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Crowley T, Rohwer A. Self-management interventions for adolescents living with HIV: a systematic review. BMC Infect Dis 2021; 21:431. [PMID: 33962558 PMCID: PMC8105944 DOI: 10.1186/s12879-021-06072-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. METHODS We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. RESULTS We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. CONCLUSION Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126313.
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Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Agwu AL, Yusuf HE, D'Angelo L, Rathore M, Marchesi J, Rowell J, Smith R, Toppins J, Trexler C, Carr R, Johnson B, Selden AK, Mahmoudi S, Black S, Guadamuz J, Huettner S, Trent M. Recruitment of Youth Living With HIV to Optimize Adherence and Virologic Suppression: Testing the Design of Technology-Based Community Health Nursing to Improve Antiretroviral Therapy (ART) Clinical Trials. JMIR Res Protoc 2020; 9:e23480. [PMID: 33306036 PMCID: PMC7762679 DOI: 10.2196/23480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023] Open
Abstract
Background Despite advances in HIV diagnosis and treatment, adolescents and young adults 12-25 years old have high HIV incidence, poor engagement and retention in treatment, and low rates of adherence and virologic suppression when compared to their older counterparts. HIV has emerged as a chronic disease for which antiretroviral therapy (ART) adherence is critical for virologic suppression and long-term survival. Virologic suppression has been elusive for many youth with HIV (YHIV). Novel strategies designed to facilitate health care systems’ support for YHIV between medical visits are essential for improving ART adherence, virologic suppression, and long-term survival. Objective The aim of this study is to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH2CHECK) to a standard of care (SOC) control group for improving ART adherence and subsequent viral suppression using a randomized trial design. The objectives are to assess the feasibility, acceptability, and cost-effectiveness of TECH2CHECK as compared to SOC for management of HIV in the outpatient setting and to examine the sustainability of self-care behavior, adherence, and virologic suppression among youth following the intervention period. Methods We will recruit 120 adherence-challenged YHIV being followed at clinics specializing in HIV care in the Baltimore-Washington metropolitan area and in Jacksonville. Eligible participants complete an audio, computer-assisted self-interview and are randomized to either TECH2CHECK intervention or the SOC (60 participants in each arm). The primary outcome of interest is virologic suppression (viral load <20 copies/mL) and improved treatment adherence. Participants in the intervention arm receive community health nursing visits at 2 weeks, 6 weeks, 10 weeks, 14 weeks, and 26 weeks. The intervention arm also receives SMS messaging comprising daily adherence and appointment reminders and positive reinforcement for medication adherence daily for 2 weeks, on alternate days for 2 weeks, thrice weekly for 1 month, weekly for 3 months, and every 2 weeks for the rest of the study duration. The control group receives appointment reminders and SOC per clinic protocol. Exploratory analysis will be conducted to determine differences in medication adherence and virologic suppression in the 2 arms and to assess cost-effectiveness and study feasibility and acceptability. Results In the first 23 months of the study (July 2018-April 2020), 56 (55%) of 102 eligible patients were enrolled and randomized. At present, participating youths are primarily African American (53/56, 95%), male (37/56, 66%), and ≥18 years old (53/56, 95%). Follow-up study visits, as required per the protocol, have been completed by 77% (43/56), 94% (45/48), 95% (37/39), 96% (24/25), and 100% (10/10) of participants at the 1-month, 3-month, 6-month, 12-month, and 18-month follow-ups, respectively. Conclusions Preliminary accrual and retention data suggest that TECH2CHECK is feasible and acceptable. Trial Registration ClinicalTrials.gov NCT03600103 https://clinicaltrials.gov/ct2/show/NCT03600103 International Registered Report Identifier (IRRID) DERR1-10.2196/23480
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Affiliation(s)
- Allison Lorna Agwu
- Department of Pediatric and Adult Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | | | - Mobeen Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service, University of Florida College of Medicine, Jacksonville, FL, United States
| | | | - Julia Rowell
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Raina Smith
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jackie Toppins
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Rashida Carr
- Children's National Medical Center, Washington, DC, United States
| | - Betty Johnson
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Saniyyah Mahmoudi
- University of Florida Center for HIV/AIDS Research, Education and Service, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Susan Black
- University of Florida College of Medicine, Jacksonville, FL, United States
| | - Jisell Guadamuz
- University of Florida College of Medicine, Jacksonville, FL, United States
| | - Steven Huettner
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Maria Trent
- Johns Hopkins School of Medicine, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Health Knowledge and Adherence as Predictors of Viral Burden and CD4+ T-Cell Count in Youth and Young Adults Living With HIV. J Assoc Nurses AIDS Care 2020; 31:457-465. [PMID: 31261286 DOI: 10.1097/jnc.0000000000000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health literacy influences HIV treatment for youth and, thus, is a research priority. We explored health knowledge and self-reported adherence, as indicators of health literacy, among youth living with HIV (YLWH) and the association between health literacy and health outcomes. A total of 102 YLWH ages 13-25 years participated in the study. Participants completed the Brief Estimate of Health Knowledge and Action-HIV Version; CD4 T-cell counts and viral loads were extracted from participant medical records. Participants had a moderate amount of HIV knowledge, and most reported taking their medications under most conditions. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. Health literacy is an important factor that should be addressed by practitioners working with YLWH. More research is needed to determine the best way to measure and improve health literacy.
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Alcon S, Ahmed B, Sloane D, Lim YS, Cervia JS. Interventions to improve medication adherence in adolescents with HIV: a systematic review and meta-analysis. J Investig Med 2020; 68:1217-1222. [DOI: 10.1136/jim-2020-001295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/04/2022]
Abstract
As of 2017, 1.8 million people living with HIV (PLWH) were adolescents between ages 10 and 19, accounting for 5% of all PLWH and 590,000 people between the ages 15 and 24 were newly infected with HIV. Between 2004 and 2011, AIDS-related deaths increased 50% among adolescents, and optimal adolescent adherence to antiretroviral treatment (ART) is estimated at only 62% of adolescents worldwide. While there have been great strides toward achieving the UNAIDS 90-90-90 goals, adolescents remain a group lacking appropriate resources and research to achieve these. This review analyzes current interventions aimed toward increasing adolescent ART adherence. Systematic searches of EMBASE, PubMed and PsycINFO were performed using the keywords ‘adolescent HIV medication adherence interventions’. The Gain Score effect size was calculated for studies reporting the Cohen’s d and variance to include both prestudy and poststudy values. A random-effects model analyzed intervention significance. Authors were contacted to obtain additional data values and study clarification. Twelve studies met inclusion criteria for meta-analysis. There were no significant differences seen between control and intervention groups in medication adherence (z=−1.4714, p<0.1412), viral load (z=−0.1946, p<0.8547) or CD4+ lymphocyte count (z=0.2650, p<0.7910). There was no significant difference between studies in increasing medication adherence. Results indicate that interventions did not improve medication adherence in adolescents with HIV. However, the paucity of quantitative research available speaks to a need for more quantitative intervention studies and standardization of measures of intervention efficacy.
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Cahill SM, Beisbier S. Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years. Am J Occup Ther 2020; 74:7404397010p1-7404397010p48. [PMID: 32602457 DOI: 10.5014/ajot.2020.744001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth. OBJECTIVE This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community. METHOD The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research. RESULTS One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners. CONCLUSIONS AND RECOMMENDATIONS On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence. WHAT THIS ARTICLE ADDS When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.
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Affiliation(s)
- Susan M Cahill
- Susan M. Cahill, PhD, OTR/L, FAOTA, is Associate Professor and Occupational Therapy Department Chair, MSOT Program, Lewis University, Romeoville, IL
| | - Stephanie Beisbier
- Stephanie Beisbier, OTD, OTR/L, is Associate Professor, Occupational Therapy Department, Mount Mary University, Milwaukee, WI;
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6
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Beisbier S, Laverdure P. Occupation- and Activity-Based Interventions to Improve Performance of Instrumental Activities of Daily Living and Rest and Sleep for Children and Youth Ages 5-21: A Systematic Review. Am J Occup Ther 2020; 74:7402180040p1-7402180040p32. [PMID: 32204775 DOI: 10.5014/ajot.2020.039636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Practitioners seek evidence from intervention effectiveness studies to provide best-practice services for children. OBJECTIVE To examine the effectiveness of occupation- and activity-based interventions to improve instrumental activities of daily living (IADLs) and sleep outcomes for children and youth ages 5-21 yr. DATA SOURCES MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews. STUDY SELECTION AND DATA COLLECTION The American Occupational Therapy Association research methodologist conducted the first review of literature published from 2000 to 2017. The results were exported, and we completed the subsequent stages of review. Only peer-reviewed Level I, II, and III evidence was reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane risk-of-bias guidelines were used to compile evidence and risk-of-bias tables. FINDINGS We reviewed 96 articles; 28 studies met the inclusion criteria for IADL and rest-sleep outcomes. Analysis resulted in several themes: rest-sleep, health management (nutrition-dietary, physical activity-fitness, wellness), and the IADLs of driving, communication management, and safety. Strong evidence exists for interventions embedded in school programming to improve physical activity and fitness and for sleep preparation activities to maximize quality of rest and sleep. Moderate-strength evidence exists for interactive education and skills training interventions to improve health routines, dietary behaviors, and IADL participation and performance. CONCLUSIONS AND RELEVANCE Use of skills-focused training in activity- and occupation-based interventions was supported. Service provision in the context of natural environments, including school settings and with parental or caregiver participation, is recommended for children and youth ages 5-21 yr with varied abilities and diagnoses. WHAT THIS ARTICLE ADDS Occupational therapy practitioners can confidently examine their current practices and choose activity- and occupation-based interventions and methods of service delivery that are supported by evidence.
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Affiliation(s)
- Stephanie Beisbier
- Stephanie Beisbier, OTD, OTR/L, is Associate Professor, Occupational Therapy Department, Mount Mary University, Milwaukee, WI;
| | - Patricia Laverdure
- Patricia Laverdure, OTD, OTR/L, BCP, FAOTA, is Assistant Professor and Program Director, Occupational Therapy Department, Old Dominion University, Norfolk, VA
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Wolfe I, Satherley RM, Scotney E, Newham J, Lingam R. Integrated Care Models and Child Health: A Meta-analysis. Pediatrics 2020; 145:peds.2018-3747. [PMID: 31888959 DOI: 10.1542/peds.2018-3747] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Integrated care models may improve health care for children and young people (CYP) with ongoing conditions. OBJECTIVE To assess the effects of integrated care on child health, health service use, health care quality, school absenteeism, and costs for CYP with ongoing conditions. DATA SOURCES Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018). STUDY SELECTION Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome. DATA EXTRACTION Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care. RESULTS Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44; P = .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37; P = .57). LIMITATIONS Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist. CONCLUSIONS Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.
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Affiliation(s)
- Ingrid Wolfe
- Department of Women's and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom;
| | - Rose-Marie Satherley
- Department of Women's and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Elizabeth Scotney
- King's College Hospital National Health Services Foundation Trust, London, United Kingdom; and
| | - James Newham
- Department of Women's and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Saberi P, Dawson Rose C, Wootton AR, Ming K, Legnitto D, Jeske M, Pollack LM, Johnson MO, Gruber VA, Neilands TB. Use of technology for delivery of mental health and substance use services to youth living with HIV: a mixed-methods perspective. AIDS Care 2019; 32:931-939. [PMID: 31132864 DOI: 10.1080/09540121.2019.1622637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Technology use has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18-29 year-old YLWH, and explored technology use as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with mental health measures such as depression, trauma, and adverse childhood experiences and marijuana and stimulants use. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with 29 participants, barriers to and facilitators of accessing and maintaining mental health services were identified. Most participants favored technology use for mental health and substance use service delivery, including videoconferencing with a counselor. Provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing accessibility of these services.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Carol Dawson Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Angie R Wootton
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kristin Ming
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Dominique Legnitto
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Melanie Jeske
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Lance M Pollack
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Valerie A Gruber
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
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Coyne KD, Trimble KA, Lloyd A, Petrando L, Pentz J, Van Namen K, Fawcett A, Laing CM. Interventions to Promote Oral Medication Adherence in the Pediatric Chronic Illness Population: A Systematic Review From the Children's Oncology Group. J Pediatr Oncol Nurs 2019; 36:219-235. [PMID: 30943831 DOI: 10.1177/1043454219835451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric oncology protocols frequently include multiple oral medications administered at varied dosing schedules, often for prolonged periods of time. Nonadherence to protocol-directed oral medications may place patients at increased risk for morbidity and mortality. The purpose of this systematic review was to evaluate the existing body of evidence to determine best-practice recommendations regarding interventions for oral medication adherence in children and adolescents with cancer. Twenty-four articles were systematically reviewed and evaluated according to the Grading of Recommendations, Assessment, Development, and Evaluation criteria; 2 studies focused on the pediatric oncology population, and the remaining 22 studies focused on other chronic illnesses of childhood. A variety of interventions to increase oral medication adherence in children were identified, including pill swallowing, technology, incentivization, education-based intervention, psychosocial support-based intervention, and combination intervention. Most interventions were shown to have some benefit in pediatrics, most in the non-oncology setting. The overall synthesis of the literature indicates that nonadherence to oral medications is a prevalent problem in pediatrics, and much work is needed to address this problem, particularly in pediatric oncology.
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Affiliation(s)
- Kelly D Coyne
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Ashley Lloyd
- 2 Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Laura Petrando
- 2 Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Jennie Pentz
- 2 Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Kari Van Namen
- 3 Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA
| | - Andrea Fawcett
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Catherine M Laing
- 4 University of Calgary Faculty of Nursing, Calgary, Alberta, Canada
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Pednekar PP, Ágh T, Malmenäs M, Raval AD, Bennett BM, Borah BJ, Hutchins DS, Manias E, Williams AF, Hiligsmann M, Turcu-Stiolica A, Zeber JE, Abrahamyan L, Bunz TJ, Peterson AM. Methods for Measuring Multiple Medication Adherence: A Systematic Review-Report of the ISPOR Medication Adherence and Persistence Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:139-156. [PMID: 30711058 DOI: 10.1016/j.jval.2018.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/29/2018] [Accepted: 08/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications. OBJECTIVES To identify and characterize the multiple medication adherence (MMA) methods used in the literature. METHODS A literature search was conducted using PubMed, PsycINFO, the International Pharmaceutical Abstracts, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library databases on methods used to measure MMA published between January 1973 and May 2015. A two-step screening process was used; all abstracts were screened by pairs of researchers independently, followed by a full-text review identifying the method for calculating MMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic review. For studies that met the eligibility criteria, general study and adherence-specific characteristics and the number and type of MMA measurement methods were summarized. RESULTS The 147 studies that were included originated from 32 countries, in 13 disease states. Of these studies, 26 used proportion of days covered, 23 used medication possession ratio, and 72 used self-reported questionnaires (e.g., the Morisky Scale) to assess MMA. About 50% of the studies included more than one method for measuring MMA, and different variations of medication possession ratio and proportion of days covered were used for measuring MMA. CONCLUSIONS There appears to be no standardized method to measure MMA. With an increasing prevalence of polypharmacy, more efforts should be directed toward constructing robust measures suitable to evaluate adherence to complex regimens. Future research to understand the validity and reliability of MMA measures and their effects on objective clinical outcomes is also needed.
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Affiliation(s)
- Priti P Pednekar
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA.
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | - Maria Malmenäs
- Real World Strategy & Analytics, Mapi Group, Stockholm, Sweden
| | | | | | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia
| | - Allison F Williams
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Mickaël Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Adina Turcu-Stiolica
- Department of Pharmaceutical Marketing and Management, University of Medicine and Pharmacy, Craiova, Romania
| | - John E Zeber
- Central Texas Veterans Health Care System, Scott & White Healthcare, Center for Applied Health Research, Temple, TX, USA
| | | | | | - Andrew M Peterson
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA
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11
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Belzer ME, MacDonell KK, Ghosh S, Naar S, McAvoy-Banerjea J, Gurung S, Cain D, Fan CA, Parsons JT. Adaptive Antiretroviral Therapy Adherence Interventions for Youth Living With HIV Through Text Message and Cell Phone Support With and Without Incentives: Protocol for a Sequential Multiple Assignment Randomized Trial (SMART). JMIR Res Protoc 2018; 7:e11183. [PMID: 30573448 PMCID: PMC6320399 DOI: 10.2196/11183] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Youth living with HIV (YLH) aged 13 to 24 years made up over a fifth (21%) of new HIV diagnoses in 2016, yet only 27% of YLH are virally suppressed. YLH have been shown to be poorly adherent to antiretroviral therapy (ART); however, there has been limited research investigating how to increase adherence in YLH. Mobile health (mHealth) interventions may be one promising way to do this. OBJECTIVE This study (ATN [Adolescent Trials Network] 144 SMART) aimed to compare adaptive interventions that could increase ART adherence in YLH aged 15 to 24 years. This includes mHealth initiatives, the tapering of interventions, and the use of incentives. Cost-effectiveness of sequencing the interventions without incentives before providing incentives and the savings on societal costs due to suppressed viral loads will be determined. This protocol is part of the ATN Scale It Up program described in this issue by Naar et al. METHODS This study uses a Sequential Multiple Assignment Randomized Trial design. Approximately 190 participants are being recruited, enrolled, and randomized to either cell phone support or text message support. Both intervention groups receive 3 months of intervention, followed by a second randomization based on response to the intervention. Responders test tapering their intervention, and nonresponders test receiving incentives. RESULTS Data collection for this study is projected to begin in August 2018 and last until June 2020. CONCLUSIONS This is an innovative study, particularly in terms of population, intervention types, focus on cost-effectiveness, and recruitment. This study could be particularly effective in improving adherence in YLH while reducing long-term individual and societal costs. TRIAL REGISTRATION ClinicalTrials.gov NCT03535337; https://clinicaltrials.gov/ct2/show/NCT03535337 (Archived by WebCite at http://www.webcitation.org/74alXb92z). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/11183.
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Affiliation(s)
- Marvin E Belzer
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Samiran Ghosh
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sylvie Naar
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | | | - Sitaji Gurung
- Hunter College Center for HIV Educational Studies and Training, New York, NY, United States
| | - Demetria Cain
- Hunter College Center for HIV Educational Studies and Training, New York, NY, United States
| | - Carolyn A Fan
- Hunter College Center for HIV Educational Studies and Training, New York, NY, United States
| | - Jeffrey T Parsons
- Hunter College Center for HIV Educational Studies and Training, New York, NY, United States
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Naar S, Ellis D, Cunningham P, Pennar AL, Lam P, Brownstein NC, Bruzzese JM. Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents. Pediatrics 2018; 142:peds.2017-3737. [PMID: 30185428 PMCID: PMC6317763 DOI: 10.1542/peds.2017-3737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804911922001PEDS-VA_2017-3737Video Abstract BACKGROUND: African American adolescents appear to be the most at risk for asthma morbidity and mortality even compared with other minority groups, yet there are few successful interventions for this population that are used to target poorly controlled asthma. METHODS African American adolescents (age 12-16 years) with moderate-to-severe persistent asthma and ≥1 inpatient hospitalization or ≥2 emergency department visits in 12 months were randomly assigned to Multisystemic Therapy-Health Care or an attention control group (N = 167). Multisystemic Therapy-Health Care is a 6-month home- and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions. The attention control condition was weekly family supportive counseling, which was also provided for 6 months in the home. The primary outcome was lung function (forced expiratory volume in 1 second [FEV1]) measured over 12 months of follow-up. RESULTS Linear mixed-effects models revealed that compared with adolescents in the comparison group, adolescents in the treatment group had significantly greater improvements in FEV1 secondary outcomes of adherence to controller medication, and the frequency of asthma symptoms. Adolescents in the treatment group had greater reductions in hospitalizations, but there were no differences in reductions in emergency department visits. CONCLUSIONS A comprehensive family- and community-based treatment significantly improved FEV1, medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma. Further evaluation in effectiveness and implementation trials is warranted.
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Affiliation(s)
- Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Research, College of Medicine, Florida State University, Tallahassee, Florida;
| | - Deborah Ellis
- Department of Family Medicine and Public Health
Services, School of Medicine, Wayne State University, Detroit, Michigan
| | - Phillippe Cunningham
- Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina, Charleston, South Carolina
| | - Amy L. Pennar
- Department of Family Medicine and Public Health
Services, School of Medicine, Wayne State University, Detroit, Michigan
| | - Phebe Lam
- Faculty of Arts, Humanities, and Social Sciences,
University of Windsor, Windsor, Canada; and
| | - Naomi C. Brownstein
- Department of Behavioral Sciences and Social
Medicine, Center for Translational Behavioral Research, College of Medicine,
Florida State University, Tallahassee, Florida
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13
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Mimiaga MJ, Kuhns LM, Biello KB, Olson J, Hoehnle S, Santostefano CM, Hughto JMW, Safi H, Salhaney P, Chen D, Garofalo R. Positive STEPS - a randomized controlled efficacy trial of an adaptive intervention for strengthening adherence to antiretroviral HIV treatment among youth: study protocol. BMC Public Health 2018; 18:867. [PMID: 30001703 PMCID: PMC6043988 DOI: 10.1186/s12889-018-5815-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background HIV infection among youth in the United States is on the rise. A high level of antiretroviral therapy (ART) adherence is crucial to treatment success and can minimize the population burden of the disease. However, the overall rate of ART adherence among youth is generally suboptimal and no published efficacious interventions exist to address the specific needs of this population. This paper describes the design of a stepped-care, “adaptive” ART adherence intervention protocol for HIV-infected adolescents and young adults. Methods This is a randomized controlled trial (RCT) to establish the efficacy of “Positive STEPS,” a behavioral and technology-based intervention to optimize ART adherence and viral suppression among HIV-infected youth, ages 16 to 29. Participants are equally randomized to 1) the Positive STEPS intervention, which begins with two-way daily text messaging as a reminder system to take their medications; participants progress to a more intensive in-person counseling intervention if text messaging is not sufficient to overcome barriers; or 2) or standard of care (SOC). At randomization, all participants receive standardized ART adherence education. During the 4 major study assessment visits (baseline, 4-, 8-, and 12-months), participants have their blood drawn to measure HIV viral load and complete a mix of computer-based self-administered and interviewer-administered behavioral and psychosocial measures. The primary outcomes are improvements in viral load and ART adherence measured via a medication-tracking device (i.e., Wisepill) and self-report. Discussion Behavioral interventions are greatly needed to improve ART adherence among HIV-infected adolescents and young adults and prevent onward transmission. If effective, the intervention tested here will be one of the first rigorously-designed efficacy trials to promote ART adherence in this population, using an approach that holds promise for being readily integrated into real-world clinical settings. Trial registration ClinicalTrials.gov number NCT03092531, registered March 28, 2017.
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Affiliation(s)
- Matthew J Mimiaga
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA. .,Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - Katie B Biello
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA.,Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Olson
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Sam Hoehnle
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | | | - Jaclyn M W Hughto
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA.,Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Hadeis Safi
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - Peter Salhaney
- Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Diane Chen
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, USA
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14
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Antiretroviral Therapy Adherence Enhancing Interventions for Adolescents and Young Adults 13-24 Years of Age: A Review of the Evidence Base. J Acquir Immune Defic Syndr 2017; 72:387-99. [PMID: 26959190 PMCID: PMC4935533 DOI: 10.1097/qai.0000000000000977] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Youth living with HIV are highly under-represented in the evidence base for adherence interventions, despite their diverse and unique needs and barriers. OBJECTIVE This systematic review aimed to identify antiretroviral therapy (ART) adherence interventions specifically targeting adolescents and young adults (defined as ages 13-24) with the goal of characterizing the evidence base. METHODS Articles were identified using the PubMed database and cover work published through September 14, 2015. INCLUSION CRITERIA (1) average age 13 to 24, (2) HIV positive, (3) on or beginning ART, (4) intervention targeted ART adherence in full or in part, (5) reported adherence, viral load, and/or CD4 count outcomes. Strength of evidence was defined as level 1 [randomized controlled trial (RCT) with significance testing on outcomes], 2 (within group studies with statistical testing on outcomes), 3 (RCTs with descriptive results), or 4 (within group studies with descriptive results). RESULTS Of 151 articles, 10 met inclusion criteria. Published between 2003 and 2014, these studies evaluated diverse intervention approaches. Most were conducted in the US and were small pilots that have yet to be replicated despite promising results. Only 3 studies met criteria for highest level strength of evidence; 2 supported a phone-based counseling approach with adherence monitors and 1 for weekly individual and family counseling. CONCLUSIONS Despite nearly 20 years passing since the wide-scale availability of ART, and clear recognition that adolescents and youth adults fair worse on the cascade of HIV care, the evidence base remains sparse and underdeveloped. Promising approaches need replication and more rigorous studies are desperately needed.
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15
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Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up. Curr Opin HIV AIDS 2017; 11:477-486. [PMID: 27272537 DOI: 10.1097/coh.0000000000000302] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW There is an increasing number of deaths among adult survivors of perinatal HIV. Multiple and complex factors drive this mortality, including problems with retention in care and adherence during adolescence, coupled with the critical period of transition from paediatric to adult care, increasing their risk of treatment failure and severe immunosuppression. We reviewed studies that evaluated the impact of service delivery interventions to improve the health of perinatally infected adolescents living with HIV (P-ALHIV) to gain insight into what might help them survive the vulnerable period of adolescence. RECENT FINDINGS Youth-focused health services and individual-level interventions may improve P-ALHIV adherence and retention in care. However, there have been few studies, many with small sample sizes and with short durations of follow-up that end before the transition period. Studies from other childhood-onset chronic diseases are similarly limited. SUMMARY Further studies are urgently needed to identify optimal intervention strategies to reduce mortality and poor outcomes as the adolescent population expands and ages into adult care. Until we have a more robust evidence base, programmes can develop transition plans based on best practice recommendations to optimize the health and longevity of ALHIV in adulthood.
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16
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Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, Shearer K, Dowdy D, Rosenberg E, Sullivan P, Shah M. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 2017; 21:2101-2123. [PMID: 28120257 PMCID: PMC5843766 DOI: 10.1007/s10461-017-1687-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
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Affiliation(s)
- Kathryn A Risher
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
| | - Sunaina Kapoor
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Moji Daramola
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Doyle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Shearer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - Eli Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Dillard PK, Zuniga JA, Holstad MM. An integrative review of the efficacy of motivational interviewing in HIV management. PATIENT EDUCATION AND COUNSELING 2017; 100:636-646. [PMID: 27838113 DOI: 10.1016/j.pec.2016.10.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/25/2016] [Accepted: 10/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The purpose of this integrative review is to examine the use of motivational interviewing (MI) to improve health outcomes in persons living with HIV (PLWH). METHODS We reviewed the existing literature, using the PRISMA model. The PubMed, Web of Science, Embase, and CINAHL databases were searched for all relevant studies, using the terms HIV, AIDS, and motivational interviewing. RESULTS Of 239 articles identified initially, 19 met our criteria for synthesis. These studies were conducted throughout the world, including the U.S., Thailand, and South Africa. In general, studies that used MI, either alone or in conjunction with other interventions, reported improved adherence, decreased depression, and decreased risky sexual behaviors. CONCLUSION This review demonstrates a positive relationship between MI-based interventions and behavioral change, which may lead to improved health outcomes in PLWH. PRACTICE IMPLICATIONS Motivational interviewing can be an effective method of therapeutic communication for PLWH, who struggle with adherence, depression, and risky sexual behaviors.
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Affiliation(s)
- Phillip K Dillard
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Julie Ann Zuniga
- The University of Texas at Austin, School of Nursing 1710 Red River, Austin, TX, 78701, USA.
| | - Marcia M Holstad
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd, Atlanta, GA, 30322, USA.
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18
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Kanters S, Park JJH, Chan K, Socias ME, Ford N, Forrest JI, Thorlund K, Nachega JB, Mills EJ. Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis. Lancet HIV 2016; 4:e31-e40. [PMID: 27863996 DOI: 10.1016/s2352-3018(16)30206-5] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND High adherence to antiretroviral therapy is crucial to the success of HIV treatment. We evaluated comparative effectiveness of adherence interventions with the aim of informing the WHO's global guidance on interventions to increase adherence. METHODS For this systematic review and network meta-analysis, we searched for randomised controlled trials of interventions that aimed to improve adherence to antiretroviral therapy regimens in populations with HIV. We searched Cochrane Central Register of Controlled Trials, Embase, and MEDLINE for reports published up to July 16, 2015, and searched major conference abstracts from Jan 1, 2013, to July 16, 2015. We extracted data from eligible studies for study characteristics, interventions, patients' characteristics at baseline, and outcomes for the study populations of interest. We used network meta-analyses to compare adherence and viral suppression for all study settings (global network) and for studies in low-income and middle-income countries only (LMIC network). FINDINGS We obtained data from 85 trials with 16 271 participants. Short message service (SMS; text message) interventions were superior to standard of care in improving adherence in both the global network (odds ratio [OR] 1·48, 95% credible interval [CrI] 1·00-2·16) and in the LMIC network (1·49, 1·04-2·09). Multiple interventions showed generally superior adherence to single interventions, indicating additive effects. For viral suppression, only cognitive behavioural therapy (1·46, 1·05-2·12) and supporter interventions (1·28, 1·01-1·71) were superior to standard of care in the global network; none of the interventions improved viral response in the LMIC network. For the global network, the time discrepancy (whether the study outcome was measured during or after intervention was withdrawn) was an effect modifier for both adherence to antiretroviral therapy (coefficient estimate -0·43, 95% CrI -0·75 to -0·11) and viral suppression (-0·48; -0·84 to -0·12), suggesting that the effects of interventions wane over time. INTERPRETATION Several interventions can improve adherence and viral suppression; generally, their estimated effects were modest and waned over time. FUNDING WHO.
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Affiliation(s)
- Steve Kanters
- Precision Global Health, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Keith Chan
- Precision Global Health, Vancouver, BC, Canada
| | - Maria Eugenia Socias
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Jamie I Forrest
- Precision Global Health, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Jean B Nachega
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Departments of Epidemiology, Infectious Diseases, and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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19
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Henggeler SW, Schaeffer CM. Multisystemic Therapy(®) : Clinical Overview, Outcomes, and Implementation Research. FAMILY PROCESS 2016; 55:514-28. [PMID: 27370172 DOI: 10.1111/famp.12232] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Multisystemic therapy (MST) is an evidence-based treatment originally developed for youth with serious antisocial behavior who are at high risk for out-of-home placement and their families; and subsequently adapted to address other challenging clinical problems experience by youths and their families. The social-ecological theoretical framework of MST is presented as well as its home-based model of treatment delivery, defining clinical intervention strategies, and ongoing quality assurance/quality improvement system. With more than 100 peer-reviewed outcome and implementation journal articles published as of January 2016, the majority by independent investigators, MST is one of the most extensively evaluated family based treatments. Outcome research has yielded almost uniformly favorable results for youths and families, and implementation research has demonstrated the importance of treatment and program fidelity in achieving such outcomes.
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Affiliation(s)
- Scott W Henggeler
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
| | - Cindy M Schaeffer
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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20
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Letourneau EJ, McCart MR, Sheidow AJ, Mauro PM. First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents. J Subst Abuse Treat 2016; 72:56-65. [PMID: 27629581 DOI: 10.1016/j.jsat.2016.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/27/2016] [Accepted: 08/17/2016] [Indexed: 11/19/2022]
Abstract
There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions.
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Affiliation(s)
- Elizabeth J Letourneau
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, United States.
| | - Michael R McCart
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, United States.
| | - Ashli J Sheidow
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, United States.
| | - Pia M Mauro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington St., Suite 531, Baltimore, MD, United States.
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21
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Rowe CL, Alberga L, Dakof GA, Henderson CE, Ungaro R, Liddle HA. Family-Based HIV and Sexually Transmitted Infection Risk Reduction for Drug-Involved Young Offenders: 42-Month Outcomes. FAMILY PROCESS 2016; 55:305-20. [PMID: 26879671 DOI: 10.1111/famp.12206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study tested a family-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention approach integrated within an empirically supported treatment for drug-involved young offenders, Multidimensional Family Therapy (MDFT). A randomized, controlled, two-site community-based trial was conducted with 154 youth and their parents. Drug-involved adolescents were recruited in detention, randomly assigned to either MDFT or Enhanced Services as Usual (ESAU), and assessed at intake, 3, 6, 9, 18, 24, 36, and 42-month follow-ups. Youth in both conditions received structured HIV/STI prevention in detention and those in MDFT also received family-based HIV/STI prevention as part of ongoing treatment following detention release. Youth in both conditions and sites significantly reduced rates of unprotected sex acts and STI incidence from intake to 9 months. They remained below baseline levels of STI incidence (10%) over the 42-month follow-up period. At Site A, adolescents who were sexually active at intake and received MDFT showed greater reduction in overall frequency of sexual acts and number of unprotected sexual acts than youth in ESAU between intake and 9-month follow-ups. These intervention differences were evident through the 42-month follow-up. Intervention effects were not found for STI incidence or unprotected sex acts at Site B. Intensive group-based and family intervention in detention and following release may reduce sexual risk among substance-involved young offenders, and a family-based approach may enhance effects among those at highest risk. Site differences in intervention effects, study limitations, clinical implications, and future research directions are discussed.
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Affiliation(s)
- Cynthia L Rowe
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Linda Alberga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Gayle A Dakof
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Craig E Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX
| | - Rocio Ungaro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Howard A Liddle
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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22
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Robbins RN, Spector AY, Mellins CA, Remien RH. Optimizing ART adherence: update for HIV treatment and prevention. Curr HIV/AIDS Rep 2015; 11:423-33. [PMID: 25304006 DOI: 10.1007/s11904-014-0229-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Optimal adherence to antiretroviral therapy (ART) is central to achieving viral suppression and positive health outcomes in HIV-infected individuals. Virally suppressed individuals can also reduce the risk of HIV transmission to uninfected partners. Hence, adherence to ART has become both an HIV treatment and an HIV prevention strategy. However, achieving optimal ART adherence can be challenging, especially over the long term. It is increasingly important for clinicians and researchers to be abreast of the most recent developments in the field as new biomedical approaches to treatment emerge and as guidelines for the use of pre-exposure prophylaxis (PrEP) are disseminated to providers serving HIV affected populations. Several reviews have described numerous ART adherence interventions that have been developed and/or tested with the most recent review including literature up to 2012. To augment the literature, we present a review of ART adherence interventions from 2013 to the present. We included peer-reviewed journals as well as abstracts from two key conferences.
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Affiliation(s)
- Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive #15, New York, NY, 10032, USA,
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MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand RA, Ross DA. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care. Trop Med Int Health 2015; 20:1015-32. [PMID: 25877007 PMCID: PMC4579546 DOI: 10.1111/tmi.12517] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART. Methods We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle–Ottawa Scale. Results Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent‐friendliness of clinics. Most studies were of low to moderate methodological quality. Conclusions This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent‐tailored services appear promising interventions and warrant further investigation.
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Affiliation(s)
- Peter MacPherson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Chigomezgo Munthali
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Katharina Kranzer
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - David A Ross
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Mbuagbaw L, Sivaramalingam B, Navarro T, Hobson N, Keepanasseril A, Wilczynski NJ, Haynes RB. Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies. AIDS Patient Care STDS 2015; 29:248-66. [PMID: 25825938 DOI: 10.1089/apc.2014.0308] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We sought to review the effectiveness of interventions designed to improve adherence to antiretroviral therapy (ART) from studies included in a recent Cochrane review that reported a clinical and an adherence outcome, with at least 80% follow-up for 6 months or more. Data were extracted independently and in duplicate, with an adjudicator for disagreements. Risk of bias was assessed using the Cochrane Risk of Bias tool. Of 182 relevant studies in the Cochrane review, 49 were related to ART. Statistical pooling was not warranted due to heterogeneity in interventions, participants, treatments, adherence measures and outcomes. Many studies had high risk of bias in elements of design and outcome ascertainment. Only 10 studies improved both adherence and clinical outcomes. These used the following interventions: adherence counselling (two studies); a once-daily regimen (compared to twice daily); text messaging; web-based cognitive behavioral intervention; face-to-face multi-session intensive behavioral interventions (two studies); contingency management; modified directly observed therapy; and nurse-delivered home visits combined with telephone calls. Patient-related adherence interventions were the most frequently tested. Uniform adherence measures and higher quality studies of younger populations are encouraged.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare–Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
| | | | - Tamara Navarro
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas Hobson
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Arun Keepanasseril
- Departments of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy J. Wilczynski
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - R. Brian Haynes
- Departments of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario, Canada
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Bamford A, Turkova A, Lyall H, Foster C, Klein N, Bastiaans D, Burger D, Bernadi S, Butler K, Chiappini E, Clayden P, Della Negra M, Giacomet V, Giaquinto C, Gibb D, Galli L, Hainaut M, Koros M, Marques L, Nastouli E, Niehues T, Noguera-Julian A, Rojo P, Rudin C, Scherpbier HJ, Tudor-Williams G, Welch SB. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015; 19:e1-e42. [PMID: 25649230 PMCID: PMC5724658 DOI: 10.1111/hiv.12217] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
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Affiliation(s)
- A Bamford
- Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK
| | - A Turkova
- Medical Research Council Clinical Trials Unit, London, UK
| | - H Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - N Klein
- Institute of Child Health, University College London, London, UK
| | - D Bastiaans
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - D Burger
- Radboud University Medical Center, Nijmegan, The Netherlands
| | - S Bernadi
- University Department of Immunology and Infectious Disease, Bambino Gesù Children's Hospital, Rome, Italy
| | - K Butler
- Our Lady's Children's Hospital Crumlin & University College Dublin, Dublin, Ireland
| | - E Chiappini
- Meyer University Hospital, Florence University, Florence, Italy
| | | | - M Della Negra
- Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - V Giacomet
- Paediatric Infectious Disease Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - C Giaquinto
- Department of Paediatrics, University of Padua, Padua, Italy
| | - D Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | - L Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - M Hainaut
- Department of Pediatrics, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - M Koros
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - L Marques
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Pediatric Department, Porto Central Hospital, Porto, Portugal
| | - E Nastouli
- Department of Clinical Microbiology and Virology, University College London Hospitals, London, UK
| | - T Niehues
- Centre for Pediatric and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - P Rojo
- 12th of October Hospital, Madrid, Spain
| | - C Rudin
- University Children's Hospital, Basel, Switzerland
| | - H J Scherpbier
- Department of Paediatric Immunology and Infectious Diseases, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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26
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Ellis DA, King P, Naar-King S, Lam P, Cunningham PB, Secord E. Effects of family treatment on parenting beliefs among caregivers of youth with poorly controlled asthma. J Dev Behav Pediatr 2014; 35:486-93. [PMID: 25186121 PMCID: PMC4180784 DOI: 10.1097/dbp.0000000000000093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Caregiver involvement is critical in ensuring optimal adolescent asthma management. The study investigated whether multisystemic therapy (MST), an intensive home-based family therapy, was superior to family support for changing beliefs regarding asthma-related positive parenting among caregivers of African-American youth with poorly controlled asthma. The relationship between parenting beliefs and asthma management at the conclusion of the intervention was also assessed. METHODS A randomized controlled trial was conducted with 167 adolescents with moderate-to-severe, persistent, poorly controlled asthma and their primary caregivers. Families were randomly assigned to MST or family support (FS), a home-based family support condition. Data were collected at baseline and 7-month posttest. Changes in caregiver ratings of importance and confidence for engaging in asthma-related positive parenting were assessed through questionnaire. Illness management was assessed by the Family Asthma Management System Scale. RESULTS Participation in MST was associated with more change in caregiver beliefs as compared with FS for both importance (t = 2.39, p = .02) and confidence (t = 2.04, p = .04). Caregiver beliefs were also significantly related to youth controller medication adherence at the conclusion of treatment (importance: r = .21, p = .01; confidence: r = .23, p = .004). CONCLUSION Results support the effectiveness of MST for increasing parental beliefs in the value of asthma-related positive parenting behaviors and parental self-efficacy for these behaviors among families of minority adolescents with poorly controlled asthma.
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Affiliation(s)
- Deborah A Ellis
- *Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI; †Department of Psychiatry, Medical University of South Carolina, Charleston, SC
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Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
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Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
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28
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Pai ALH, McGrady M. Systematic review and meta-analysis of psychological interventions to promote treatment adherence in children, adolescents, and young adults with chronic illness. J Pediatr Psychol 2014; 39:918-31. [PMID: 24952359 DOI: 10.1093/jpepsy/jsu038] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This meta-analysis examined the effectiveness of recent adherence-promoting interventions for youth with chronic health conditions. METHODS Peer-reviewed randomized controlled trials of adherence-promoting interventions for youth with a chronic illness published between 2007 and 2013 (n = 23) were reviewed. Intervention delivery (in-person vs. technology-based) and outcome measurement (e.g., self-report) were examined as potential moderators of treatment effects. RESULTS Mean effect sizes were small at posttreatment (d = 0.20, 95% confidence interval (CI): 0.08, 0.31, n = 23) and follow-up (d = 0.29, 95% CI: 0.15, 0.43, n = 9). Intervention delivery and outcome measurement did not account for variation in treatment effects (p > .05). CONCLUSIONS The small treatment effects of recent adherence-promoting intervention (APIs) reflect the methodological limitations of the included studies and the need to reexamine the delivery and mechanisms of adherence-promoting interventions.
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Affiliation(s)
- Ahna L H Pai
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Meghan McGrady
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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29
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McCart MR, Sheidow AJ, Letourneau EJ. Risk Reduction Therapy for Adolescents: Targeting Substance Use and HIV/STI-Risk Behaviors. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:161-175. [PMID: 25419101 PMCID: PMC4235161 DOI: 10.1016/j.cbpra.2013.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper describes a family-based intervention for addressing both substance use and unprotected sexual behavior in adolescents presenting for outpatient substance use treatment. The intervention combines contingency management (CM) for adolescent substance use, which is a behavioral intervention modeled on the Community Reinforcement Approach, with a sexual risk reduction protocol that mirrors aspects of the CM model. As a family-based intervention, caregivers attend every session and actively collaborate with the therapist to address their youth's behavior problems. The treatment is criterion-based with treatment duration determined by the youth's achievement of reduced substance use and unprotected sexual behavior goals. A case study describes the implementation of this treatment with an adolescent presenting a history of polysubstance use and unprotected sexual intercourse. Following the adolescent and caregiver's participation in weekly sessions, the adolescent demonstrated improvements in substance use, unprotected sexual behavior, and other behavior problems. Clinical summary data from two outpatient clinics reveal similar positive outcomes for youth receiving the intervention. This paper illustrates the potential utility of an integrated treatment approach targeting substance use and unprotected sexual behavior in an adolescent population.
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30
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Smith R, Wilkins M. Perinatally acquired HIV infection: long-term neuropsychological consequences and challenges ahead. Child Neuropsychol 2014; 21:234-68. [PMID: 24697320 DOI: 10.1080/09297049.2014.898744] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Over the past three decades, perinatal HIV infection in the United States has evolved from a fatal disease to a manageable chronic illness. As the majority of youth with perinatal HIV infection age into adolescence and adulthood, management of this stigmatizing, transmittable disease in the backdrop of a cadre of environmental stressors presents challenges beyond those of other chronic illnesses. The neurologic and neuropsychological consequences of this neurotropic virus have important implications for the successful navigation of responsibilities related to increasingly independent living of this aging population. This article will review the neurologic and neuropsychological consequences of perinatal HIV infection and concomitant factors in the era of highly active antiretroviral therapy and will provide an overview of the neuropathology, pathogenesis, neuroimaging findings, and treatment of perinatal HIV infection, as well as recommendations for service provision and future research.
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Affiliation(s)
- Renee Smith
- a Department of Pediatrics , University of Illinois at Chicago , Chicago IL , USA
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31
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Letourneau EJ, McCart MR, Asuzu K, Mauro PM, Sheidow AJ. Caregiver Involvement in Sexual Risk Reduction with Substance Using Juvenile Delinquents: Overview and Preliminary Outcomes of a Randomized Trial. ADOLESCENT PSYCHIATRY 2014; 3:342-351. [PMID: 26413463 DOI: 10.2174/22106766113036660002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Substance using juvenile offenders have some of the highest rates for engaging in risky sexual behaviors compared to other adolescent subgroups. METHODS An overview of the literature on sexual risk behaviors among these youth is provided, including the empirical support for including caregivers/parents as critical partners in sexual risk reduction efforts with this population. In particular, there is (a) evidence that family factors contribute to adolescent sexual risk, (b) emerging support for caregiver focused interventions that target adolescent sexual risk, and (c) established support for caregiver focused interventions that target other complex adolescent behavior problems. In addition, this paper presents preliminary results from a randomized controlled trial evaluating a family-based intervention for substance using juvenile delinquents that combines contingency management (CM) for adolescent substance use with a novel sexual risk reduction (SRR) protocol. Results through six months post-baseline (corresponding with the end of treatment) are presented for intervention fidelity and outcomes including number of intercourse acts (Sex Acts), use of condoms or abstinence (Safe Sex), and obtaining HIV testing (Testing). CONCLUSIONS In comparison to youth focused group substance abuse treatment, the CM-SRR intervention was associated with significantly greater therapist use of SRR techniques and greater caregiver involvement in treatment sessions (supporting treatment fidelity) and significantly lower increases in Sex Acts (supporting treatment efficacy). There were also higher odds for Safe Sex and for Testing, although these results failed to reach statistical significance. Findings add to the growing literature supporting the feasibility and efficacy of caregiver focused interventions targeting sexual risk behaviors among high-risk adolescent populations.
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Affiliation(s)
- Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Michael R McCart
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Kammarauche Asuzu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Pia M Mauro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Ashli J Sheidow
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Naar-King S, Montepiedra G, Garvie P, Kammerer B, Malee K, Sirois PA, Aaron L, Nichols SL. Social ecological predictors of longitudinal HIV treatment adherence in youth with perinatally acquired HIV. J Pediatr Psychol 2013; 38:664-74. [PMID: 23629146 DOI: 10.1093/jpepsy/jst017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To apply a social ecological model to explore the psychosocial factors prospectively associated with longitudinal adherence to antiretroviral treatment in youth perinatally infected with HIV. METHODS Randomly selected youth, age 8 to <19 years old, completed cognitive testing and psychosocial questionnaires at baseline as part of a multisite protocol (N = 138). A validated caregiver-report measure of adherence was completed at baseline and 24 and 48 weeks after baseline. RESULTS In multivariate analysis, youth awareness of HIV status, caregiver not fully responsible for medications, low caregiver well-being, adolescent perceptions of poor caregiver-youth relations, caregiver perceptions of low social support, and African American ethnicity were associated with nonadherence over 48 weeks. CONCLUSIONS Interventions focusing on caregivers and their interactions with the individual youth and extrafamilial system should be prioritized for prevention and treatment efforts to address nonadherence during the transition into adolescents.
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Affiliation(s)
- Sylvie Naar-King
- Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, USA.
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Naar-King S, Outlaw AY, Sarr M, Parsons JT, Belzer M, Macdonell K, Tanney M, Ondersma SJ. Motivational Enhancement System for Adherence (MESA): pilot randomized trial of a brief computer-delivered prevention intervention for youth initiating antiretroviral treatment. J Pediatr Psychol 2013; 38:638-48. [PMID: 23359664 DOI: 10.1093/jpepsy/jss132] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To pilot test a two-session computer-delivered motivational intervention to facilitate adherence among youth with HIV newly prescribed antiretroviral treatment (ART). METHODS Youth (N = 76) newly prescribed ART were recruited from 8 sites, and were randomized to the intervention or an active nutrition and physical activity control. Primary outcomes were HIV-1 viral load at baseline, 3 months, and 6 months, and self-reported adherence at 3 and 6 months. RESULTS Satisfaction ratings were high. Effect sizes suggested that the intervention group showed a greater drop than controls in viral load from baseline to 6 months (Cohen's d = 0.39 at 3 months; d = 0.19 at 6 months), and had greater percent undetectable by 6 months (d = 0.28). Effects sizes were medium to large for 7-day and weekend adherence. CONCLUSIONS A brief computer-delivered motivational intervention showed promise for youth starting ART and is ready to be tested in a full-scale clinical trial.
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