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Chawla S, Kaida A, Brouillette MJ, Kleiner B, Dubuc D, Skerritt L, Burchell AN, Rouleau D, Loutfy M, de Pokomandy A. Mental health service use and shortages among a cohort of women living with HIV in Canada. BMC Health Serv Res 2024; 24:923. [PMID: 39135046 PMCID: PMC11321070 DOI: 10.1186/s12913-024-11396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care. METHODS Baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages. RESULTS Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03-2.77], higher education level (aOR: 1.43, 95% CI: 1.02-2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02-1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26-0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39-0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50-0.96) were associated with lower odds of reporting service shortages. CONCLUSION Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.
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Affiliation(s)
- Seerat Chawla
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Harvard Medical School, Boston, MA, USA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Marie-Josée Brouillette
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Bluma Kleiner
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danièle Dubuc
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Rouleau
- Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
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Womack JA, Murphy TE, Leo-Summers L, Bates J, Jarad S, Smith AC, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt CA, Justice AC. Predictive Risk Model for Serious Falls Among Older Persons Living With HIV. J Acquir Immune Defic Syndr 2022; 91:168-174. [PMID: 36094483 PMCID: PMC9470988 DOI: 10.1097/qai.0000000000003030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older (older than 50 years) persons living with HIV (PWH) are at elevated risk for falls. We explored how well our algorithm for predicting falls in a general population of middle-aged Veterans (age 45-65 years) worked among older PWH who use antiretroviral therapy (ART) and whether model fit improved with inclusion of specific ART classes. METHODS This analysis included 304,951 six-month person-intervals over a 15-year period (2001-2015) contributed by 26,373 older PWH from the Veterans Aging Cohort Study who were taking ART. Serious falls (those falls warranting a visit to a health care provider) were identified by external cause of injury codes and a machine-learning algorithm applied to radiology reports. Potential predictors included a fall within the past 12 months, demographics, body mass index, Veterans Aging Cohort Study Index 2.0 score, substance use, and measures of multimorbidity and polypharmacy. We assessed discrimination and calibration from application of the original coefficients (model derived from middle-aged Veterans) to older PWH and then reassessed by refitting the model using multivariable logistic regression with generalized estimating equations. We also explored whether model performance improved with indicators of ART classes. RESULTS With application of the original coefficients, discrimination was good (C-statistic 0.725; 95% CI: 0.719 to 0.730) but calibration was poor. After refitting the model, both discrimination (C-statistic 0.732; 95% CI: 0.727 to 0.734) and calibration were good. Including ART classes did not improve model performance. CONCLUSIONS After refitting their coefficients, the same variables predicted risk of serious falls among older PWH nearly and they had among middle-aged Veterans.
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Affiliation(s)
- Julie A Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, West Haven, CT
| | | | | | - Jonathan Bates
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | | | | | - Evelyn Hsieh
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Maria C Rodriguez-Barradas
- Michael E DeBakey VA Medical Center, Infectious Diseases Section and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C Tien
- University of California, San Francisco, CA
- Department of Veterans Affairs, San Francisco, CA
| | | | - Cynthia A Brandt
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
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Fletcher-Hildebrand S, Alimezelli H, Carr T, Lawson K, Ali A, Groot G. Understanding the impact of a residential housing programme for people living with HIV/AIDS: a realist evaluation protocol. BMJ Open 2021; 11:e044522. [PMID: 33820789 PMCID: PMC8030488 DOI: 10.1136/bmjopen-2020-044522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Housing instability and homelessness are significant barriers to medical treatment for people living with HIV/AIDS. For these individuals, lack of stable housing and stigma is associated with insufficient access to care, poor adherence to medication and higher cost burdens to the healthcare system. This protocol reports on the efforts to evaluate Sanctum V.1.0, a hospice and transitional care home for adults with HIV/AIDS in Saskatoon, Saskatchewan, Canada. The current project was developed out of a need to identify how Sanctum V.1.0 produces varying programme outcomes to assist in endeavours to replicate the programme in other geographic locations. METHODS AND ANALYSIS A realist evaluation will be conducted to explore how and why Sanctum V.1.0 is successful or unsuccessful, in which circumstances and for whom. Rather than explore the degree to which a programme is effective, realist evaluations seek to uncover mechanisms that explain processual links between programme inputs and outcomes. The completed first phase of the project involved the development of an initial realist programme theory. Phases 2 and 3 will consist of methods to test, refine and validate the initial theory using various data sources. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional review board at the University of Saskatchewan on 2 July 2020. Results will be disseminated according to stakeholders' desires.
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Affiliation(s)
| | - Hubert Alimezelli
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tracey Carr
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Karen Lawson
- Psychology, University of Saskatchewan College of Arts and Science, Saskatoon, Saskatchewan, Canada
| | - Anum Ali
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Aquino G, Byrne M, Dorsey K, Siegel M, Mitchell O, Grant S, Fox A, Lum G, Allston A, Monroe A, Doshi R. Examining Retention in HIV Care and HIV Suppression on Housing Services Intake at a Washington, DC Community Based Organization. J Community Health 2021; 46:861-868. [PMID: 33507489 DOI: 10.1007/s10900-020-00959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
In Washington, DC, 2% of residents are living with HIV, with 15.3% of them experiencing homelessness. Additionally, over half of DC-area renters are paying over 30% of their income for housing. The primary objective of this study was to describe HIV outcomes at initial intake at Housing Counseling Services (HCS). This retrospective study included adults with HIV completing HCS intake between 2015 and 2018 and linked HCS data with DC Department of Health (DOH) HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) surveillance data. Proportions of individuals with retention in care (RIC) and viral suppression (VS) were compared across client subgroups using chi-square or rank sum tests. The sample of 734 participants was mostly male (67%), Non-Hispanic Black (89%), had MSM as the HIV transmission risk factor (44%) and had rental housing (60%). Most participants (634/734, 86%) were RIC at HCS intake. A majority of participants (477/621 or 77%) had VS at intake. Older age was associated with VS (p = 0.0007). Homeless individuals (with intake from the street) were less likely to be VS (4.8% vs. 11.1%, p < 0.0045). Our results suggest that PWH who have unstable housing or who are homeless may need additional support services for maintaining RIC and VS, as the proportion meeting those benchmarks was not at goal when they sought services at HCS.
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Affiliation(s)
- Gabrielle Aquino
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA
| | - Kerri Dorsey
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
| | | | | | - Sherita Grant
- District of Columbia Department of Health, Washington, DC, USA
| | - Anthony Fox
- District of Columbia Department of Health, Washington, DC, USA
| | - Garrett Lum
- District of Columbia Department of Health, Washington, DC, USA
| | - Adam Allston
- District of Columbia Department of Health, Washington, DC, USA
| | - Anne Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.
| | - Rupali Doshi
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA.,District of Columbia Department of Health, Washington, DC, USA
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Clark L, Karki C, Noone J, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/126632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zhang X, Oman RF, Larson TA, Christiansen EJ, Granner ML, Lu M, Yang Y. Healthcare Utilization, Unmet Service Needs, and Medication Adherence Among People Living with HIV/AIDS. Curr HIV Res 2020; 18:436-442. [PMID: 32807058 DOI: 10.2174/1570162x18666200817112255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA's service utilization, unmet service needs, and ART adherence. METHODS PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence. RESULTS Only 12 (7.5%) participants reported they received all the needed services. The ART nonadherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence. CONCLUSION The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.
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Affiliation(s)
- Xiangjun Zhang
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Roy F Oman
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Trudy A Larson
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Elizabeth J Christiansen
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Michelle L Granner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Minggen Lu
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. Mail Stop 0274, United States
| | - Yueran Yang
- Department of Psychology, University of Nevada, Reno , 1664 N. Virginia St. Mail Stop 0296, United States
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Zhang M, Garcia A, Bretones G. Demographics and Clinical Profiles of Patients Visiting a Free Clinic in Miami, Florida. Front Public Health 2019; 7:212. [PMID: 31428596 PMCID: PMC6688117 DOI: 10.3389/fpubh.2019.00212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Although the ranks of the uninsured in the United States have decreased in recent years, some states still lack Medicaid expansion programs, leaving many Americans, especially the indigent and homeless, without adequate healthcare coverage. Free-for-care clinics are oftentimes the last safety net for these vulnerable populations. Because these clinics have limited funding, a thorough understanding of the patients they serve is necessary to effectively direct their resources. The objective of the present study is to investigate the characteristics and clinical profiles of patients utilizing a free clinic in Miami, Florida. Methods: Aggregate EMR data reflecting consecutive adult patient visits to the Miami Rescue Mission Clinic in Miami, Florida between January 1st, 2018 to March 15th, 2019 (n = 846) were reviewed for sociodemographic characteristics and chronic disease prevalence. Prevalence rates were compared by sex and to county estimates from the Florida Behavioral Risk Factor Surveillance System. Results: The most common conditions were mental health (19.3%), circulatory system (14.7%), and musculoskeletal system disorders (13.9%). Males had a greater prevalence of depression (difference = 6.6%; 95% CI [1.5 to 10.7%]; χ2 = 6.2; p = 0.013) and overall mental illness (22.0 vs. 10.4%, difference = 11.6%; 95% CI [5.7 to 16.4%]; χ2 = 13.2; p = 0.0003) compared to females, and male sex was identified as an independent risk factor for mental illness on multivariate logistic regression analysis (OR = 2.8; 95% CI [1.7 to 4.7]; p < 0.001). There was also a higher prevalence of depression (difference = 6.41%; 95% CI [2.1 to 10.2%]; χ2 = 8.0; p = 0.0047) and HIV (difference = 1.4%; 95% CI [0.3 to 3.0%]; χ2 = 7.3; p = 0.007) in male patients compared to county estimates. Rates of hypertension, diabetes, elevated cholesterol, asthma, and COPD were lower in the clinic population compared to the surrounding county. Conclusion: There is an acute need for mental health services in this population. The lowered prevalence of other chronic conditions is due to underdiagnosis and loss to follow-up. Such analyses are important in guiding policy decisions for meeting the health needs of vulnerable, at risk populations.
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Affiliation(s)
- Michael Zhang
- Miami Rescue Mission Clinic, Miami, FL, United States
| | - Alejandro Garcia
- School of Health Sciences, Miami Dade College, Miami, FL, United States
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Hawk M, Maulsby C, Enobun B, Kinsky S. HIV Treatment Cascade by Housing Status at Enrollment: Results from a Retention in Care Cohort. AIDS Behav 2019; 23:765-775. [PMID: 30334234 DOI: 10.1007/s10461-018-2295-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Though housing instability is linked to poor HIV health outcomes, studies that assess the HIV treatment cascade by housing status are limited. Using data from a multi-site Retention in Care initiative we constructed HIV treatment cascades for participants (n = 463) of five grantee sites. We found no significant differences in viral suppression at follow-up among participants who were unstably housed at enrollment (49%) as compared to those who were stably housed at enrollment (54%). Among participants with available data at 6- or 12-month follow-up, 94% were engaged in care, 90% were retained in, 94% were on ART, and 71% had suppressed viral load. Some site-level differences were noted; at two of the sites participants who were stably housed were more likely to be retained in care and on ART. Overall, findings demonstrated that participants moved successfully through the HIV treatment cascade regardless of housing status at enrollment, suggesting that evidence-based support and services to help people living with HIV/AIDS can help mitigate barriers to engagement in care associated with lack of stable housing.
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Prust ML, Mellor-Crummey L, Sullivan T, Lang S, Hansen NB. Capacity of AIDS service organisations in Connecticut to respond to intimate partner violence. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:329-337. [PMID: 26584673 PMCID: PMC9377319 DOI: 10.1111/hsc.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 06/05/2023]
Abstract
Although intimate partner violence (IPV) is prevalent among women living with HIV and negatively impacts their health, few studies have examined the ability of AIDS service organisations (ASOs) to address IPV. This study used a qualitative approach to identify facilitators of and barriers to addressing IPV in female clients of ASOs in the United States. In-depth interviews were conducted between March and August 2011 with 20 ASO staff members and 19 female clients who reported a current or past history of IPV. Interviews were audio recorded, transcribed and analysed using the constant comparative method. These data identify barriers to addressing IPV at the organisation, provider and client levels, and include suggestions from both clients and providers about improving access to care. Client and provider suggestions differed in some areas. While providers emphasised structural changes such as increased training on IPV provided by their organisation, clients highlighted the importance of trusting personal relationships with staff to increase client disclosure of IPV experiences. Given the differing opinions of clients and staff, ASOs should consider involving women with histories of IPV in the process of programme and policy development. ASOs have the unique opportunity to provide comprehensive and holistic care by addressing IPV. The extent to which ASOs are able to recognise and address IPV and strategies for increasing this ability warrant greater attention from funders, ASO administrators and researchers.
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Affiliation(s)
- Margaret L. Prust
- School of Public Health, Yale University, New Haven, CT, United States
| | | | - Tami Sullivan
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Ave, Yale University, New Haven, CT, United States
| | - Shawn Lang
- AIDS Connecticut, Hartford, CT, United States
| | - Nathan B. Hansen
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Ave, Yale University, New Haven, CT, United States
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Burger-Calderon R, Smith JS, Ramsey KJ, Webster-Cyriaque J. The Association between the History of HIV Diagnosis and Oral Health. J Dent Res 2016; 95:1366-1374. [PMID: 27527399 DOI: 10.1177/0022034516661518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Unmet oral care needs are high among people living with human immunodeficiency virus (HIV)/AIDS (PLWH). Oral health care is of increasing importance as life expectancy is being prolonged extensively among PLWH. The benefit of oral health care in relation to time since HIV diagnosis has not previously been assessed. A retrospective multivariable analysis of the Special Project of National Significance Oral Health Initiative observational cohort study ( N = 2,178) was performed to estimate the odds ratios (ORs) of oral health outcomes comparing historically diagnosed subjects (>1 y since HIV diagnosis) to newly diagnosed subjects (≤1 y since HIV diagnosis). ORs were adjusted for age, study site, language, income, last dental care visit, and dental insurance. Historically diagnosed subjects were more likely to report oral problems than newly HIV-diagnosed subjects (OR, 2.10). Historically diagnosed subjects were more likely to require oral surgery (OR, 1.52), restorative treatment (OR, 1.35), endodontic treatment (OR, 1.63), and more than 10 oral clinic visits over the 24-mo study period (OR, 2.02). The crude cumulative 2-y risk of requiring prosthetic (risk difference [RD], 0.21) and endodontic (RD, 0.11) treatment was higher among historically than newly diagnosed subjects, despite no significance postadjustment. Furthermore, poor oral health outcomes were exacerbated among non-highly active antiretroviral therapy users. Summarizing, the authors found that historically diagnosed subjects were more likely to report oral problems and require dental procedures compared with newly diagnosed subjects, suggesting that oral health among PLWH declines over time since HIV diagnosis. Hence, newly diagnosed PLWH may benefit from the implementation of early oral interventions.
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Affiliation(s)
- R Burger-Calderon
- 1 Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - J S Smith
- 1 Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA.,2 Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, NC, USA
| | - K J Ramsey
- 3 Department of Dental Ecology, School of Dentistry, The University of North Carolina at Chapel Hill, NC, USA
| | | | - J Webster-Cyriaque
- 2 Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, NC, USA.,3 Department of Dental Ecology, School of Dentistry, The University of North Carolina at Chapel Hill, NC, USA.,4 Department of Microbiology and Immunology, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
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Abstract
Interprofessional collaboration in health has become essential to providing high-quality care, decreased costs, and improved outcomes. Patient-centered care requires synthesis of all the components of primary and specialty medicine to address patient needs. For individuals living with chronic diseases, this model is even more critical to obtain better health outcomes. Studies have shown shown that oral health and systemic disease are correlated as it relates to disease development and progression. Thus, inclusion of oral health in many of the existing and new collaborative models could result in better management of chronic illnesses and improve overall health outcomes.
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13
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Khosla N, Zachary I. Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA. AIDS Care 2016; 28:1249-54. [PMID: 26875546 DOI: 10.1080/09540121.2015.1124977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust.
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Affiliation(s)
- Nidhi Khosla
- a Department of Health Sciences , School of Health Professions, University of Missouri , Columbia , MO , USA
| | - Iris Zachary
- b Department of Health Management and Informatics , School of Medicine, University of Missouri , Columbia , MO , USA
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Hill LM, Maman S, Holness D, Moodley D. Legal knowledge, needs, and assistance seeking among HIV positive and negative women in Umlazi, South Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:3. [PMID: 26800890 PMCID: PMC4722747 DOI: 10.1186/s12914-016-0077-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The rights of women and people living with HIV (PLHIV) are protected under South African law, yet there is a gap in the application of these laws. While there are numerous systemic and social barriers to women's and PLHIV's exercise of their legal rights and rights to access social services, there has been little effort to document these barriers as well as legal needs and knowledge in this context. METHODS 1480 HIV-positive and HIV-negative women recruited from an antenatal clinic in Umlazi Township completed a questionnaire on legal knowledge, experience of legal issues, assistance seeking for legal issues, and barriers to seeking assistance. We compared the legal knowledge and experience of legal issues of HIV-positive and HIV-negative women, and described assistance seeking and barriers to assistance seeking among all women. RESULTS Both HIV-positive and HIV-negative women had high levels of knowledge of their legal rights. There were few important differences in legal knowledge and experience of legal issues by HIV status. The most common legal issues women experienced were difficulty obtaining employment (11 %) and identification documents (7 %). A minority of women who had ever experienced a legal issue had sought assistance for this issue (38 %), and half (50 %) of assistance sought was from informal sources such as family and friends. Women cited lack of time and government bureaucracy as the major barriers to seeking assistance. CONCLUSIONS These results indicate few differences in legal knowledge and needs between HIV-positive and HIV-negative women in this context, but rather legal needs common among women of reproductive age. Legal knowledge may be a less important barrier to seeking assistance for legal issues than time, convenience, and cost. Expanding the power of customary courts to address routine legal issues, encouragement of pro bono legal assistance, and introduction of legal navigators could help to address these barriers.
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Affiliation(s)
- Lauren M. Hill
- />Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 331 Rosenau Hall, CB #7440, Chapel Hill, 27599 NC USA
| | - Suzanne Maman
- />Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 331 Rosenau Hall, CB #7440, Chapel Hill, 27599 NC USA
| | - David Holness
- />University of KwaZulu-Natal Law Clinic, Durban, South Africa
| | - Dhayendre Moodley
- />Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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15
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Terzian AS, Irvine MK, Hollod LM, Lim S, Rojas J, Shepard CW. Effect of HIV Housing Services on Engagement in Care and Treatment, New York City, 2011. AIDS Behav 2015; 19:2087-96. [PMID: 25631320 PMCID: PMC4598342 DOI: 10.1007/s10461-015-1003-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The federal Housing Opportunities for Persons with AIDS (HOPWA) program addresses housing needs of low-income persons living with HIV/AIDS (PLWHA). The New York City (NYC) Department of Health and Mental Hygiene oversees 22 HOPWA contracts for over 2,400 clients, and manages the NYC HIV Registry. HOPWA clients (N = 1,357) were matched to a random 20 % sample of other PLWHA (N = 13,489). Groups were compared on HIV care retention, viral suppression, and rebound. HOPWA clients were, on average, 3 years younger and more likely to be concurrently diagnosed with HIV and AIDS. While HOPWA clients were more likely to be retained in care (94 vs. 82 %; mOR = 2.97, 95 % CI 2.35-3.74), they were no more likely to achieve suppression (84 vs. 86 %; mOR = 0.85, 95 % 0.70-1.03) and were more likely to rebound (11 vs. 7 %; mOR = 1.45; 95 % CI 1.10-1.91). HIV care retention does not fully translate to virologic suppression in this low-income service population.
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Affiliation(s)
- Arpi S Terzian
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA.
| | - Mary K Irvine
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - Laura M Hollod
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - John Rojas
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - Colin W Shepard
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
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16
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O'Rourke A, Ruiz MS, Allen ST. Client-identified needs and agency-provided services at a harm reduction community based organization in the District of Columbia. Harm Reduct J 2015; 12:17. [PMID: 26037624 PMCID: PMC4455049 DOI: 10.1186/s12954-015-0051-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Harm reduction case management relies on client-identified goals to drive the provision of care in order to “meet clients where they are at”. This research measured the level of agreement between client-identified needs and agency-provided services at a community based organization (CBO) in Washington DC by examining: (1) the services clients most often identified, (2) the services most often given to clients by the CBO, and (3) the level of alignment between client-identified needs and services provided. Methods Case file reviews were completed for 151 clients who received case management services at the CBO between January 2010 and February 2011. Client-identified needs and agency-provided services were extracted from case files and divided into 9 matching need and service categories: pharmaceutical assistance (e.g., prescription renewal), medical or dental care, housing, mental health services, substance use services, support services (e.g., support group meetings), legal assistance, and employment/job training. Client-identified needs and services provided were analyzed using McNemar’s Chi-square to assess for significant differences in discordant pairs. Results Clients were mostly Black (90.7 %), heterosexual (63.6 %), HIV positive (93.4 %), and over 40 years old at the time of intake (76.2 %). On average, clients identified 2.44 needs and received 3.29 services. The most common client-identified needs were housing (63.7 %), support services (34.3 %), and medical/dental care (29.5 %). The most common agency-provided services were housing (58.2 %), support services (51.4 %), and medical/dental care (45.2 %). In 6 of the 9 service categories, there were statistically significant (p < .01) differences between those who received services not asked for and those who did not receive asked for services in the categories of pharmaceutical assistance, medical/dental care, substance abuse services, support services, legal assistance, and food access. In each of these matched service categories, the percentage of clients who received services not asked for was significantly higher than those who did not. Conclusion This research shows that, while there is general alignment between the services that clients most often want and the services most often provided, there are still instances where services are requested but are not being provided.
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Affiliation(s)
- Allison O'Rourke
- Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave, Suite 300, Washington, DC, 20052, USA.
| | - Monica S Ruiz
- Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave, Suite 300, Washington, DC, 20052, USA.
| | - Sean T Allen
- Milken Institute School of Public Health at the George Washington University, 950 New Hampshire Ave, Suite 300, Washington, DC, 20052, USA.
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17
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Abstract
PURPOSE OF REVIEW HIV-infected individuals are living longer as a result of effective treatment. Age-related comorbidities now account for the majority of morbidity and mortality among treated HIV-infected adults. Previous findings regarding the age at, and risk of, these comorbidities have been mixed, sparking debate in the field. Discerning potential differences in the occurrence and burden of age-related comorbidities among treated HIV-infected adults as compared with uninfected adults of the same age requires careful selection of the appropriate uninfected comparison group. RECENT FINDINGS The validity of comparisons with HIV-uninfected populations is threatened when differences in demographic, clinical, and lifestyle characteristics between HIV-infected and uninfected adults are not considered. Identifying a pool of HIV-uninfected individuals from existing secondary data resources and employing selection methodologies may be a novel approach to reduce threats to internal validity. Issues related to identifying data sources, understanding inclusion criteria, determining measurement error, and threats to inference are discussed. SUMMARY The development of clinical interventions targeting age-related comorbidities will rely on deriving valid inferences from appropriate comparison groups. The use of secondary data resources and selection methodology to create the appropriate uninfected comparison group is an attractive approach in the setting of finite resources, but are not without limitations.
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Affiliation(s)
- Cherise Wong
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keri Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen J. Gange
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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