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Asiimwe SB, Kekibiina A, Woolf-King SE, Fatch R, Emenyonu N, Hahn JA. Alcohol Consumption Among Persons Living with HIV: Perceptions, Messages and Interventions-A Qualitative Study at an HIV Treatment Clinic in South Western Uganda. AIDS Behav 2024; 28:2559-2576. [PMID: 38839725 DOI: 10.1007/s10461-024-04377-0] [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] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
In Sub-Saharan Africa, efficacy trials of brief interventions to reduce unhealthy drinking among persons living with HIV (PLWH) have yielded mixed results. A better understanding of the perceptions of drinking, especially by PLWH, and how drinking is talked about at HIV treatment clinics in this setting, may guide more optimal designs for future trials. We conducted a qualitative study at an HIV treatment clinic in South Western Uganda to better understand perceptions of drinking, how drinking is talked about, and perceptions of interventions, especially a protocolled screening and brief intervention (SBI) for unhealthy drinking among PLWH. We conducted in-depth interviews with 17 PLWH who engaged in unhealthy drinking and 6 health workers, and one focus group discussion with 3 community advisory-board members. We performed manual preliminary data analysis and computer-assisted detailed thematic analysis to identify emergent themes. Four themes emerged: perceptions of alcohol use in the general population; perceptions of alcohol use in PLWH; interaction between PLWH and health workers about alcohol use; perceptions of interventions for unhealthy drinking including SBI. Unhealthy drinking was seen as a problem in the general population and among those with HIV, where it was negatively perceived. Communication about drinking was done by counselors, but doctors participated in screening for unhealthy alcohol use. Messages about drinking covered reduction and abstinence. Participants expressed positive attitudes towards SBI and preference for person-delivered SBI over technological alternatives. A protocolled SBI for unhealthy alcohol use among PLWH would be well-received but successful implementation may depend on mode of delivery.
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Affiliation(s)
- Stephen B Asiimwe
- Uganda AIDS Commission, Plot 1-3 Salim Bay Road, Ntinda, P.O Box 10779, Kampala, Uganda.
| | - Allen Kekibiina
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Robin Fatch
- University of California San Francisco, San Francisco, CA, USA
| | - Nneka Emenyonu
- University of California San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- University of California San Francisco, San Francisco, CA, USA
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Acharya S, Parthasarathy MR, Karanjkar V, Katkar S, Setia MS. Barriers and facilitators for adherence to antiretroviral therapy, and strategies to address the barriers in key populations, Mumbai-A qualitative study. PLoS One 2024; 19:e0305390. [PMID: 38990894 PMCID: PMC11239046 DOI: 10.1371/journal.pone.0305390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/28/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Even though quantitative studies have described barriers to anti-retroviral therapy (ART), a more exploratory approach will provide in-depth information on these issues, and potential suggestions to address these issues at individual as well as structural level. We designed this qualitative study to examine the barriers and facilitators for antiretroviral therapy adherence in key population (KP) in Mumbai, India. We also wanted to understand the strategies adopted by these groups and get suggestions to improve adherence to ART. METHODS This is a qualitative analysis of seven focus group discussions (FGDs) conducted with four KP subgroups in Mumbai. We conducted two FGDs each with female sex workers (FSW), men who have sex with men (MSM), male-to-female transgendered people/Hijras (TGH) each, and one FGD with people who inject drugs (IDU). We transcribed the audio-recorded electronic records of these FGDs. We also added the notes of the observers on the group dynamics to the transcribed data. We used the Framework Approach to analyse these data. RESULTS Some experiences-such as side effects to ART medicines-were common across groups. However, incarceration as a reason for stopping ART was reported by FSWs but not by other KPs. Friends and family (including Guru) are important support systems for HIV infected individuals and adherence to ART. Stigma and discrimination by community members and general community prevent regular access of ART centres and other health care facilities. Additional factors which led to missed doses were mental health issues, alcohol use, and misplacing the ART tablets during police raids or during robbery attempts at the cruising sites. Since a common source of discrimination among peers and the community was the presence of 'Green book' (or their treatment book); the key population wanted the AIDS program to change it to digital cards so that labelling one as 'HIV positive' for being seen with the book can be avoided. CONCLUSIONS The qualitative study helped us explore the barriers to ART among key population and the community provided specific suggestions to address them. In addition to Key Population centric enhanced adherence counselling, some administrative guidelines and procedures may need to be altered to improve adherence to ART in these populations.
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Affiliation(s)
- Shrikala Acharya
- Mumbai Districts AIDS Control Society, Mumbai, India
- Seth GS Medical College and KEM Hospital, Mumbai, India
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Kalichman SC, Eaton LA, Kalichman MO. Perceived sensitivity to medicines and medication concerns beliefs predict intentional nonadherence to antiretroviral therapy among young people living with HIV. Psychol Health 2024; 39:931-946. [PMID: 36111623 DOI: 10.1080/08870446.2022.2122462] [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: 01/25/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Objective: Among the sources of antiretroviral therapy (ART) nonadherence are patient decisions to skip or stop taking their medications, often stemming from medication beliefs and concerns about side- effects. While individuals who perceive greater sensitivity to medicines may be prone to medication concerns, understanding how these factors contribute to HIV treatment adherence requires further research. The current study tested the direct and indirect effects of perceived sensitivity to medicines on intentional nonadherence to ART, and whether medication concerns mediate this association. Methods: A sample of 418 younger (< 36 years of age) people living with HIV was recruited through community outreach to complete assessments of perceived sensitivity to medicines, medication concerns beliefs, adherence assessed by unannounced phone- based pill counts and HIV viral load, as well as monthly follow- up assessments of intentional nonadherence over a 15- month period. Results: Analyses at baseline and prospective Poisson regression models conducted over 15- months converged to show that perceived sensitivity to medicines significantly predicted intentional nonadherence to ART through medication concerns. Conclusions: These findings suggest that people who perceive greater sensitivity to medicines are prone to greater medication concerns that are related to intentional nonadherence. Cognitive behavioral interventions are needed to resolve medication concerns and reduce intentional nonadherence among people receiving ART.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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Jagiellowicz J, Acevedo BP, Tillmann T, Aron A, Aron EN. The relationship between sensory processing sensitivity and medication sensitivity: brief report. Front Psychol 2024; 14:1320695. [PMID: 38292521 PMCID: PMC10826854 DOI: 10.3389/fpsyg.2023.1320695] [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: 10/12/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
Sensory processing sensitivity (SPS) is a biological/temperament trait that is associated with greater awareness of and reactivity to the environment, which results in amplified responses to various stimuli, and possibly medications. We investigated the relationship between SPS and medication sensitivity in three studies. Participants (ages 18-81) were recruited from university (Study 1: N = 125; Study 2: N = 214) and online (Study 3: N = 351) samples. In each study, participants completed a medication sensitivity scale, the standard highly sensitive person (HSP) scale to assess SPS, and a negative affectivity (NA) scale as a control variable. All three studies found moderate, significant correlations between SPS and medication sensitivity (r = 0.34, p < 0.001: r = 0.21, p = 0.003; r = 0.36, p < 0.001, respectively). Correlations remained significant, and similar, when controlling for NA and gender; and there were no significant interactions with gender. In sum, our results suggest that SPS is associated with medication sensitivity, even when considering NA and gender. Thus, future work might consider SPS when investigating recommended medication, medication dosage, effectiveness, and adverse drug reactions.
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Affiliation(s)
- Jadzia Jagiellowicz
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Bianca P. Acevedo
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Teresa Tillmann
- Faculty of Psychology and Educational Sciences, Chair for School and Teacher Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Arthur Aron
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Elaine N. Aron
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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Santos B, Blondon KS, Sottas M, Carpenter D, Backes C, Van Gessel E, Schneider MP. Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system. BMJ Open 2023; 13:e070468. [PMID: 37940158 PMCID: PMC10632873 DOI: 10.1136/bmjopen-2022-070468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE Patients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims of this study are to: (1) characterise conflicting medication information perceived by patients with long-term conditions, (2) better understand the related impact on patients' medication self-management and healthcare system navigation and (3) explore ways in which such events could be prevented. DESIGN This study was conducted through qualitative semistructured interviews. Data were analysed using thematic analysis. SETTING Community pharmacies and medical centres in Geneva, Switzerland. PARTICIPANTS This study included outpatients from April 2019 to February 2020. Patients were included after participating in a quantitative survey of perceived conflicting information about medications for long-term diseases. METHODS Semistructured audiotaped interviews of 20 to 60 min following a pre-established interview guide to explore participants' perceptions of conflicting information. Interviews were transcribed verbatim, and a thematic analysis was conducted with inductive and deductive coding using MAXQDA (2018, Release 18.2.3). RESULTS Twenty-two patients were interviewed, until data saturation, mentioning indication or need for a medication as the main topic of conflicting information between two healthcare professionals. Perceived conflicting information often resulted from insufficient information provided and poor communication leading to confusion, doubts and medication non-adherence. Patients expected more information and more interprofessional communication on their medications. As a result of conflicting information, most participants learnt or were learning to take an active role and become partners of the healthcare providers. CONCLUSION The need to strengthen and improve communication and interprofessional collaborative practice among healthcare professionals and with the patient is emerging to increase the quality and consistency of information about medications, and consequently, to ensure better use and experience of medications.
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Affiliation(s)
- Beatriz Santos
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Pharma24, Academic community pharmacy, Geneva, Switzerland
| | - Katherine S Blondon
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
- Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie Sottas
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Delesha Carpenter
- Department of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Claudine Backes
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | | | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Pharma24, Academic community pharmacy, Geneva, Switzerland
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Castelan A, Nellen JF, van der Valk M, Nieuwkerk PT. Intentional- but not Unintentional Medication Non-adherence was Related with Beliefs about Medicines Among a Multi-Ethnic Sample of People with HIV. AIDS Behav 2023; 27:1045-1054. [PMID: 36056998 PMCID: PMC9440648 DOI: 10.1007/s10461-022-03842-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/24/2022]
Abstract
Medication non-adherence can be intentional or unintentional. We investigated the prevalence of unintentional and intentional non-adherence to antiretroviral therapy (ART) and the relationship with beliefs about medicines, sociodemographic- and HIV-related variables among people with HIV (PWH) attending the HIV clinic of the Amsterdam University Medical Centers. Participants completed the Medication Adherence Rating Scale (MARS) and the Beliefs about Medicines (BMQ) questionnaire. About half of 80 participants reported unintentional non-adherence and 20% reported intentional non-adherence. Both unintentional and intentional non-adherence were associated with younger age. Additionally, intentional non-adherence was associated with being a migrant from Suriname /Netherlands Antilles, having more concerns about negative effects of ART and stronger beliefs that medicines in general are overused/ overprescribed. In conclusion, intentional but not unintentional non-adherence was associated with beliefs about medicines. Eliciting and discussing beliefs about medicines may be a promising avenue to address patients' concerns and perceptions thereby potentially enhancing medication adherence.
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Affiliation(s)
- Anjuly Castelan
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, J3-219-1), Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Jeannine F Nellen
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, J3-219-1), Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Golub SA, Starbuck L, Fikslin R, Gamarel KE. Psychometric Evaluation and Predictive Validity of an Adapted Adherence Self-Efficacy Scale for PrEP. AIDS Behav 2023; 27:218-230. [PMID: 35809144 DOI: 10.1007/s10461-022-03758-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Adherence to and sustainment of HIV pre-exposure prophylaxis (PrEP) are critical to its effectiveness. Adherence self-efficacy, i.e., confidence in one's ability to adhere to a particular medication, is a key psychological determinant of health behavior that strongly predicts HIV treatment adherence but has been understudied in PrEP research. This paper describes the psychometric evaluation and validation of the PrEP Adherence Self-Efficacy Scale (PrEP-ASES), adapted from the previously validated HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Data are drawn from two studies conducted at a community health center, one focused on gay and bisexual cisgender men and the other on transgender women. Factor analyses support a one-factor score (eigenvalue = 6.78) that explained 75.3% of the variance, with good test-retest reliability (rs > 0.40). In both studies, higher PrEP-ASES scores were associated with PrEP uptake, adherence, and sustainment. Findings support the utility of the PrEP-ASES in research and suggest the importance of addressing self-efficacy in PrEP programs and services.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA.
- Basic and Applied Social Psychology PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA.
| | - Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Rachel Fikslin
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
- Basic and Applied Social Psychology PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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