1
|
Deng M, Chen N, Lao X, Wang X, Fu J, Xing L, Zhao H. Reasons, Efficacy and Safety of Switching to Dolutegravir-Based Regimens Among Virologically Suppressed PLWH: A Retrospective Cohort Study of 96 Weeks. Infect Drug Resist 2024; 17:1571-1582. [PMID: 38681898 PMCID: PMC11055531 DOI: 10.2147/idr.s451346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The study aimed to explore the reasons, efficacy, and safety of switching to dolutegravir (DTG) based regimens in virologically suppressed people living with HIV (PLWH) in tertiary hospitals in China. Therefore, the study could provide a valuable reference for the rational clinical use of DTG. Methods PLWH's basic information, treatment details, and reasons for switching were collected, through the electrical clinical medical record system and telephone follow-up. Data included the proportion of PLWH with HIV RNA <50 copies/mL, changes in immunological indicators, and metabolic metrics at week 48 and week 96. Results 319 PLWH were included in the analysis. The three major reasons for switching were neurological toxicity (16.30%), simplification (13.79%), and renal toxicity (11.29%). Our study showed high rates of virologic suppression in the per-protocol analysis (week 48: 99.69%; week 96: 99.29%) after switching to DTG-based regimens. The median CD4+ T cell count increased from 579 cells/μL (IQR 420.5-758) to 642 cells/μL (IQR 466.5-854) at week 96 (p<0.0001). An improvement was observed in liver function (ALT: p<0.0001; AST: p<0.0001) and fasting glucose (p<0.0001). However, there was an elevation in creatinine (Cr) (p<0.0001) and a slight decrease in the estimated glomerular filtration rate (eGFR) (p<0.0001). Regarding lipid profile, triglyceride (TG) levels declined, while total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased. Further analysis revealed that the increase in TC and LDL-C was associated with the withdrawal of tenofovir disoproxil fumarate (TDF). This observed increase in lipid parameters only concerned the PLWH who switched from a TDF-containing regimen to a non-TDF regimen. Conclusion This study confirmed the virologic efficacy of switching to DTG-based regimens in virologically suppressed PLWH over a 96-week period. The findings also expanded the evidence of immune reconstitution and metabolic safety associated with this switch.
Collapse
Affiliation(s)
- Meiju Deng
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Na Chen
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Xiaojie Lao
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Xiaolei Wang
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Jiantao Fu
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Lulu Xing
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Hongxin Zhao
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| |
Collapse
|
2
|
Yang Y, Chen B, Zhang H, Huang P, Qian J, Lin L, Zhang L, Cai F. Global prevalence of depressive symptoms among people living with HIV/AIDS: a systematic review and meta-analysis of the past five years. AIDS Care 2024; 36:153-164. [PMID: 37995747 DOI: 10.1080/09540121.2023.2285733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
A clear and accurate assessment of depressive symptoms among people living with HIV/AIDS (PLWHA) in the past five years is essential to help develop reasonable and sound interventions to improve their depressive symptoms. PubMed, Web of Science, MEDLINE, Cochrane, Embase, CINAHL, and APA were searched from 1 January 2017 to 12 April 2022. The data were analyzed using STATA 15 Software to pool the global prevalence of depressive symptoms in PLWHA. Ultimately, 103785 PLWHA from 81 original studies were included. The pooled analysis showed that the global prevalence of depressive symptoms in PLWHA over the past five years was 0.35 (95% CI: 0.31-0.38), with differences in depressive symptoms in PLWHA by geographic location, gender, assessment instruments, alcohol use, smoking, marriage, co-morbid disease, financial situation, and educational level. Scientific and timely public health interventions should be developed among PLWHA to improve their depressive symptoms and thereby improve mental health and clinical outcomes.
Collapse
Affiliation(s)
- Yufan Yang
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Bei Chen
- Nursing Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Haiyan Zhang
- College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Pan Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jieyu Qian
- College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Lulu Lin
- College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Liping Zhang
- Nursing Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Fuman Cai
- College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| |
Collapse
|
3
|
Sriprasart T, Saiphoklang N, Kawamatawong T, Boonsawat W, Mitthamsiri W, Chirakalwasan N, Chiewchalermsri C, Athipongarporn A, Kamalaporn H, Kornthatchapong K, Kulpraneet M, Sompornrattanaphan M, Oer-Areemitr N, Rerkpattanapipat T, Silairatana S, Thawanaphong S, Gaensan T, Jirakran K, Poachanukoon O. Allergic rhinitis and other comorbidities associated with asthma control in Thailand. Front Med (Lausanne) 2024; 10:1308390. [PMID: 38274465 PMCID: PMC10808701 DOI: 10.3389/fmed.2023.1308390] [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: 10/06/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
Background Asthma and allergic rhinitis (AR) can coexist and cause disabilities. This study aimed to assess the association between AR, asthma control, asthma-related quality of life, and other comorbidities. Methods A cross-sectional study was conducted in adults with asthma in six hospitals in Thailand. The outcomes were association of asthma control assessed by the asthma control test (ACT), AR, and asthma comorbidities. Not-well-controlled asthma was defined as ACT scores ≤22. The severity of AR was determined by visual analog scale (VAS). Severe AR was defined as VAS ≥5. Asthma-related quality of life (AQLQ), comorbidities, and total IgE were recorded. Results A total of 682 asthmatic patients were included. Median (IQR) age was 58.0 (47.0-64.0) years. 69.9% were female. Not-well-controlled asthma was present in 44.7%. The prevalence of AR was 86.1%. Moderate/severe persistent AR was diagnosed in 21.7% and severe AR was diagnosed in 30.2% of the patients. Inhaled corticosteroid-containing regimens were prescribed in 97.7% of patients. Intranasal corticosteroid and antihistamine were prescribed in 65.7 and 31.7%, respectively. Patients with not-well-controlled asthma had higher body mass index, VAS scores, proportions of pollution exposure, aeroallergen sensitization, severe AR, nasal polyp, urticaria, food allergy, gastroesophageal reflux disease, depression and anxiety, peptic ulcer, and asthma exacerbations, but younger age, lower AQLQ scores, and lower FEV1. Correlation was found between AR severity and ACT (r = -0.461, p < 0.001), AQLQ (r = -0.512, p < 0.001), and total IgE (r = 0.246, p < 0.023). Multiple regression analysis revealed that ACT, AQLQ, and percentage of FEV1/FVC were significantly associated with severe AR. Conclusion Allergic rhinitis is prevalent in Thai asthmatic patients. AR severity is associated with asthma control, quality of life, and pulmonary function. Comprehensive care is essential for patients with uncontrolled asthma, particularly when coexisting with conditions.
Collapse
Affiliation(s)
- Thitiwat Sriprasart
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Narongkorn Saiphoklang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Theerasuk Kawamatawong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Watchara Boonsawat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wat Mitthamsiri
- Allergy and Clinical Immunology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Excellence Center for Sleep Disorders, Thai Red Cross Society, Bangkok, Thailand
| | - Chirawat Chiewchalermsri
- Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Athipat Athipongarporn
- Department of Pediatrics, Phra Nakhon Si Ayutthaya Hospital, Phra Nakhon Si Ayutthaya, Thailand
| | - Harutai Kamalaporn
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumpol Kornthatchapong
- Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Manaphol Kulpraneet
- Division of Pulmonary and Critical Care, Department of Medicine, Srinakarinwirot University, Bangkok, Thailand
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nittha Oer-Areemitr
- Division of Pulmonary and Critical Care Medicine, Ekachai Hospital, Samut Sakhon, Thailand
| | - Ticha Rerkpattanapipat
- Allergy Immunology and Rheumatology Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Santi Silairatana
- Division of Pulmonary Medicine and Pulmonary Critical Care, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sarita Thawanaphong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thanate Gaensan
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ketsupar Jirakran
- Center of Excellence for Maximizing Children’s Developmental Potential, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Orapan Poachanukoon
- Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University, Pathum Thani, Thailand
| |
Collapse
|
4
|
Kharat N, Ramachandra R, Chaurasia H, Shetty S, Begum S, Joshi B. Assessment of Health-Related Quality of Life Using EQ-5D-5L Tool With Indian Tariffs Among Reproductive Age Group Women Living With HIV in India. Value Health Reg Issues 2023; 37:113-120. [PMID: 37481902 DOI: 10.1016/j.vhri.2023.04.006] [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: 01/11/2023] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE India is witnessing declining HIV prevalence because of dedicated efforts by the government. The highly active antiretroviral therapy has improved life span of people living with HIV but bearing many side effects. Women living with HIV (WLHIV) in reproductive age group have additional burden of pregnancy-related issues. This study aimed to estimate the health utility score among WLHIV in India, particularly in context of their contraceptive use, during pregnancy and postpartum period. METHODS A primary cross-sectional study was conducted among 195 WLHIV availing antiretroviral treatment services at public health facilities of Mumbai. The EQ-5D-5L interview-based questionnaire in local language and Indian value set was used to estimate health-related quality of life (QOL) reported as mean (± SD) utility and visual analog scale (VAS) scores. The relationship between utility values and VAS scores was assessed. RESULTS The WLHIV with mean age of 31.6 (6.4) years were on antiretroviral medication for nearly 7 years, and 63% had CD4+ cell count > 500 cells/mm3. Response of "11111," that is, in full health state, was reported by 66.7%. The mean utility and VAS scores were 0.976 (± 0.0519) and 82.21 (± 15.77). Reduced health-related QOL scores were associated with pain and discomfort dimension. Utility scores among contraceptive users (0.986 [± 0.029]) was higher than nonusers (0.976 [± 0.028]). Currently pregnant WLHIV had least utility score (0.959 [± 0.088]). CONCLUSIONS WLHIV had better QOL while using contraceptives more so when they were sterilized. Pregnancy reduces the QOL. This emphasizes the need to promote effective contraceptive methods among WLHIV and prevent unintended pregnancies.
Collapse
Affiliation(s)
- Namrata Kharat
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Revathy Ramachandra
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Himanshu Chaurasia
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Siddesh Shetty
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Shahina Begum
- Department of Biostatistics, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Beena Joshi
- HTA Regional Resource Hub, Department of Operational and Implementation Research, Indian Council of Medical Research - National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India.
| |
Collapse
|
5
|
Ross JL, Jiamsakul A, Avihingsanon A, Lee MP, Ditangco R, Choi JY, Rajasuriar R, Gatechompol S, Chan I, Melgar MIE, Kim JH, Chong ML, Sohn AH, Law M. Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region. AIDS Behav 2022; 26:3862-3877. [PMID: 35668223 PMCID: PMC9170121 DOI: 10.1007/s10461-022-03714-5] [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] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.
Collapse
Affiliation(s)
- Jeremy L Ross
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
| | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China
| | - Rossana Ditangco
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Iris Chan
- Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China
| | - Maria Isabel Echanis Melgar
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
- Ateneo de Manila University, Quezon City, Philippines
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Annette H Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| |
Collapse
|
6
|
Aurpibul L, Tangmunkongvorakul A, Jirattikorn A, Ayuttacorn A, Musumari PM, Srithanaviboonchai K. Depressive symptoms, HIV disclosure, and HIV-related stigma among migrant workers living with HIV in Chiang Mai, Thailand. AIDS Care 2022; 34:1565-1571. [PMID: 35603865 DOI: 10.1080/09540121.2022.2078770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Currently migrant workers living with HIV (MWLHIV) in Thailand have access to antiretroviral treatment. We determined the frequency of depressive symptoms, HIV disclosure, and HIV-related stigma in this population. The cross-sectional study was conducted at 12 HIV clinics in community hospitals in Chiang Mai, Thailand. Data were collected from MWLHIV through face-to-face interviews. A 9-item Patient Health Questionnaire-9 (PHQ-9) and a Thai-validated HIV/AIDS stigma scales were used. A total of 316 MWLHIV participated; their median age was 39 years and 65% were female. Sixty (19%) had depressive symptoms, with higher frequency of depression in females (22.4% vs.12.6%, respectively; p = .033). The overall HIV disclosure rate was 69.9%. Females were more likely than males to disclose HIV status to someone outside the clinic (72.2% vs. 65.8%, respectively; p = .234). The most prevalent type of HIV-related stigma was internalized, followed by felt stigma. Enacted stigma had the lowest prevalence. Multiple linear regression revealed that being female (β = 0.125, p = .029), enacted stigma (β = 0.152, p = .011) and felt stigma (β = 0.248, p < .001) were significantly associated with depressive scores. To ensure favorable HIV treatment outcomes, individual counseling, psychosocial support, and mental health screening should be integrated into HIV services.
Collapse
Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Patou Masika Musumari
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
7
|
Xiao J, Liu Y, Li B, Zhang L, Han J, Zhao H. Anxiety, depression, and sleep disturbances among people on long-term efavirenz-based treatment for HIV: a cross-sectional study in Beijing, China. BMC Psychiatry 2022; 22:710. [PMID: 36384522 PMCID: PMC9667435 DOI: 10.1186/s12888-022-04366-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Efavirenz (EFV)-induced neuropsychiatric toxicity bothers people living with HIV (PLHIV). Neuropsychiatric adverse effects of EFV may differ by length of time on EFV-based antiretroviral treatment (ART). METHODS A cross-sectional, single-center study was conducted at Beijing Ditan Hospital in China from June-August 2020 among ART-experienced PLHIV who were on long-term EFV-based ART. 424 eligible virological suppressed participants were enrolled and divided into four groups according to time on EFV-based ART: group A (0.5 ≤ ART < 2 year), B (2 ≤ ART < 4 year), C (4 ≤ ART < 6 year), and D (ART ≥ 6 year). The questionnaires about 12-item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess neuropsychiatric adverse events of EFV among different groups. RESULTS Overall mental component summary scores (MCS) of SF-12 in PLHIV was 50.2, which was lower than general population. Overall prevalence of anxiety, depression and sleep disturbances was 15.6%, 15.3% and 58%, respectively. Prevalence of anxiety, depression and sleep disturbances did not vary significantly between the time-on-ART groups. Anxiety, depression, sleep disturbances had no correlation with time on EFV-based ART or CD4+ T cells counts. CONCLUSIONS In ART-experienced PLHIV in China, neuropsychiatric adverse events exist persistently and prevalence do not significantly change with prolonged time on EFV-based ART. The prevalence of sleep disturbances was high, suggesting that clinicians should pay more attention to long-standing psychiatric health to perform early and effective interventions.
Collapse
Affiliation(s)
- Jing Xiao
- grid.11135.370000 0001 2256 9319Peking University Ditan Teaching Hospital, Beijing, 100015 China
| | - Ying Liu
- grid.24696.3f0000 0004 0369 153XNational Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015 China ,grid.24696.3f0000 0004 0369 153XClinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015 China
| | - Bei Li
- grid.24696.3f0000 0004 0369 153XNational Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015 China ,grid.24696.3f0000 0004 0369 153XClinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015 China
| | - Leidan Zhang
- grid.11135.370000 0001 2256 9319Peking University Ditan Teaching Hospital, Beijing, 100015 China
| | - Junyan Han
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China. .,Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China. .,Beijing Institute of Infectious Diseases, Beijing, 100015, China.
| | - Hongxin Zhao
- Peking University Ditan Teaching Hospital, Beijing, 100015, China. .,National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China. .,Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
| |
Collapse
|
8
|
Tan T, Zhou C, Lu R, Chen C, Bai C, Li L, Wu G. Depression and Associated Factors Among Men Living with HIV/AIDS Aged 50 Years and Over in Chongqing, China. J Multidiscip Healthc 2022; 15:2033-2040. [PMID: 36110578 PMCID: PMC9470116 DOI: 10.2147/jmdh.s378956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to assess the proportion of depression and its associated factors among men living with HIV/AIDS and aged 50 and over in Chongqing, China. Methods This cross-sectional study included 774 men diagnosed as HIV/AIDS and aged 50 and over in four regions. Data were collected through face-to-face interviews with a structured questionnaire. Multivariate logistic regression analysis was performed to identify factors associated with depression. A two-tailed P-value less than 0.05 was considered as statistical significance. Results A total of 293 participants (37.9%) reported depressive symptoms. Results from multivariate logistic regression suggested that individuals aged ≥70 (AOR = 1.99, 95% CI: 1.28-3.08) and those living in rural areas (AOR = 2.79, 95% CI: 1.96-3.97) were associated with higher odds of depression, while those being employed (AOR = 0.50, 95% CI: 0.32-0.80) and with monthly income >3000 CNY (AOR = 0.47, 95% CI: 0.30-3.74) had lower odds of depression. Conclusion Our findings indicate a high prevalence of depression among older men living with HIV/AIDS in Chongqing, China. Age, residence, employment, and income have been identified as potential risk factors of depressive symptoms. Mental-health intervention initiatives should be tailored to target adults with a higher risk of depression.
Collapse
Affiliation(s)
- Tianyu Tan
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, People's Republic of China
| | - Chao Zhou
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, People's Republic of China
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, People's Republic of China
| | - Cheng Chen
- Chongqing Jiulongpo District Center for Disease Control and Prevention, Chongqing, 400039, People's Republic of China
| | - Chongyang Bai
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, People's Republic of China
| | - Long Li
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, People's Republic of China
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, People's Republic of China
| |
Collapse
|
9
|
Xie M, Wang A, Wang K, Yu Y, Lin Z. Association between HIV duration and symptom distress among middle-aged and elderly people with HIV-infected in China: a cross-sectional study. BMC Geriatr 2022; 22:728. [PMID: 36058926 PMCID: PMC9442943 DOI: 10.1186/s12877-022-03411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Debate has persisted regarding whether PLWH with longer HIV durations have lower levels of prevalence and severity of symptoms compared with their newly diagnosed counterparts. Whether and how the HIV duration impact the symptom distress among middle-aged and older PLWH has not been explored clearly. Methods The patients with HIV-infected aged more than 40 years old were included from seven designated medical institutions of seven regions in China. Outcome was the score of symptom distress. We used the multiple regression model to calculate adjusted Coefficient of Regression (β) with 95% CI in this study. Results Among 210 participants (mean age 50.8 years; 71.0% male; 68.1% at asymptomatic stage) in the study, the median number of symptoms was 5. Of all symptoms reported, the most distressed symptoms were sleep disturbance (33.33%), followed by memory loss (31.90%), fatigue (26.67%), slow reactions (22.86%), and vision blur (21.90%). All participants were divided into four groups according to HIV duration, and the median of total score of symptom ditress among all participants was 0.1(0.0,0.9). Difference of total scores and clusters’ scores of symptom distress among four HIV duration groups were statistically significant. 51 participants with 6–10 years HIV duration were more likely to be higher level of education, at asymptomatic stage and have higher CD4 + T cell count. After adjustment for gender, age, race, education, marital status, employment, family income, region, stage of disease and CD4 + T cell count, the score of symptom distress among participants with 6–10 years HIV duration had was higher with the extension of HIV duration. Specially in physical symptoms and psychological symptoms,participants with 6–10 years HIV duration reported the persisting worse burdensome. Conclusions HIV duration with 6–10 yearsmay be a key period that the medical team needs to pay special attention to among middle-aged and elderly PLWH. There is a need to provide medical and psychosocial services targeting middle-aged and elderly PLWH according to their changing symptom distress. Trial registration Clinicaltrials.gov: ChiCTR2100046225. Registered 11 May 2021.
Collapse
Affiliation(s)
- Meilian Xie
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Department of Nursing, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Kerong Wang
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanping Yu
- Beijing Home of Red Ribbon, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Zhaoxia Lin
- Department of Quality Control, Beijing Ditan Hospital Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Kim SS, DeMarco RF. The Intersectionality of HIV-Related Stigma and Tobacco Smoking Stigma With Depressive and Anxiety Symptoms Among Women Living With HIV in the United States: A Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:523-533. [PMID: 34999667 DOI: 10.1097/jnc.0000000000000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study examined the intersectionality of HIV-related stigma, tobacco smoking stigma, and mental health among women living with HIV who were daily smokers. This secondary analysis used baseline data from 2 pilot smoking cessation studies. Participants received either an HIV-tailored or an attention-control intervention focused on smoking cessation as an outcome. There were significant positive relationships between HIV-related stigma and depressive and anxiety symptoms. In contrast, tobacco smoking stigma had no significant relationship with either of the symptoms when HIV-related stigma was controlled. However, there was a significant interaction effect (β = 1.37, p = .02) of tobacco smoking stigma with internalized HIV-related stigma on anxiety symptoms. Tobacco smoking stigma worsened anxiety symptoms for women who had high internalized HIV-related stigma. Health care providers should understand the effect of HIV-related stigma on mental health and address the intersectionality of HIV-related stigma with other socially disapproved behaviors, such as tobacco smoking.
Collapse
Affiliation(s)
- Sun S Kim
- Sun S. Kim, PhD, APRN-BC, is an Associate Professor, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Massachusetts, USA. Rosanna F. DeMarco, PhD, RN, FAAN, is a Professor and Associate Dean for Academic Affairs, College of Nursing and Health Sciences, University of Massachusetts Boston, Massachusetts, USA
| | | |
Collapse
|
11
|
Xiao J, Xiao J, Liu Y, Li B, Zhang L, Han J, Zhao H. Efficacy and safety of Efavirenz 400 mg-based regimens switching from 600 mg-based regimens in people living with HIV with virological suppression in China: a randomized, open-label, non-inferiority study. Int J Infect Dis 2022; 117:48-55. [DOI: 10.1016/j.ijid.2022.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
|
12
|
Rahmati J, Ahmadi S, Rezaei S, Hosseinifard H, Dehnad A, Shabaninejad H, Aryankhesal A, Ghasemyani S, Alihosseini S, Mansour Kiaee Z, Noorani Mejareh Z, Aghalou S, Ghashghaee A, Shoghi M, Ahmadi Nasab M, Khajehvand A. The worldwide prevalence of anxiety in acquired immune deficiency syndrome patients: A systematic review and meta-analysis. Med J Islam Repub Iran 2021; 35:101. [PMID: 34956947 PMCID: PMC8683796 DOI: 10.47176/mjiri.35.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Anxiety affects social, economic, and physical aspects of daily life in patients with AIDS. Therefore, it is necessary to take preventive measures and design plans to maintain their general health. The present study was the first comprehensive systematic literature review research that examined the worldwide prevalence rate of anxiety in patients with AIDS.
Methods: We searched for papers published in the English language in the major databases including Embase, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar from 2000 to October 2018. There were 40 studies which found to be eligible. These studies were independently evaluated and the collected data were entered in a data extraction form, which was then analyzed by two authors and a third author if necessary. Der Simonian-Laird model was used to estimate the prevalence rate on a Forest plot at the interval confidence of 95%.
Results: The total sample size was 24111, and the total number of people with anxiety was 5546. The results based on the random-effects model showed that the rate of anxiety prevalence in the patients was 25% (CI: 95%, 21% -30%) with heterogeneity of 97.9% and a significance level of p<0.001. The South America continent with a prevalence of 38% (95% CI, 34%-42%) had the highest anxiety prevalence rates and Africa with 19% (95% CI, 12% -29%) had the lowest anxiety prevalence rates.
Conclusion: Based on findings, the prevalence of anxiety in developed countries was partially higher than in underdeveloped countries and the obtained mean in the present study. It can be a significant point for policymakers. Therefore, WHO and the world community should have special plans for these countries.
Collapse
Affiliation(s)
- Jeiran Rahmati
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Ahmadi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Rezaei
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Hosseinifard
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Dehnad
- Department of Foreign Languages, School of Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Shabaninejad
- Population Health Sciences Institute (PHSI), Newcastle University, Newcastle, UK
| | - Aidin Aryankhesal
- Health Management and Economics Research Centre, Iran University of Medical Sciences, Tehran, Iran.,Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Ghasemyani
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Mansour Kiaee
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Noorani Mejareh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Aghalou
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahnaz Shoghi
- Nursing care research center, Nursing and midwifery school, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ahmadi Nasab
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Anahita Khajehvand
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Hasan MA, Hakim FT, Islam Shovon MT, Islam MM, Islam MS, Islam MA. The investigation of nonsynonymous SNPs of human SLC6A4 gene associated with depression: An in silico approach. Heliyon 2021; 7:e07815. [PMID: 34466701 PMCID: PMC8384904 DOI: 10.1016/j.heliyon.2021.e07815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022] Open
Abstract
Genetic polymorphism of the SLC6A4 gene is associated with several behavioral disorders, including depression. Since studying the total nonsynonymous single nucleotide polymorphisms (nsSNPs) of the SLC6A4 gene at the population level is a difficult task, we aim to utilize in silico approach to detect the most deleterious nsSNPs of the SLC6A4 gene. In our study, 7 computational tools were used in the initial stage, including SIFT, Polyphen-2, PROVEAN, SNAP2, PhD-SNP, PANTHER, and SNPs&GO to find out the most damaging nsSNPs. In the second phase, we performed structural, functional, and stability analysis of SLC6A4 protein by popular computation tools, including I-Mutant 2.0 and MutPred2. Also, the ConSurf server was utilized to find the conserved region of the SLC6A4 protein to determine the relationship between these conserved regions with high-risk nsSNPs. Based on these analyses, 5 high-risk mutations of the SLC6A4 protein were selected. Then, we carried out comparative modeling by using the Robetta server and aligned the mutant protein model with the native protein structure. Later, we performed the post-translational modification and functional domain analysis of the SLC6A4 protein. This study concludes that Arginine → Tryptophan at position 79 and Arginine → Cysteine at position 104 are the two significant mutations in SLC6A4 protein which might play an essential role in causing diseases. Future studies should take these high-risk nsSNPs (rs1221448303, rs200953188) into consideration while exploring diseases related to the SLC6A4 gene. Besides, our research is the first-ever comprehensive in silico investigation of the SLC6A4 gene. Thus, the findings of this study could be beneficial for developing precision medicines against diseases caused by SLC6A4 malfunction. Furthermore, extensive wet-lab research and experiments on various model organisms might be helpful to investigate the precise role of these damaging nsSNPs of the SLC6A4 gene.
Collapse
Affiliation(s)
- Md. Amit Hasan
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Rajshahi, Rajshahi-6205, Rajshahi, Bangladesh
| | - Fuad Taufiqul Hakim
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Rajshahi, Rajshahi-6205, Rajshahi, Bangladesh
| | - Md. Tanjil Islam Shovon
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Rajshahi, Rajshahi-6205, Rajshahi, Bangladesh
| | - Md. Mirajul Islam
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Rajshahi, Rajshahi-6205, Rajshahi, Bangladesh
| | - Md. Samiul Islam
- RT-PCR Laboratory, Department of Microbiology, Rangpur Medical College, Rangpur-5403, Bangladesh
| | - Md. Asadul Islam
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Rajshahi, Rajshahi-6205, Rajshahi, Bangladesh
| |
Collapse
|
14
|
Zhu Z, Guo M, Dong T, Han S, Hu Y, Wu B. Assessing psychological symptom networks related to HIV-positive duration among people living with HIV: a network analysis. AIDS Care 2021; 34:725-733. [PMID: 34043459 DOI: 10.1080/09540121.2021.1929815] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to explore and visualize relationships among multiple psychological symptoms among people living with HIV (PLWH) with different HIV-positive durations and to compare centrality indices and densities of psychological symptom networks. We used subsets of data collected from five designated HIV/AIDS hospitals in China. Networks were constructed among 16 psychological symptoms. Centrality properties, including strength and closeness, were adopted to describe relationships among symptoms. The results showed that PLWH with longer HIV-positive durations had denser emotional networks, which indicated that they had more emotional neuroticism than their newly diagnosed counterparts. Sadness, self-abasement, and self-loathing were the most central psychological symptoms across different HIV-positive durations. Our study suggests the need to provide psychosocial support services targeting PLWH according to changing symptom severity and neuroticism trajectories. Interventions should focus on increasing empathy for PLWH and enhancing the ability to consider the situation from different perspectives to avoid the development of neuroticism in long-term survivors.
Collapse
Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, People's Republic of China
| | - Mengdi Guo
- School of Government and Public Affairs, Communication University of China, Beijing, People's Republic of China
| | - Tingyue Dong
- Beijing Administration Institute, Beijing, People's Republic of China
| | - Shuyu Han
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, People's Republic of China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, People's Republic of China
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York University, New York City, New York, USA
| |
Collapse
|
15
|
Pampaka D, Pantavou K, Giallouros G, Pavlitina E, Williams LD, Piovani D, Bonovas S, Nikolopoulos GK. Mental Health and Perceived Access to Care among People Who Inject Drugs in Athens, Greece. J Clin Med 2021; 10:jcm10061181. [PMID: 33808991 PMCID: PMC8002050 DOI: 10.3390/jcm10061181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Poor mental health among human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) may contribute to stigma, and together they act as barriers to medical care. This analysis aims to examine factors associated with the mental health of PWID and their network contacts, and the association of poor mental health with the experience of HIV-related stigmatizing events, with HIV-related social support, and with perceived access to care. Data were collected during the Transmission Reduction Intervention Project (TRIP) conducted in Athens, Greece (2013-2015). PWID (n = 292; n = 122 HIV-positive) were interviewed both at baseline and follow-up. Items of depression, anxiety, and general positive affect subscales of the Mental Health Inventory were used to explore the psychological distress and well-being of participants at follow-up. Items of the Access to Care Scale were used to evaluate perceived access to medical care at baseline and follow-up. Linear regression showed that unemployment was positively related to depression (β = 1.49, p = 0.019), while injecting drug use was a risk factor for a low general positive affect score (β = -3.21, p = 0.015). Poor mental health was not linked to HIV-related stigma or social support. Positive perception of access to care was associated in multivariable analyses with low depression (β = -0.22, p = 0.049). The perceived access to care score improved from baseline to follow-up (p = 0.019) and HIV-positive participants had a higher score than HIV-negative participants. Future interventions should include targets to improve the mental well-being of participants, reduce psychosocial distress, and minimize perceived barriers to accessing medical care.
Collapse
Affiliation(s)
- Despina Pampaka
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus;
| | - Katerina Pantavou
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
| | - George Giallouros
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
- Department of Business and Public Administration, University of Cyprus, Nicosia 1678, Cyprus
| | - Eirini Pavlitina
- Transmission Reduction Intervention Project, Athens Site, 11527 Athens, Greece;
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA;
- National Development and Research Institutes, New York, NY 10010, USA
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Georgios K. Nikolopoulos
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
- Correspondence: ; Tel.: +357-228-952-23
| |
Collapse
|
16
|
Bagheri Z, Noorshargh P, Shahsavar Z, Jafari P. Assessing the measurement invariance of the 10-item Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory questionnaires across people living with HIV/AIDS and healthy people. BMC Psychol 2021; 9:42. [PMID: 33750473 PMCID: PMC7941965 DOI: 10.1186/s40359-021-00546-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Recently, extensive research has been reported the higher rate of depression and anxiety among people living with HIV/AIDS (PLWHAs) as compared to the general population. However, no single study has been carried out to investigate whether this disparity is a real difference or it happens due to lack of measurement invariance. This study aims to assess the measurement invariance of the Beck Anxiety Inventory (BAI) and 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) questionnaires across PLWHAs and healthy individuals. Methods One hundred and fifty PLWHAs and 500 healthy individuals filled out the Persian version of the BAI and CESD-10 questionnaires. Multi-group multiple-indicators multiple-causes model (MG-MIMIC) was used to assess measurement invariance across PLWHAs and healthy people. Results Our findings revealed that PLWHAs and healthy individuals perceived the meaning of all the items in the BAI and CESD-10 questionnaires similarly. In addition, although depression scores were significantly higher in PLWHAs as opposed to the healthy individuals, no significant difference was observed in anxiety scores of these two groups. Conclusions The current study suggests that the BAI and CESD-10 are invariant measures across PLWHAs and healthy people which can be used for meaningful cross-group comparison. Therefore, in comparison to healthy individuals, higher depression score of PLWHAs is a real difference. It is highly recommended that health professionals develop therapeutic interventions and psychological supports to promote the mental health of PLWHAs which alleviate their depressive symptoms.
Collapse
Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pegah Noorshargh
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shahsavar
- Department of English Language, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
17
|
Girma D, Assegid S, Gezahegn Y. Depression and associated factors among HIV-positive youths attending antiretroviral therapy clinics in Jimma town, southwest Ethiopia. PLoS One 2021; 16:e0244879. [PMID: 33406163 PMCID: PMC7787463 DOI: 10.1371/journal.pone.0244879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression is recognized as a prominent health problem and a growing public health concern in HIV-positive youths. Despite this fact, in Ethiopia, there is a dearth of evidence on the prevalence of depression and its associated factors among HIV-positive youths. METHODS A facility-based cross-sectional study was conducted from March 16 to June 01, 2020, among 331 HIV-positive youths attending antiretroviral therapy clinics in Jimma town. A systematic random sampling technique was used to enroll study participants. Bivariable and multivariable logistic regression was done to identify factors associated with depression. Variables with a p-value ≤0.25 on the bivariable analysis were candidates for multivariable analysis. Adjusted odds ratios with the respective 95% CI were calculated and p-value <0.05 were used to set statistically significant variables in the multivariable analysis. RESULTS Out of a total of 331 sampled HIV positive youth, 325 have participated in this study with a response rate of 98.2%. The prevalence of depression was 30.2% (95%CI:25.2%-35.1%). Female sex (AOR = 4.12, 95%CI:2.28-7.47), history of hospital admission (AOR = 2.45, 95%CI:1.28-4.70), discontinued education due to HIV/AIDS illness (AOR = 2.09, 95%CI:1.12-3.90), poor treatment adherence (AOR = 2.23, 95%CI:1.04-4.78), opportunistic infections (AOR = 2.16, 95%CI:1.17-3.97), high baseline viral load (AOR = 3.35, 95%CI:1.82-6.16) and ≤6 months duration of HIV diagnosis (AOR = 3.14, 95%CI: 1.47-5.72) were factors significantly associated with depression. CONCLUSION This study demonstrated a high prevalence of depression among HIV-positive youths. Factors such as female sex, treatment non-adherence, opportunistic infections,
Collapse
Affiliation(s)
- Derara Girma
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Sahilu Assegid
- Epidemiology Department, Institute of Public Health, Health Sciences College, Jimma University, Jimma, Ethiopia
| | - Yenealem Gezahegn
- Epidemiology Department, Institute of Public Health, Health Sciences College, Jimma University, Jimma, Ethiopia
| |
Collapse
|
18
|
Jain MK, Li X, Adams-Huet B, Tiruneh YM, Luque AE, Duarte P, Trombello JM, Nijhawan AE. The risk of depression among racially diverse people living with HIV: the impact of HIV viral suppression. AIDS Care 2020; 33:645-653. [PMID: 32880184 DOI: 10.1080/09540121.2020.1815167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Understanding the correlates of depression in HIV patients can help identify groups whose members are at increased risk for depression. We conducted a cross-sectional retrospective study among racially diverse, indigent patients living with HIV (PLWH) who were obtaining care in an urban safety-net hospital system and had completed a Patient Health Questionnaire-9 (PHQ-9) in 2014 or 2015. We collected demographics, HIV risk factors, HIV viral loads, CD4 counts, missed visits, and emergency department (ED) visits. Data from the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) were abstracted. Missing data on substance use and CD4 cell counts were imputed to examine the odds of depression (PHQ-9 ≥ 10) by multivariable analysis for a complete case and sensitivity analysis. Stratified analysis by HIV viral suppression (VS) was used to determine the odds of depression among subgroups. Of the 5126 HIV patients (70.8% male,56.3% Black, 44.6% MSM, 6.0% IDU), 1271 (24.8%) experienced depression (PHQ ≥ 10). In a multivariable logistic model female gender, White race, injection drug use (IDU) or men who have sex with men (MSM) as an HIV risk factor, making ≥1 ED visit, having missed any HIV visit, having AIDS, and having a positive drug screen by SAMISS increased the odds for depression. Those who had achieved HIV VS or received efavirenz had lower odds of depression. Even among those with AIDS, those failing to achieve VS were at increased odds for depression, whereas those achieving VS were not. Moderate to severe depression is prevalent among PLWH. Among those with AIDS, HIV VS modifies the odds of depression.
Collapse
Affiliation(s)
- Mamta K Jain
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Parkland Health and Hospital System, Dallas, TX, USA
| | - Xilong Li
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Beverley Adams-Huet
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yordanos M Tiruneh
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA.,University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Amneris E Luque
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Parkland Health and Hospital System, Dallas, TX, USA
| | - Piper Duarte
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Joseph M Trombello
- Center for Depression and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,Parkland Health and Hospital System, Dallas, TX, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
19
|
Yousuf A, Musa R, Isa MLM, Arifin SRM. Anxiety and Depression Among Women Living with HIV: Prevalence and Correlations. Clin Pract Epidemiol Ment Health 2020; 16:59-66. [PMID: 32742296 PMCID: PMC7372730 DOI: 10.2174/1745017902016010059] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION It has been found that HIV positive women are becoming increasingly affected by various illnesses, including Common Mental Disorders (CMDs) such as depression. Such comorbidity escalates the disease progression to the severe stage and commonly hinders treatment adherence. This study determined the prevalence of anxiety and depression amidst women living with HIV. METHODS Based on a cross-sectional and facility-based study, 357 HIV positive women were recruited using the systematic sampling technique from two public hospitals in Jijiga town, Ethiopia. The Hospital Anxiety and Depression Scale (HADS) was administered for screening, and followed by a pre-tested questionnaire that comprised of Perceived Social Support and HIV stigma. RESULTS The results revealed that the prevalence of both anxiety and depression amidst HIV positive women was 28.9% and 32.5%, respectively. In the multivariate analysis, it was discovered that lack of formal education, being divorced, unemployed, and earning a monthly income less than 1400 ETB (37.5 USD) were significantly associated with depression. Women with symptomatic HIV clinical stage III (AOR =2.06, 95% C.I (0.75-5.61), with CD4 cell count below 250 (AOR = 1.14, 95% C.I (0.57-2.28), and with co-infections (AOR= 1.04, 95% C.I (0.40-2.71) also suffered from depression. CONCLUSION The study outcomes show that the prevalence of depression in women with HIV was 32.5%, but they were more likely to be depressed if they were illiterate, divorced, unemployed or had a financial burden. In addition, HIV positive women with less CD4 cell count and in the final clinical stage or suffered from a co-infection were also associated with depressive symptoms. This signifies the public health implications of psychological and cognitive morbidities of the illness among these women with chronic illnesses. Hence, future mental health interventions and HIV care should be integrated with substantial emphasis given to vulnerable groups, including HIV positive women.
Collapse
Affiliation(s)
- Abdilahi Yousuf
- College of Medicine and Health Sciences, Jijiga University, Jijiga, Ethiopia
| | - Ramli Musa
- Department of Psychiatric, Kulliyah of Medicine, IIUM, Kuantan, Malaysia
| | | | | |
Collapse
|
20
|
Yousuf A, Mohd Arifin SR, Musa R, Md Isa ML. Depression and HIV Disease Progression: A Mini-Review. Clin Pract Epidemiol Ment Health 2019; 15:153-159. [PMID: 32174997 PMCID: PMC7040472 DOI: 10.2174/1745017901915010153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
Abstract
Background Depression is the most common mental disorder and a leading cause of disability, which commonly presents unexplained psychological and physical symptoms. Depression and HIV/AIDS are commonly comorbid. This review provides an insight into the effect of depression on disease progression among people living with HIV. Methods A search for relevant articles was conducted using a database like MEDLINE, Scopus, PsycINFO and CINAHL. Peer-reviewed English journals published between 2015 and 2019 were included in the review. Results A total of eight studies conducted in different settings were included in the review. This review has found that psychosocial, neurohormonal and virologic factors associated with depression affect HIV disease progression. Yet, the chronicity of depression, absence of the hormones that have a buffer effect on depression and lack of examination if depression is a predictor, or an outcome of disease progression, were some of the gaps that require further investigation. Conclusion Considerably, more research is needed to better understand the effect of mental disorder, especially depression, on HIV disease progression to AIDS and future interventions should, therefore, concentrate on the integration of mental health screening in HIV clinical setup.
Collapse
Affiliation(s)
- Abdilahi Yousuf
- College of Medicine and Health Sciences, Jijiga University , Jijiga, Ethiopia
| | | | - Ramli Musa
- Department of psychiatric, Kulliyah of medicine, IIUM, Malaysia
| | | |
Collapse
|
21
|
Wykowski J, Kemp CG, Velloza J, Rao D, Drain PK. Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:2059-2071. [PMID: 30659424 PMCID: PMC6639150 DOI: 10.1007/s10461-018-02390-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Untreated mental health disorders among people living with HIV (PLHIV) may prevent low- and middle-income countries (LMICs) from achieving the UNAIDS 90-90-90 targets. Anxiety disorders may be associated with decreased adherence to antiretroviral therapy (ART). We sought to review and meta-analyze studies estimating associations between anxiety and ART adherence in LMICs. We searched PubMed, PsychINFO, CINAHL and EMBASE for relevant studies published before July 18, 2018. We defined anxiety as reported anxiety scores from screening questionnaires or having a clinical diagnosis of an anxiety disorder, and poor ART adherence as missed doses, poor visit attendance, or scores from structured adherence questionnaires. We used a random effects model to conduct a meta-analysis for calculating a pooled odds ratio, and conducted sensitivity analyses by time on ART, anxiety evaluation method, and study region. From 472 screened manuscripts, thirteen studies met our inclusion criteria. Eleven studies were included in the meta-analysis. PLHIV who reported anxiety had 59% higher odds of poor ART adherence compared with those who did not report anxiety disorder (pooled odds ratio [pOR]: 1.59, 95% confidence interval [CI] 1.29-1.96, p < 0.001). When excluding PLHIV who initiated ART within 6 months, reported anxiety remained strongly associated with poor ART adherence (pOR: 1.61, 95% CI 1.18-2.20, p = 0.003). Among PLHIV in LMICs, reported anxiety was associated with poor ART adherence. This association persisted after the ART initiation period. Increased resources for mental health may be important for achieving virologic suppression in LMICs.
Collapse
Affiliation(s)
- James Wykowski
- Department of Medicine, School of Medicine, University of Washington, 325 Ninth Ave, UW, Box 359927, Seattle, WA, 98104-2420, USA.
| | - Christopher G Kemp
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
| | - Jennifer Velloza
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Deepa Rao
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Paul K Drain
- Department of Medicine, School of Medicine, University of Washington, 325 Ninth Ave, UW, Box 359927, Seattle, WA, 98104-2420, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| |
Collapse
|
22
|
Cassidy AR, Williams PL, Leidner J, Mayondi G, Ajibola G, Makhema J, Holding PA, Powis KM, Batlang O, Petlo C, Shapiro R, Kammerer B, Lockman S. In Utero Efavirenz Exposure and Neurodevelopmental Outcomes in HIV-exposed Uninfected Children in Botswana. Pediatr Infect Dis J 2019; 38:828-834. [PMID: 30985518 PMCID: PMC6629483 DOI: 10.1097/inf.0000000000002332] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimal data exist related to neurodevelopment after in utero exposure to Efavirenz (EFV). We sought to compare neurodevelopmental outcomes in HIV-exposed/uninfected (HEU) children with in utero exposure to EFV-based triple antiretroviral treatment (ART) versus non-EFV-based ART, and to examine whether timing of initial EFV exposure is associated with neurodevelopment deficits. METHODS Women living with HIV who had received EFV-based ART during pregnancy and whose HEU newborn participated in a prior study were reconsented for their HEU toddler to undergo neurodevelopmental testing at 24 months old. We administered the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), Developmental Milestones Checklist (DMC) and Profile of Social Emotional Development (PSED). We compared outcomes to previously-collected data from a cohort of 24-month-old HEU children with in utero exposure to non-EFV-based ART. Adjusted general linear models were used to compare mean outcomes. RESULTS Our analysis included 493 HEU children (126 EFV-exposed, 367 EFV-unexposed). Adjusted mean scores for the EFV-exposed group were worse than the EFV-unexposed group on BSID-III Receptive Language (adjusted means = 21.5 vs. 22.5, P = 0.05), DMC Locomotor (30.7 vs. 32.0, P < 0.01) and Fine Motor scales (17.8 vs. 19.2, P < 0.01); and PSED (11.7 vs. 9.9, P = 0.02); but better on the DMC Language scale (17.6 vs. 16.5, P = 0.01). Earlier (vs. later) EFV exposure was associated with worse scores on the BSID-III Receptive Language scale (20.7 vs. 22.2, P = 0.02). CONCLUSIONS HEU children exposed in utero to EFV-based ART may be at higher risk for neurodevelopmental and social-emotional deficits than HEU children exposed to non-EFV-based ART.
Collapse
Affiliation(s)
- Adam R. Cassidy
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Gloria Mayondi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Kathleen M. Powis
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Massachusetts General Hospital, Boston, MA, USA
| | - Oganne Batlang
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chipo Petlo
- Ministry of Health and Wellness, Gaborone, Botswana
| | - Roger Shapiro
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Betsy Kammerer
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shahin Lockman
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
23
|
Health-related quality of life assessment among people living with HIV in Rio de Janeiro, Brazil: a cross-sectional study. Qual Life Res 2018; 28:1035-1045. [PMID: 30415417 DOI: 10.1007/s11136-018-2044-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWHA) in Rio de Janeiro, Brazil. METHODS A cross-sectional study including PLWHA receiving usual HIV-care at Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz) was conducted between 2014 and 2016 in Rio de Janeiro, Brazil. The EQ-5D-3L assessed HRQoL; PHQ-2 and ASSIST were used for screening depression and substance use, respectively. Clinical variables were obtained from the INI/Fiocruz cohort database, and structured questions evaluated intimate partner violence, sexual abstinence and relationship status. Data were analysed using multivariable Tobit regression model. RESULTS A total of 1480 PLWHA were included: 64.7% were male at birth (38.4% men who have sex with men [MSM], 24.3% heterosexual men and 2% transgender women [TGW]); median age was 43.1 years, and 95.8% were receiving antiretroviral therapy. The median EQ-5D-3L utility score was 0.801. Results showed that the following factors: MSM and women; older age; lower educational level; no engagement in a relationship; depression screening positive; polysubstance use; and, detectable viral load were independently associated with worse HRQoL. CONCLUSIONS PLWHA under care at INI/Fiocruz presented good HRQoL. Polysubstance use, depression and lower educational level were among the factors negatively associated with HRQoL. This was the first time that the EQ-5D-3L utility scores were calculated for a considerable number of PLWHA in Brazil, which is a fundamental piece of information for future cost-effectiveness analysis.
Collapse
|
24
|
Reduced heart rate variability and increased saliva cortisol in patients with TMD. Arch Oral Biol 2018; 90:125-129. [DOI: 10.1016/j.archoralbio.2018.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/28/2018] [Accepted: 03/23/2018] [Indexed: 01/02/2023]
|
25
|
Poudel-Tandukar K, Jacelon CS, Bertone-Johnson ER, Palmer PH, Poudel KC. Serum albumin levels and depression in people living with Human Immunodeficiency Virus infection: a cross-sectional study. J Psychosom Res 2017; 101:38-43. [PMID: 28867422 DOI: 10.1016/j.jpsychores.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lower serum albumin levels and depression are common among HIV-infected persons. High serum albumin levels may provide protection against depression through its defensive role in inflammation and infection. We tested the hypothesis of an independent relationship between serum albumin levels and depressive symptoms in a cohort of HIV-infected persons. METHODS A cross-sectional survey was conducted among 310 HIV-infected persons (176 men and 134 women) aged 20-60years residing in the Kathmandu Valley, Nepal. The bromocresol green method was used to measure serum albumin levels and the Beck Depression Inventory method was used to measure depressive symptoms, with a cut off score of 20 or higher indicating likely depression. The relationship between serum albumin levels and depressive symptoms was assessed using both multiple linear regression analysis and multiple logistic regression analysis, with adjustment for sociodemographic, cardiovascular, life-style, and HIV-related clinical and treatment confounding factors. RESULTS Serum albumin levels were inversely associated with depressive symptoms scores (beta for 1 unit change in serum albumin levels: β=-3.91; p=0.001) for the total participant sample. This inverse association was significant in both men (β=-3.93; p=0.009) and women (β=-4.47; p=0.03). A significantly decreased risk of depression was observed among participants with the highest serum albumin levels, with odds ratio and 95% CI for those with >5.0g/dL versus <4.0g/dL of 0.22 (0.06-0.80) (p=0.01). CONCLUSION Serum albumin levels were inversely associated with depressive symptoms scores in HIV-infected persons.
Collapse
Affiliation(s)
| | - Cynthia S Jacelon
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Paula H Palmer
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| |
Collapse
|