACTA ACUST UNITED AC 2016; 10:18-25. [PMID: 21368011 DOI: 10.1177/1545109710385120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV and poor mental health are intricately related. In settings of poverty, both are often rooted in structural factors related to material and social deprivation. We performed a qualitative analysis to understand factors contributing to poor emotional health and its impact among impoverished Peruvian HIV-infected individuals. We conducted focus group discussions with patients and providers consisting of semistructured, open-ended questions. Qualitative analysis provided insight into the profound impact of depression, isolation, stigma, and lack of social support among these patients. Living with HIV contributed significantly to mental health problems experienced by HIV-positive individuals; furthermore, long-standing stressors-such as economic hardship, fragmented family relationships, and substance use-shaped patients' outlooks, and may have contributed not only to current emotional hardship but to risk factors for contracting HIV as well. Once diagnosed with HIV/AIDS, many patients experienced hopelessness, stigma, and socioeconomic marginalization. Patients tended to rely on informal sources of support, including peers and community health workers, and rarely used formal mental health services. In resource-poor settings, the context of mental health problems among HIV-positive individuals must be framed within the larger structural context of poverty and social exclusion. Optimal strategies to address the mental health problems of these individuals should include integrating mental health services into HIV care, task shifting to utilize community health workers where human resources are scarce, and interventions aimed at poverty alleviation.
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Affiliation(s)
- Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Socios En Salud Sucursal Perú, Lima, Peru, Harvard Medical School, Boston, MA, USA, Division of Infectious Diseases, Brigham and Women's Hospital, Boston MA, USA,
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Xiao H, Mains W. Relationship between Housing Status and Retention Rates among HIV-Positive African Americans Enrolled in a Comprehensive Care Program. J Psychoactive Drugs 2016; 48:109-14. [PMID: 26960017 DOI: 10.1080/02791072.2015.1130882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Service provision using "one-stop shopping" of medical, psychiatric, and case management services at the same location has been associated with superior client retention. The Yadumu project tested this premise, with attention to HIV-infected African Americans. Each client was assigned a case manager, who arranged meetings with mental health, substance abuse, and medical care professionals. The Center for Mental Health Services, National Outcome Measures (CMHS NOMs) questionnaire was used to evaluate client progress. Data were collected longitudinally and the program evaluation was performed by an outside center. Among 129 clients, 47% were male, 30% were female, and 22% were transgender. The majority (72%) were African American. Clients who lived in detox/drug treatment programs had higher completion rates (48%) than those who were homeless or otherwise housed (28%) (p = 0.04). Logistic regression was used to assess associations between independent factors and retention. Clients satisfied with their housing situation were less likely to retain in the program than those who were not satisfied with their housing situation (OR = 0.15, 95% CI: 0.03-0.78). High discharge rates among HIV-infected people were observed and may reflect the unstable circumstances of the population studied, but structured residential programs could be advantageous for improving retention.
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Affiliation(s)
- Hong Xiao
- a Physician, Department of Internal Medicine , Whan Donghu Hospital , Wuhan , China.,b Outpatient Volunteer Physician , Haight Ashbury Free Clinic , San Francisco , CA , USA
| | - William Mains
- c Psychiatrist, Telecare Corporation , Oakland , CA , USA.,d Outpatient Staff Psychiatrist , Haight Ashbury Free Clinic , San Francisco , CA , USA
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11
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Brennan-Ing M, Seidel L, London AS, Cahill S, Karpiak SE. Service utilization among older adults with HIV: the joint association of sexual identity and gender. JOURNAL OF HOMOSEXUALITY 2014; 61:166-196. [PMID: 24313258 DOI: 10.1080/00918369.2013.835608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examines the association of sexual identity and gender among older clients with HIV at an AIDS service organization using the Andersen Model. Data confirm those aging with HIV exhibit high rates of age-associated illnesses 10 to 20 years before expected. They have fragile social networks that cannot supply the informal supports needed. This aging population will need to increasingly access community-based services. Sexual identity and gender were weak covariates of service utilization. Although heterosexual men used more services, utilization was largely predicted by service needs and the use of case management. Implications for service delivery and policy are discussed.
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Affiliation(s)
- Mark Brennan-Ing
- a AIDS Community Research Initiative of America (ACRIA), ACRIA Center on HIV & Aging , New York , New York , USA
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Halkitis PN, Kupprat SA, Mukherjee PP. Longitudinal associations between case management and supportive services use among black and Latina HIV-positive women in New York City. J Womens Health (Larchmt) 2012; 19:99-108. [PMID: 20088665 DOI: 10.1089/jwh.2008.1315] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The literature analyzing the relationship between case management and supportive service use longitudinally among African American and Latina HIV-positive women is limited. METHODS This retrospective analysis of participant case management, supportive service, and medical charts sought to examine both descriptive and relational data on use of case management and supportive services over a 2-year period from 2002 to 2005 and to analyze moderating person- level or institution-level factors. RESULTS The analyzed case management, supportive service, and medical charts revealed that participants interacted with their case manager four times and received 3.6 supportive services per month. Transportation, primary healthcare/medical specialists, and support groups were the services most used, with rates ranging from 70% to 80%. Using hierarchical linear modeling (HLM), the unconditional growth models showed that case management and supportive service use patterns remained constant over the 24-month period. Additionally, the multivariate unconditional model suggests a significant positive relationship between case management and supportive services. No moderation was indicated in the association between case management and supportive service use by person-level (e.g., mental illness, substance use) and institution-level (i.e., service delivery model) factors. CONCLUSIONS Participants use supportive and case management services in a similar manner based on individual need. This synergistic relationship suggests that increases in either may result in retaining women in care. Implications for service delivery point to the need for skills building training for case managers, outreach workers, or system navigators to assist with short-term goals of establishing rapport and maintaining the client relationship, as this may lead to HIV-positive women accessing services. Additionally, outreach and engagement strategies need to be developed for those who typically underuse these services.
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Affiliation(s)
- Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA.
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Wohl AR, Carlos JA, Tejero J, Dierst-Davies R, Daar ES, Khanlou H, Cadden J, Towner W, Frye D. Barriers and unmet need for supportive services for HIV patients in care in Los Angeles County, California. AIDS Patient Care STDS 2011; 25:525-32. [PMID: 21774689 DOI: 10.1089/apc.2011.0149] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract HIV-infected patients frequently experience depression, drug use, and unstable housing but are often unable to access supportive services to manage these challenges. Data on barriers to needed supportive services are critical to improving patient access. Data from the Medical Monitoring Project (MMP), a national supplemental surveillance system for HIV-infected persons in care, was used to examine barriers to support service use and factors associated with need and unmet need for services. Interview data for 333 patients in care in 2007 and 2008 in Los Angeles County (LAC) showed that 71% (n=236) reported needing at least one supportive service and of these, 35% (n=83) reported at least one unmet need for services (46% Latino; 25% white; 83% male; 92% 30+; 77% gay/bisexual; 40% response rate). The main reasons that supportive services were not accessed included lack of information (47%; do not know where to go or who to call); an agency barrier (33%; system too confusing, wait list too long); or a financial/practical barrier (18%; too expensive, transportation problems). In a logistic regression that included all participants (n=333), African Americans (OR=3.1, 95% CI: 1.1-8.7) and those with incomes less than $10,000 were more likely to have service needs (odds ratio [OR]=3.5; 95% confidence interval [CI]: 1.3-9.3). Among those with at least one service need (n=236), those who were gay or bisexual were more likely to report at least one unmet service need (OR=2.8; 95% CI: 1.3-6.1). Disparities were found for need and unmet need for supportive services by race/ethnicity; income and sexual orientation. The reported reasons that services were not obtained suggest needed improvements in information dissemination on availability and location of HIV support services and more streamlined delivery of services.
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Affiliation(s)
- Amy Rock Wohl
- HIV Epidemiology Program, Los Angeles County Department of Public Health, Los Angeles, California 90005-4001, USA.
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