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Shah S, Shillington AC, Kabagambe EK, Deering KL, Babin S, Capelouto J, Pulliam C, Patel A, LaChappelle B, Liu J. Racial and Ethnic Disparities in Patients With Inflammatory Bowel Disease: An Online Survey. Inflamm Bowel Dis 2024; 30:1467-1474. [PMID: 37703380 PMCID: PMC11369073 DOI: 10.1093/ibd/izad194] [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: 04/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Data regarding care access and outcomes in Black/Indigenous/People of Color/Hispanic (BIPOC/H) individuals is limited. This study evaluated care barriers, disease status, and outcomes among a diverse population of White/non-Hispanic (W/NH) and BIPOC/H inflammatory bowel disease (IBD) patients at a large U.S. health system. METHODS An anonymous online survey was administered to adult IBD patients at Ochsner Health treated between Aug 2019 and Dec 2021. Collected data included symptoms, the Consumer Assessment of Healthcare Providers and Systems and Barriers to Care surveys, health-related quality of life (HRQOL) via the Short Inflammatory Bowel Disease Questionnaire, the Medication Adherence Rating Scale-4, and the Beliefs about Medicines Questionnaire. Medical record data examined healthcare resource utilization. Analyses compared W/NH and BIPOC/H via chi-square and t tests. RESULTS Compared with their W/NH counterparts, BIPOC/H patients reported more difficulties accessing IBD specialists (26% vs 11%; P = .03), poor symptom control (35% vs 18%; P = .02), lower mean HRQOL (41 ± 14 vs 49 ± 13; P < .001), more negative impact on employment (50% vs 33%; P = .029), worse financial stability (53% vs 32%; P = .006), and more problems finding social/emotional support for IBD (64% vs 37%; P < .001). BIPOC/H patients utilized emergency department services more often (42% vs 22%; P = .004), reported higher concern scores related to IBD medication (17.1 vs 14.9; P = .001), and worried more about medication harm (19.5% vs 17.7%; P = .002). The survey response rate was 14%. CONCLUSIONS BIPOC/H patients with IBD had worse clinical disease, lower HRQOL scores, had more medication concerns, had less access to specialists, had less social and emotional support, and used emergency department services more often than W/NH patients.
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Affiliation(s)
- Shamita Shah
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
| | | | - Edmond Kato Kabagambe
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
- Research Administration, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | | | - Sheena Babin
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
| | - Joseph Capelouto
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
| | | | - Aarti Patel
- Population Health, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Julia Liu
- Department of Gastroenterology, Morehouse School of Medicine, Atlanta, GA, USA
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Sardarzehi R, Seyed Alinaghi SA, Kianimoghadam AS, Masjedi-Arani A, Bakhtiari M, Dehghan Manshadi SA, Mohraz M. An empirical test of the chronic illness quality of life model: the prominent role of barrier to health care and social support. AIDS Care 2024:1-10. [PMID: 39047158 DOI: 10.1080/09540121.2024.2378375] [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: 10/20/2023] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
The Chronic Illness Quality of Life (CIQOL) model highlights satisfaction with life in individuals with a chronic illness (i.e., HIV-related diseases) determined by factors such as barriers to health care, AIDS-related discrimination, social support, physical well-being, and engagement coping. Despite the empirical evidence supporting the CIQOL model, its validation in the Iranian population has not yet been conducted. This study aimed to validate the CIQOL model among Iranian patients with HIV-related diseases. Four hundred fifty-two patients completed the study questionnaire including Barriers to Care Scale (BACS), Satisfaction with Life Scale (SWLS), Chronic Illness Anticipated Stigma Scale (CIASS), Social Provision Scale (SPS), The Functional Assessment of Human Immunodeficiency Virus Infection (FAHI), and the Brief COPE Scale. Structural equation modeling (SEM) was used to analyze the data. The assumed model demonstrated an acceptable level of fit to study data. Findings showed that this model could explain 39% of variances in life satisfaction in Iranian patients with HIV-related diseases. Therefore, in psychological interventions aimed at enhancing life satisfaction, the CIQOL model factors especially barriers to health care and social support can be taken into consideration.
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Affiliation(s)
- Reyhaneh Sardarzehi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Seyed Alinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sam Kianimoghadam
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Masjedi-Arani
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Bakhtiari
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Department of Infectious Diseases and Tropical Medicine, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Gagnon KW, Bradford W, Bassler J, Nassel A, Kay ES, Jeziorski M, Prados M, McCleskey B, Kobie J, Eaton E. Community-Based Services for Hospitalized Patients With Serious Injection-Related Infections in Alabama: A Brief Report. Open Forum Infect Dis 2024; 11:ofae231. [PMID: 38813257 PMCID: PMC11134460 DOI: 10.1093/ofid/ofae231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Injection-related infections continue to rise, particularly in the South. People who inject drugs are increasingly utilizing hospital services for serious injection-related infections but may be discharged to areas without harm reduction services. We explored the availability and travel time to services for HIV and substance use in Alabama.
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Affiliation(s)
- Kelly W Gagnon
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William Bradford
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Bassler
- Center for AIDS Research, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ariann Nassel
- Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emma Sophia Kay
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Madison Jeziorski
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Myles Prados
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandi McCleskey
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James Kobie
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ellen Eaton
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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4
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Ham AS, Hacker CT, Guo J, Sorby-Adams A, Kimberly WT, Mateen FJ. Feasibility and tolerability of portable, low-field brain MRI for patients with multiple sclerosis. Mult Scler Relat Disord 2024; 85:105515. [PMID: 38489947 DOI: 10.1016/j.msard.2024.105515] [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: 11/10/2023] [Revised: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 03/17/2024]
Abstract
Low-field, portable MRI (LF-MRI) promises to expand neuroimaging access for patients with multiple sclerosis (MS). We aimed to measure the feasibility and tolerability of LF-MRI for clinical use in 50 people with MS (mean age 46.5 ± 15.3 years; 72 % female; median disease duration 5.9 years), 38 % of whom reported barriers to undergoing MRI, and 34 % of whom were low-income or unemployed. Experience ratings of LF-MRI were strongly positive (mean rating of 9.2 on a ten-point scale). Seventy percent of participants were willing to receive future LF-MRI scans, and 46 % preferred LF-MRI to standard MRI (35 % undecided). The overall feasibility and tolerability of LF-MRI support its integration into a one-stop, patient-centered model of outpatient MS care.
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Affiliation(s)
- Andrew Siyoon Ham
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jennifer Guo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Annabel Sorby-Adams
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Walsh JL, Quinn KG, Hirshfield S, John SA, Algiers O, Al-Shalby K, Giuca AM, McCarthy C, Petroll AE. Acceptability, Feasibility, and Preliminary Impact of 4 Remotely-Delivered Interventions for Rural Older Adults Living with HIV. AIDS Behav 2024; 28:1401-1414. [PMID: 38170275 DOI: 10.1007/s10461-023-04227-5] [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: 11/15/2023] [Indexed: 01/05/2024]
Abstract
People living with HIV (PLH) who live in rural areas of the United States (US) face more challenges to obtaining medical care and suffer higher mortality rates compared to non-rural PLH. Compared with younger PLH, older PLH (age 50+) also face additional challenges to maintaining their health and wellbeing. Despite the heightened barriers to receiving care and remaining adherent to treatment among older rural PLH, few interventions to increase viral suppression and improve quality of life exist for this population. We pilot-tested four remotely-delivered interventions-group-based social support, group-based stigma-reduction, individual strengths-based case management, and individual technology detailing-aimed to improve care engagement and quality of life in rural older PLH in the southern US. Participants (N = 61, Mage = 58, 75% male) completed surveys and self-collected blood specimens at baseline and 3 months; in between, they were randomized to 0-4 interventions. We assessed feasibility, acceptability, and preliminary impact on medication adherence, viral suppression, quality of life, depressive symptoms, and hypothesized mediating mechanisms. More than 80% participated in assigned intervention(s), and 84% completed the study. Interventions were highly acceptable to participants, with more than 80% reporting they would recommend interventions to peers. More than 80% found the social support and case management interventions to be relevant and enjoyable. We found promising preliminary impact of interventions on quality of life, medication adherence, depressive symptoms, internalized stigma, and loneliness. Remotely-delivered interventions targeting rural older PLH are feasible to conduct and acceptable to participants. Larger scale study of these interventions is warranted.
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Affiliation(s)
- Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olivia Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kamal Al-Shalby
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Anne-Marie Giuca
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Geriatric Psychiatry, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Caitlin McCarthy
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Khansa I, Pollard SH, Fogolin A, Baylis A, Sitzman TJ, Chapman KL, Kirschner RE. Factors Associated with Delayed Palatoplasty Before, During, and After the COVID-19 Pandemic. J Craniofac Surg 2024:00001665-990000000-01383. [PMID: 38411196 PMCID: PMC11347716 DOI: 10.1097/scs.0000000000010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Cleft palatoplasty is typically performed around 10 to 12 months of age in the US, and delays can negatively affect speech development. Early during COVID-19, elective surgeries were canceled. The aims of this study were to (1) identify overall risk factors for greater age at palatoplasty and (2) analyze delays in palatoplasty during COVID-19. METHODS This study was part of a larger prospective, multicenter comparative study of speech outcomes in palatoplasty. Participants underwent palatoplasty between March 2019 and September 2022 at 18 pediatric hospitals in the United States. Ages were corrected for prematurity. Dates of palatoplasty were divided into 4 periods corresponding to different phases of the pandemic. Factors analyzed included region, language, adoption status, sex, ethnicity, race, rurality, health insurance type, and cleft type. Analyses were performed using ANOVA, Student's test, and multivariable linear regression, with a P value of ≤0.05 being significant. RESULTS Nine hundred twenty-eight participants were included. Average corrected age at palatoplasty was 374 days. In univariable analysis, palatoplasty was performed later in children who were Hispanic (P=0.003), of a race other than White, Black, or Asian (P<0.001), and without private insurance (P<0.001). On multivariable regression, predictors of delayed palatoplasty were Hispanic ethnicity (P=0.015), from other race (P<0.001), and without private insurance (P<0.001). During COVID-19, disproportionate delays occurred in patients who were female, of other races, from nonrural areas, and on Medicaid. CONCLUSIONS Palatoplasty was performed later in vulnerable populations. Some of these populations were also disproportionately affected by COVID-19 delays. Providers should be aware of these differences as they pertain to equitable access to craniofacial care. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ibrahim Khansa
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Sarah Hatch Pollard
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT
| | - Alyssa Fogolin
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Adriane Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, and University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Kathy L Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT
| | - Richard E Kirschner
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
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Burkhart Colorado AS, Lazzaro A, Neff CP, Nusbacher N, Boyd K, Fiorillo S, Martin C, Siebert JC, Campbell TB, Borok M, Palmer BE, Lozupone C. Differential effects of antiretroviral treatment on immunity and gut microbiome composition in people living with HIV in rural versus urban Zimbabwe. MICROBIOME 2024; 12:18. [PMID: 38310301 PMCID: PMC10837999 DOI: 10.1186/s40168-023-01718-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND The widespread availability of antiretroviral therapy (ART) has dramatically reduced mortality and improved life expectancy for people living with HIV (PLWH). However, even with HIV-1 suppression, chronic immune activation and elevated inflammation persist and have been linked to a pro-inflammatory gut microbiome composition and compromised intestinal barrier integrity. PLWH in urban versus rural areas of sub-Saharan Africa experience differences in environmental factors that may impact the gut microbiome and immune system, in response to ART, yet this has not previously been investigated in these groups. To address this, we measured T cell activation/exhaustion/trafficking markers, plasma inflammatory markers, and fecal microbiome composition in PLWH and healthy participants recruited from an urban clinic in the city of Harare, Zimbabwe, and a district hospital that services surrounding rural villages. PLWH were either ART naïve at baseline and sampled again after 24 weeks of first-line ART and the antibiotic cotrimoxazole or were ART-experienced at both timepoints. RESULTS Although expected reductions in the inflammatory marker IL-6, T-cell activation, and exhaustion were observed with ART-induced viral suppression, these changes were much more pronounced in the urban versus the rural area. Gut microbiome composition was the most highly altered from healthy controls in ART experienced PLWH, and characterized by both reduced alpha diversity and altered composition. However, gut microbiome composition showed a pronounced relationship with T cell activation and exhaustion in ART-naïve PLWH, suggesting a particularly significant role for the gut microbiome in disease progression in uncontrolled infection. Elevated immune exhaustion after 24 weeks of ART did correlate with both living in the rural location and a more Prevotella-rich/Bacteroides-poor microbiome type, suggesting a potential role for rural-associated microbiome differences or their co-variates in the muted improvements in immune exhaustion in the rural area. CONCLUSION Successful ART was less effective at reducing gut microbiome-associated inflammation and T cell activation in PLWH in rural versus urban Zimbabwe, suggesting that individuals on ART in rural areas of Zimbabwe may be more vulnerable to co-morbidity related to sustained immune dysfunction in treated infection. Video Abstract.
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Affiliation(s)
| | - Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Charles Preston Neff
- Department Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Nichole Nusbacher
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kathryn Boyd
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, England
| | - Suzanne Fiorillo
- Department Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Casey Martin
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Janet C Siebert
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Thomas B Campbell
- Department Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Margaret Borok
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Brent E Palmer
- Department Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Catherine Lozupone
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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Manavalan P, Li Y, Mills JC, Kwara A, Zhou Z, Ritter AS, Spencer E, Pence BW, Cook RL. Depression and Anxiety Symptoms and Treatment Utilization, and Associated HIV Outcomes among Adults with HIV in Rural Florida. AIDS Behav 2024; 28:164-173. [PMID: 37566153 PMCID: PMC11217930 DOI: 10.1007/s10461-023-04147-4] [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: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Persons living with HIV (PLWH) and depression or anxiety in the rural South may have suboptimal HIV outcomes. We sought to examine the proportion of PLWH from rural Florida with symptoms of depression or anxiety, the proportion who received depression or anxiety treatment, and the relationship between untreated and treated symptoms of depression or anxiety and HIV outcomes. Cross-sectional survey data collected between 2014 and 2018 were analyzed. Among 187 PLWH residing in rural Florida (median age 49 years, 61.5%, male 45.5% Black), 127 (67.9%) met criteria for symptoms of depression and/or anxiety. Among these 127 participants, 60 (47.2%) were not on depression or anxiety treatment. Participants with untreated symptoms of depression and anxiety (OR 3.2, 95% CI 1.2-9.2, p = 0.03) and treated depression and anxiety with uncontrolled symptoms (OR 1.4, 95% CI 0.5-4.0, p = 0.52) were more likely to have viral non-suppression compared to those without depression or anxiety in an unadjusted bivariate analysis. Only the association between untreated symptoms of depression and anxiety and viral non-suppression was statistically significant, and when adjusting for social and structural confounders the association was attenuated and was no longer statistically significant. This suggests that social and structural barriers impact both mental health and HIV outcomes. Our findings support the need for increased mental health services and resources that address the social and structural barriers to care for PLWH in the rural South.
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Affiliation(s)
- Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
| | - Yancheng Li
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Jon C Mills
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Awewura Kwara
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Alaina S Ritter
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Emma Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Menza TW, Jensen A, Hixson LK. Predictors of Viral Suppression Among People Living with HIV in Rural Oregon. AIDS Behav 2024; 28:154-163. [PMID: 37610534 DOI: 10.1007/s10461-023-04145-6] [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: 07/19/2023] [Indexed: 08/24/2023]
Abstract
With recent outbreaks of HIV in rural areas of the United States, it has become increasingly important to understand the factors affecting health outcomes of people with HIV living in rural areas. We assessed predictors of durable HIV viral suppression among rural participants using a pooled 7-year dataset from the Medical Monitoring Project (MMP), a cross-sectional, representative sample of individuals receiving HIV medical care in Oregon. Only 77.3% of rural participants achieved durable HIV viral suppression, while 22.7% had at least one detectable HIV viral load measurement within the past 12 months. The primary predictors of viral suppression were ARV adherence, poverty, and reported heavy drinking in the past 30 days. These results highlight the influence of social factors on health outcomes for persons with HIV living in rural areas and inform areas for policy and program change.
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Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA.
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Ann Jensen
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, OR, USA
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Gumede SB, Wensing AMJ, Lalla-Edward ST, de Wit JBF, Francois Venter WD, Tempelman HA, Hermans LE. Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial. AIDS Behav 2023; 27:3863-3885. [PMID: 37382825 PMCID: PMC10598166 DOI: 10.1007/s10461-023-04103-2] [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: 06/02/2023] [Indexed: 06/30/2023]
Abstract
A large proportion of people living with HIV (PLHIV) in sub-Saharan Africa reside in rural areas. Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96 weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes.
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Affiliation(s)
- Siphamandla B Gumede
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.
| | - Annemarie M J Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ndlovu Research Consortium, Elandsdoorn, South Africa
| | - Samanta T Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - W D Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - Hugo A Tempelman
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
- Ndlovu Research Consortium, Elandsdoorn, South Africa
| | - Lucas E Hermans
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 32 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ndlovu Research Consortium, Elandsdoorn, South Africa
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Lazzaro A, Colorado ASB, Neff CP, Nusbacher N, Boyd K, Fiorillo S, Martin C, Siebert J, Campbell T, Borok M, Palmer B, Lozupone C. Antiretroviral treatment is less effective at reducing gut microbiome-associated inflammation and T cell activation in people living with HIV in rural versus urban Zimbabwe. RESEARCH SQUARE 2023:rs.3.rs-3300723. [PMID: 37693491 PMCID: PMC10491326 DOI: 10.21203/rs.3.rs-3300723/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The widespread availability of antiretroviral therapy (ART) for people living with HIV (PLWH) has dramatically reduced mortality and improved life expectancy. However, even with suppression of HIV-1 replication, chronic immune activation and elevated inflammation persist. Chronic immune activation has been linked to a pro-inflammatory gut microbiome composition, exacerbated by compromised intestinal barrier integrity that occurs after HIV infection. Individuals living in urban versus rural areas of sub-Saharan Africa have differences in environmental factors such as water source or diet that may impact gut microbiome composition, yet immune phenotype and gut microbiome composition response to ART in PLWH living in rural versus urban areas of sub-Saharan Africa have not been compared. Here, we measured immune phenotypes and fecal microbiome composition in PLWH and healthy participants recruited from the urban Mabvuku polyclinic in the city of Harare, Zimbabwe and the Mutoko District hospital located in a district 146 km from Harare that services surrounding rural villages. PLWH were either ART naïve at baseline and sampled again after 24 weeks of treatment with efavirenz/lamivudine/tenofovir disoproxil fumarate (EFV/3TC/TDF) and the prophylactic antibiotic cotrimoxazole or were ART experienced at both timepoints. Although expected reductions in the inflammatory marker IL-6, T-cell activation, and exhaustion were observed in individuals who had suppressed HIV-1 with treatment, these changes were significant only when considering individuals in the urban and not the rural area. Gut microbiome composition showed more marked differences from healthy controls in the ART experienced compared to ART naïve cohort, and consistent longitudinal changes were also observed in ART naïve PLWH after 24 weeks of treatment, including a reduction in alpha diversity and altered composition. However, gut microbiome composition showed a more pronounced relationship with chronic immune activation and exhaustion phenotypes in the ART naïve compared to ART experienced PLWH, suggesting a particularly significant role for the gut microbiome in disease progression in uncontrolled infection.
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Dale SK, Etienne K, Hall S, Lazarus K, Nunnally K, Gibson G, Bolden R, Gardner N, Sanders J, Reid R, Phillips A. Five point initiative: a community-informed bundled implementation strategy to address HIV in Black communities. BMC Public Health 2023; 23:1625. [PMID: 37626315 PMCID: PMC10463742 DOI: 10.1186/s12889-023-16525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Black individuals in the U.S. remain the most disproportionately impacted by new HIV diagnoses, represent the highest portion of individuals living with HIV, and have the highest morbidity rates. Structural inequities and historical oppression are the primary drivers. Such drivers limit access to HIV prevention tools that need to be delivered with culturally congruent and community-informed approaches. METHODS The Five Point Initiative (FPI) is a community-informed bundled implementation strategy developed and piloted between September 2019 and March 2020 in Miami, Florida in communities heavily impacted by HIV. Key components of the strategy included community consultants/experts, five categories (hence the "Five Point") of community businesses (e.g., corner stores, beauty supply stores, laundromats, mechanics, barbershops), local health organizations, an academic research program engrossed in community engaged research, and community residents who provided ongoing feedback throughout. Outcomes of FPI included (a) survey information (e.g., knowledge of and access to PrEP, barriers to care) and pilot data (acceptability and feasibility), (b) expansion of reach to Black individuals in HIV high impact zip codes in Miami, (c) insights on our bundled implementation strategy, (d) condom distribution, and (e) HIV testing. RESULTS Over the course of six months FPI carried out 10 outreach events, partnered with 13 community businesses and 5 health organizations, engaged 677 community residents, collected health information via a survey, distributed 12,434 condoms, provided information on PrEP, and offered voluntary HIV testing (131 completed). FPI's ability to reach residents who are not being reached (e.g., 68.8% never heard of PrEP, 8% no HIV testing ever, 65.9% no primary care provider), positive feedback from residents (e.g., 70% very satisfied, 21% satisfied; 62% strongly agree and 25% agree they would participate again) and qualitative interviews with businesses provide evidence of acceptability and feasibility. Further, survey data provided insights on factors such as socio-demographics, discrimination experiences, barriers to care, social-structural factors, physical and sexual health, and mental health and substance use. CONCLUSIONS The FPI bundled implementation strategy shows promise to deliver health prevention/intervention for HIV and other health conditions to communities facing health inequities and for whom the current system for delivering care is insufficient.
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Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Kayla Etienne
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sidny Hall
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
- New College of Florida, Sarasota, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | | | | | - Roxana Bolden
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
- A Sister with A Testimony, Miami, FL, USA
| | - Nadine Gardner
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Jasmyn Sanders
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Arnetta Phillips
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
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Fauk NK, Gesesew HA, Mwanri L, Hawke K, Ward PR. Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia. PLoS One 2023; 18:e0280087. [PMID: 37440559 PMCID: PMC10343063 DOI: 10.1371/journal.pone.0280087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Human Immunodeficiency Virus (HIV) is a major global public health issue that affects the quality of life (QoL) of people living with HIV (PLHIV) globally and in Indonesia. As a part of a large-scale qualitative study investigating HIV risk factors and impacts on PLHIV and facilitators of and barriers to their access to HIV care services in Yogyakarta and Belu, Indonesia, this paper describes their in-depth views and experiences of the influence of HIV on their QoL. Ninety-two participants were recruited using the snowball sampling technique. Data were collected using in-depth interviews. In addition, the World Health Organisation Quality of Life questionnaire (WHOQOL-HIV BREF) was also distributed to each of them to fill out prior to the interviews. Chi-Square analysis was used to analyse data from the survey and a framework analysis was applied to guide qualitative data analysis. The findings reported several factors affecting the QoL of the participants. These included (i) environmental factors, such as living in rural areas, the unavailability of HIV care services and public transport, and long-distance travel to healthcare facilities; (ii) personal beliefs associated with HIV; (iii) sexual and social relationships and their influence of the QoL of participants; and (iv) level of independence and physical health condition following HIV diagnosis. The findings indicate the need for intervention programs that address the availability and accessibility of HIV care services to PLHIV within rural communities and support various physical, psychological, and financial needs of PLHIV. These can be implemented by providing supplements and nutritious food, HIV counselling and door-to-door/community-based ART service delivery to PLHIV, which may increase their engagement in and adherence to the treatment and improve their physical and psychological condition and QoL.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, Kupang, Nusa Tenggara Timur, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Lillian Mwanri
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
| | - Karen Hawke
- Infectious Disease—Aboriginal Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
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Stubbs LA, Ferry AM, Guffey D, Loccke C, Wade EM, Pour P, Ardalan K, Chira P, Ganske IM, Glaser D, Higgins G, Luca N, Moore KF, Sivaraman V, Stewart K, Vasquez-Canizares N, Hunt RD, Maricevich RS, Torok KS, Li SC. Barriers to care in juvenile localized and systemic scleroderma: an exploratory survey study of caregivers' perspectives. Pediatr Rheumatol Online J 2023; 21:39. [PMID: 37098622 PMCID: PMC10131373 DOI: 10.1186/s12969-023-00819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Juvenile localized scleroderma (LS) and systemic sclerosis (SSc) are rare pediatric conditions often associated with severe morbidities. Delays in diagnosis are common, increasing the risk for permanent damage and worse outcomes. This study explored caregiver perspectives on barriers they encountered while navigating diagnosis and care for their child's scleroderma. METHODS In this cross-sectional study, caregivers of juvenile LS or SSc patients were recruited from a virtual family scleroderma educational conference and a juvenile scleroderma online interest group. The survey queried respondents about their child's condition and factors affecting diagnosis and treatment. RESULTS The response rate was 61% (73/120), with 38 parents of LS patients and 31 parents of SSc patients. Most patients were female (80%) and over half were non-Hispanic white (55%). Most families had at least one person with a college education or higher (87%), traveled ≤ 2 h to see their rheumatologist (83%), and had private insurance (75%). Almost half had an annual household income ≥ $100,000 (46%). Families identified the following factors as barriers to care: lack of knowledge about scleroderma in the medical community, finding reliable information about pediatric scleroderma, long wait times/distances for a rheumatology/specialist appointment, balance of school/work and child's healthcare needs, medication side effects, and identifying effective medications. The barrier most identified as a major problem was the lack of knowledge about juvenile scleroderma in the medical community. Public insurance, household income less than $100,000, and Hispanic ethnicity were associated with specific barriers to care. Lower socioeconomic status was associated with longer travel times to see the rheumatologist/specialist. Diagnosis and systemic treatment initiation occurred at greater than one year from initial presentation for approximately 28% and 36% of patients, respectively. Families of LS patients were commonly given erroneous information about the disease, including on the need and importance of treating active disease with systemic immunosuppressants in patients with deep tissue or rapidly progressive disease. CONCLUSION Caregivers of children with LS or SSc reported numerous common barriers to the diagnosis, treatment, and ongoing care of juvenile scleroderma. The major problem highlighted was the lack of knowledge of scleroderma within the general medical community. Given that most of the caregiver respondents to the survey had relatively high socioeconomic status, additional studies are needed to reach a broader audience, including caregivers with limited English proficiency, geographical limitations, and financial constraints, to determine if the identified problems are generalizable. Identifying key care barriers will help direct efforts to address needs, reduce disparities in care, and improve patient outcomes.
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Affiliation(s)
- Leigh A Stubbs
- Department of Pediatrics, Division of Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Andrew M Ferry
- Department of Plastic Surgery, Division of Pediatric Plastic Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Christina Loccke
- Board of Directors, National Scleroderma Foundation, Danvers, MA, USA
| | | | - Pamela Pour
- Advisory Board Member, Scleroderma Foundation Michigan Chapter, Southfield, MI, USA
| | - Kaveh Ardalan
- Department of Pediatrics, Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Peter Chira
- Department of Pediatrics, Division of Rheumatology, University of California San Diego, San Diego, CA, USA
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Glaser
- Department of Pediatrics, Section of General Pediatrics, Yale University, New Haven, CT, USA
| | - Gloria Higgins
- Department of Pediatrics, Division of Rheumatology, Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
| | - Nadia Luca
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Katharine F Moore
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vidya Sivaraman
- Department of Pediatrics, Division of Rheumatology, Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
| | - Katie Stewart
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Texas Southwestern, Dallas, TX, USA
| | - Natalia Vasquez-Canizares
- Department of Pediatrics, Division of Pediatric Rheumatology, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
| | - Raegan D Hunt
- Department of Dermatology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Renata S Maricevich
- Department of Plastic Surgery, Division of Pediatric Plastic Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Kathryn S Torok
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Suzanne C Li
- Department of Pediatrics, Division of Pediatric Rheumatology, Joseph M. Sanzari Children's Hospital, Hackensack Meridian School of Medicine, 30 Prospect Avenue, Hackensack, NJ, 07601, USA.
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Shepp K, Drescher CF, Griffin JA, Stepleman LM. Loneliness in Sexual Minority Individuals in the Southeastern United States: The Role of Minority Stress and Resilience. JOURNAL OF HOMOSEXUALITY 2023; 70:963-988. [PMID: 34806943 DOI: 10.1080/00918369.2021.2006001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Health disparities in the sexual minority population may be exacerbated by the loneliness experienced due to minority stress. Using a minority stress framework, this study examined minority stress, protective variables, and mental health as correlates of loneliness in sexual minority individuals in a small metropolitan area in the southeastern United States. Participants (n = 273) were a subsample of sexual minority individuals from a broader sample of LGBTQ adults in the Central Savannah River area who completed a health needs assessment. Bivariate correlations were calculated to assess for degree of significant relationships between loneliness and barriers to health care, minority stress, and mental health. Hierarchical linear regression was conducted to examine the relative importance of the study variables' associations with loneliness. A multiple regression model found household income, assault victimization, depressive symptoms, and sense of community to be significant correlates of loneliness. Interventions to decrease loneliness in this population will need to consider these interconnected, multi-level influences.
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Affiliation(s)
- Kasey Shepp
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Christopher F Drescher
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - James A Griffin
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- LGBT Health Resource Center, Chase Brexton Health Care, Baltimore, Maryland, USA
| | - Lara M Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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16
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Petroll AE, Quinn KG, John SA, Nigogosyan Z, Walsh JL. Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States. J Rural Health 2023; 39:477-487. [PMID: 36482508 PMCID: PMC10038837 DOI: 10.1111/jrh.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. METHODS We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement. FINDINGS Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. CONCLUSIONS Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.
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Affiliation(s)
- Andrew E. Petroll
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zack Nigogosyan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer L. Walsh
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Patil SA, Sanchez VJ, Bank G, Nair AA, Pandit S, Schuman JS, Dedania V, Parikh R, Mehta N, Colby K, Modi YS. Follow-up Rates After Teleretinal Screening for Diabetic Retinopathy: Assessing Patient Barriers to Care. JOURNAL OF VITREORETINAL DISEASES 2023; 7:125-131. [PMID: 37006661 PMCID: PMC10037748 DOI: 10.1177/24741264221147103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Purpose: To study patient follow-up after they engage in a teleretinal screening program and to understand potential barriers to care. Methods: This was a retrospective analysis and a prospective study of telephone-based patient interviews of outpatients screened for diabetic retinopathy (DR) through a teleretinal referral system. Results: Of 2761 patients screened through a teleretinal referral program, 123 (4.5%) had moderate nonproliferative DR (NPDR), 83 (3.0%) had severe NPDR, and 31 (1.1%) had proliferative DR. Of the 114 patients with severe NPDR or worse, 67 (58.8%) saw an ophthalmologist within 3 months of referral. Eighty percent of interviewed patients reported they were not aware of the need for follow-up eye appointments. Conclusions: Of patients with severe retinopathy or worse, 58.8% presented for in-person evaluation and treatment within 3 months of screening. Although this result was negatively affected by factors related to the COVID-19 pandemic, key elements of patient education and improved referral strategies to facilitate in-person treatment are essential to improving follow-up after patients engage in telescreening.
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Affiliation(s)
- Sachi A. Patil
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Victor J. Sanchez
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Georgia Bank
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Archana A. Nair
- Vanderbilt University Department of
Ophthalmology, Nashville, TN, USA
| | - Saagar Pandit
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Joel S. Schuman
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
- Departments of Biomedical Engineering
and Electrical and Computer Engineering, New York University Tandon School of
Engineering, Brooklyn, New York, USA
- Department of Physiology and
Neuroscience, NYU Grossman School of Medicine, NYU Langone Health, New York
University, New York, NY, USA
- Center for Neural Science, College of
Arts and Science, New York University, New York, NY, USA
| | - Vaidehi Dedania
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Ravi Parikh
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
- Manhattan Retina and Eye, New York, NY,
USA
| | - Nitish Mehta
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Kathryn Colby
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Yasha S. Modi
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
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18
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Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Gutowski ER, Freitag S, Zhang S, Thompson MP, Kaslow NJ. Intimate Partner Violence, Legal Systems and Barriers for African American Women. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1279-NP1298. [PMID: 35442820 PMCID: PMC9709545 DOI: 10.1177/08862605221090561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.
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Affiliation(s)
| | | | | | - Martie P. Thompson
- Emory School of
Medicine, Atlanta, GA, USA
- Appalachian State
University, Boone, NC, USA
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Holt NR, Eldridge-Smith ED, Griffin JA, Stepleman LM, Drescher CF, Casanova T. Differences in Health Care Access, Utilization, and Experiences Among LGBTQ+ Subgroups in the Southern United States. FAMILY & COMMUNITY HEALTH 2023; 46:58-68. [PMID: 35943219 DOI: 10.1097/fch.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals experience health inequities and barriers to accessing appropriate, affirming care. Little is known about differing health care experiences within the LGBTQ+ population, particularly among individuals living in underserved areas. This study explored health care experiences and utilization among LGBTQ+ subgroups: lesbian and gay cisgender individuals (n = 258), bisexual+ cisgender individuals (n = 71), and transgender and gender-diverse individuals (n = 80). Participants were recruited from a geographic region in South Carolina and Georgia and completed an online survey regarding negative health care experiences, barriers to care, and utilization of different health care venues and services. Results revealed significant differences between LGBTQ+ subgroups, with transgender and gender-diverse participants reporting more discriminatory experiences and greater barriers to care. Bisexual+ cisgender individuals also experienced some disparities compared with lesbian and gay cisgender individuals. Most participants endorsed a need for more competent providers. Findings and recommendations are considered within the context of the Southeastern United States for addressing access and utilization disparities among LGBTQ+ communities.
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Affiliation(s)
- Natalie R Holt
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia (Drs Holt, Stepleman, Drescher, and Casanova); and Department of Medicine, National Jewish Health, Denver, Colorado (Dr Eldridge-Smith); Center for LGBTQ Health Equity, Chase Brexton Health Care, Baltimore, Maryland (Dr Griffin). Dr Holt is now at VA Tennessee Valley Healthcare System, Nashville, Tennessee
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Tharakan S, Faqah O, Asghar W, Ilyas A. Microfluidic Devices for HIV Diagnosis and Monitoring at Point-of-Care (POC) Settings. BIOSENSORS 2022; 12:949. [PMID: 36354458 PMCID: PMC9687700 DOI: 10.3390/bios12110949] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
Human immunodeficiency virus (HIV) is a global epidemic; however, many individuals are able to obtain treatment and manage their condition. Progression to acquired immunodeficiency syndrome (AIDS) occurs during late-stage HIV infection, which compromises the immune system, making it susceptible to infections. While there is no cure, antiretroviral therapy can be used provided that detection occurs, preferably during the early phase. However, the detection of HIV is expensive and resource-intensive when tested with conventional methods, such as flow cytometry, polymerase chain reaction (PCR), or enzyme-linked immunosorbent assays (ELISA). Improving disease detection in resource-constrained areas requires equipment that is affordable, portable, and can deliver rapid results. Microfluidic devices have transformed many benchtop techniques to on-chip detection for portable and rapid point-of-care (POC) testing. These devices are cost-effective, sensitive, and rapid and can be used in areas lacking resources. Moreover, their functionality can rival their benchtop counterparts, making them efficient for disease detection. In this review, we discuss the limitations of currently used conventional HIV diagnostic assays and provide an overview of potential microfluidic technologies that can improve HIV testing in POC settings.
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Affiliation(s)
- Shebin Tharakan
- Bio-Nanotechnology and Biomaterials (BNB) Lab, New York Institute of Technology, Old Westbury, NY 11568, USA
- Department of Biological & Chemical Sciences, New York Institute of Technology, Old Westbury, NY 11568, USA
| | - Omair Faqah
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Waseem Asghar
- Department of Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Azhar Ilyas
- Bio-Nanotechnology and Biomaterials (BNB) Lab, New York Institute of Technology, Old Westbury, NY 11568, USA
- Department of Electrical and Computer Engineering, New York Institute of Technology, Old Westbury, NY 11568, USA
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22
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Sharpe JD, Sanchez TH, Siegler AJ, Guest JL, Sullivan PS. Association between the geographic accessibility of PrEP and PrEP use among MSM in nonurban areas. J Rural Health 2022; 38:948-959. [PMID: 34997634 PMCID: PMC9259757 DOI: 10.1111/jrh.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The US HIV epidemic has become a public health issue that increasingly affects men who have sex with men (MSM), including those residing in nonurban areas. Increasing access to pre-exposure prophylaxis (PrEP) in nonurban areas will prevent HIV acquisition and could address the growing HIV epidemic. No studies have quantified the associations between PrEP access and PrEP use among nonurban MSM. METHODS Using 2020 PrEP Locator data and American Men's Internet Survey data, we conducted multilevel log-binomial regression to examine the association between area-level geographic accessibility of PrEP-providing clinics and individual-level PrEP use among MSM residing in nonurban areas in the United States. FINDINGS Of 4,792 PrEP-eligible nonurban MSM, 20.1% resided in a PrEP desert (defined as more than a 30-minute drive to access PrEP), and 15.2% used PrEP in the past 12 months. In adjusted models, suburban MSM residing in PrEP deserts were less likely to use PrEP in the past year (adjusted prevalence ratio [aPR] = 0.35; 95% confidence interval [CI] = 0.15, 0.80) than suburban MSM not residing in PrEP deserts, and other nonurban MSM residing in PrEP deserts were less likely to use PrEP in the past year (aPR = 0.75; 95% CI = 0.60, 0.95) than other nonurban MSM not residing in PrEP deserts. CONCLUSIONS Structural interventions designed to decrease barriers to PrEP access that are unique to nonurban areas in the United States are needed to address the growing HIV epidemic in these communities.
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Affiliation(s)
- J. Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Travis H. Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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23
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Pope CN, Stavrinos D, Fazeli PL, Vance DE. Transportation Barriers and Health-Related Quality of Life in a Sample of Middle-Aged and Older Adults Living with HIV in the Deep South. AIDS Behav 2022; 26:2148-2158. [PMID: 35066731 PMCID: PMC8783768 DOI: 10.1007/s10461-021-03560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
Access to reliable transportation is a social determinant of health imperative for disease management for those aging with HIV/AIDS. To what degree transportation barriers are associated with health-related quality of life (HRQOL) in middle-aged and older people living with HIV (PWH) in the Deep South region of the United States is presently unknown. PWH (n = 261, age range = 39 to 73 years old, 80.1% African American, 64.4% male) were recruited from an academic medical center in the Deep South. Variables included sociodemographics, HIV characteristics, depressive symptoms, HRQOL, and perceived transportation barriers. Spearman rho correlations and linear regressions accounting for covariates were conducted. After accounting for covariates, greater perceived transportation barriers were associated with worse health perceptions, pain, social functioning, health distress, and health transitions. Access to reliable transportation is a key factor in improving health for PWH. Considerations for healthcare and traffic safety are discussed.
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Affiliation(s)
- Caitlin N Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, KY, USA.
- Graduate Center for Gerontology, 725 Rose St. Suite 401 Multidisciplinary Sciences Building, Lexington, KY, 40536, USA.
| | - Despina Stavrinos
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Aung S, Hardy N, Chrysanthopoulou S, Htun N, Kyaw A, Tun MS, Aung KW, Kantor R, Rana A. Evaluation of peer-to-peer HIV counseling in Myanmar: a measure of knowledge, adherence, and barriers. AIDS Care 2022; 34:762-770. [PMID: 33749465 PMCID: PMC10715989 DOI: 10.1080/09540121.2021.1902929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
In Myanmar, an Asian country with one of the highest HIV-1 prevalence rates, counseling prior to initiating antiretroviral therapy (ART) is standard care, either by a healthcare worker (standard counselor, SC) or trained counselor who is also living with HIV (peer counselor, PC). PC is commonly utilized in Myanmar and other resource-limited settings. However, its benefit over SC is unclear. We conducted a cross-sectional survey of people living with HIV (PLWH), who completed either only PC or only SC before treatment initiation across four cities in Myanmar. Participants were evaluated for HIV knowledge, stigma, antiretroviral adherence, barriers to care, social support satisfaction and attitudes regarding both counseling processes. Bivariate analyses and multivariable mixed effects modeling were conducted to compare differences in these measures among PC and SC participants. Among 1006 participants (49% PC; 51% SC), 52% were females and median age was 37 years in those receiving PC and 40 years in those receiving SC. More than 70% of participants in both groups achieved up to grade school education. The average duration since HIV diagnosis was 4.6 years for PC and 5.7 years for SC participants. HIV knowledge and attitudes regarding counseling were good in both groups and more PC participants credited their HIV counselor for knowledge (75% vs 63%, p < 0.001). Compared to SC, PC participants had lower enacted stigma (Incidence Rate Ratio (IRR) 0.75, Confidence Interval (CI) [0.65, 0.86]), mean internalized stigma (-0.24, CI [-0.34, -0.14]), and risk of antiretroviral therapy non-adherence (Odds Ratio 0.59, CI [0.40, 0.88]), while reporting higher levels of barriers to care (9.63, CI [8.20, 11.75]). Our findings demonstrate potential benefits of PC compared to SC, and support the utilization of PC to enhance HIV health outcomes within the unique societal and geographical context of Myanmar, and possibly beyond.
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Affiliation(s)
- Su Aung
- Division of Infectious Diseases, University of California San Francisco, California, CA (USA)
| | - Nicole Hardy
- School of Public Health, Brown University, Providence, RI, United States
| | | | | | - Aung Kyaw
- National AIDS Programme, Yangon, Myanmar
| | | | | | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI (USA)
| | - Aadia Rana
- Division of Infectious Diseases, University of Alabama-Birmingham School of Medicine, Birmingham, AL (USA)
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25
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King EM, Kaida A, Mayer U, Albert A, Gormley R, de Pokomandy A, Nicholson V, Cardinal C, Islam S, Loutfy M, Murray MCM. Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers. J Acquir Immune Defic Syndr 2022; 89:505-510. [PMID: 34954716 DOI: 10.1097/qai.0000000000002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group. SETTING This study was conducted across 3 Canadian provinces from 2015 to 2017. METHODS Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications. RESULTS Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001]. CONCLUSION Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.
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Affiliation(s)
- Elizabeth M King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Rebecca Gormley
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | - Valerie Nicholson
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Claudette Cardinal
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and
| | - Melanie C M Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
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26
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Ingram MV, Amodei N, Perez VV, German V. Factors predicting 12-month retention in care for minority women living with HIV. Ther Adv Infect Dis 2022; 9:20499361221089815. [PMID: 35450384 PMCID: PMC9016542 DOI: 10.1177/20499361221089815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Retention in HIV medical care is associated with improved clinical outcomes
and reduced mortality. The present study was conducted to identify
significant predictors of 1-year retention in care for a sample of minority
women whose engagement in HIV care at baseline varied along the care
continuum from newly diagnosed to lost-to-care. Methods: One hundred sixty-five cisgender and transgender women living with HIV in a
southern US state were offered a multicomponent retention intervention that
included outreach, medical case management (MCM), patient navigation
services (PN), and a group intervention for stigma. Multilevel logistic
regression analysis was performed to identify baseline and intervention
predictors of retention in care at 12 months following enrollment. Results: Multilevel logistic regression analysis revealed that baseline
characteristics such as working significantly reduced the odds of being
retained as did increasing CD4 counts. However, greater amounts of patient
navigation and medical case management services received increased the odds
of being retained. Conclusion: MCM services designed to accelerate coordination and linkage or re-linkage to
primary care and PN services to help navigate the complex system of HIV
offered in the present study are particularly effective for minority women
who lack health insurance, have low CD4 counts, and are unemployed.
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Affiliation(s)
- Mercedes V. Ingram
- Community Initiatives and Population Health, University Health System, 4502 Medical Dr., MS 82-2, San Antonio, TX 78229, USA
| | - Nancy Amodei
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
| | - Veronica Villela Perez
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
| | - Victor German
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
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27
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Rudolph AE. Integrating a web-based survey application into Qualtrics to collect risk location data for HIV prevention research. AIDS Care 2022; 34:397-403. [PMID: 34839777 PMCID: PMC9016781 DOI: 10.1080/09540121.2021.2008860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aspects of the physical and social environment play an important role in shaping HIV-related risk/prevention behaviors and access to prevention and treatment services. Here, we describe the feasibility of integrating a web-based survey application to collect risk locations into Qualtrics and compare this approach with a JavaScript-based alternative. Between 2017 and 2018, we enrolled 29 persons living with HIV in Boston Massachusetts to complete an interviewer-administered questionnaire using Qualtrics. Surveys collected demographics; sex/drug use risk behaviors; locations where participants met sex partners, had condomless sex, attended group sex events, and shared a syringe or injection equipment with someone else (up to 10 locations each); and the locations where participants (a) had sex with each sex partner (past 6 months) and (b) used drugs with each drug use partner (past 6 months). Location data were collected using embedded links to an encrypted web-based survey application. Overall, participants provided valid coordinates 93% of the time; when an exact location was not provided, a neighborhood was provided instead, resulting in little missing data. Our findings suggest that this web-based data collection tool (alone or with embedded links in Qualtrics) is a feasible and secure option for collecting risk location data.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, USA
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28
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King EM, Kaida A, Prior J, Albert A, Frank P, Abdul-Noor R, Kwaramba G, Gormley R, de Pokomandy A, Loutfy M, Murray MCM. Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV. Menopause 2022; 29:430-439. [PMID: 35357366 DOI: 10.1097/gme.0000000000001926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women living with HIV (WLWH) are commonly symptomatic during perimenopause and menopause (≥1 y without menstruation), however, little is known of risks for symptoms and their timing. We analyzed these unwanted experiences to inform care. METHODS WLWH (≥40 y) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study rated midlife experiences for seven symptoms and a symptom composite (from 0 to 21). Timing was categorized into four phases: i) perimenopause (flow in the last year), ii) 1-2 years from final menstrual period (FMP), iii) 2-5 years post-FMP; and iv) >5 years post-FMP. Resilience (standardized out of 100) was assessed based on Wagnild's Resilience Scale. Univariable/multivariable mixed effects linear regression assessed correlates of symptom intensity by composite score. RESULTS Among 457 peri-/menopausal women mean age 54.7 (±6.6) over two time points (703 observations), 88% experienced ≥1 mild symptom; 75% were of moderate and 55% severe intensity. The most frequently reported symptoms were joint/muscle stiffness (67%), depressed mood (67%), and hot flashes (57%). After adjusting for reproductive phase, we found that women with greater resilience had fewer/lower intensity symptoms (symptom score 1.37 [2.30 to 0.44] lower; P = 0.004); those with depressive symptoms and recreational drug use (respectively) had more/higher intensity symptoms (scores 1.71 [0.61 to 2.82] [P = 0.002]; 2.89 [2.09 to 3.77] [P<0.001] higher). Symptoms were most intense in perimenopause and declined with increasing menopausal years (P = 0.03). CONCLUSIONS WLWH experiences a high burden of midlife symptoms, decreased by resilience and most intense during perimenopause. Unwanted experiences were linked to psychosocial and behavioral factors. These data encourage HIV providers to adopt a bio-psychosocial approach to midlife management.
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Affiliation(s)
- Elizabeth M King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Angela Kaida
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Jerilynn Prior
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - Rebecca Gormley
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Melanie C M Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
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29
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Batchelder AW, Burgess C, Perlson J, O’Cleirigh C. Age and Year of HIV Diagnosis are Associated with Perceptions of Discrimination and Internalized Stigma Among Sexual Minority Men Who Use Substances. AIDS Behav 2022; 26:125-137. [PMID: 34117966 PMCID: PMC8665940 DOI: 10.1007/s10461-021-03333-6] [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] [Accepted: 06/04/2021] [Indexed: 01/03/2023]
Abstract
Discrimination and internalized stigma are barriers to engagement in HIV self-care among men who have sex with men (MSM) living with HIV. However, differences in perceptions of discrimination and internalized stigmas by age, year of HIV-diagnosis, and race are poorly understood. We assessed differences in reported discrimination related to HIV, race, sexual orientation, and substance use and internalized stigmas among 202 MSM living with HIV who use substances. Younger participants reported higher levels of all types of discrimination and internalized stigmas (p-values < 0.001-0.030). Those diagnosed after the advent of antiretrovirals reported higher levels of discrimination related to HIV, sexual orientation, and substance use, as well as internalized stigma related to HIV and substance use (p-values 0.001-0.049). We explored perceived community HIV stigma, which accounted for associations involving age and year of diagnosis. Age, year of diagnosis, and race should be considered when assessing and intervening with stigma.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA,Corresponding Author: Abigail Batchelder, Ph.D., M.P.H., One Bowdoin Square, 7th Floor, Boston, MA 02114; Phone: 617-643-0387; Fax: 617-536-8602;
| | - Claire Burgess
- Department of Psychiatry, Harvard Medical School, Boston, MA,VA Boston Healthcare System, Boston, MA
| | - Jacob Perlson
- The Fenway Health Institute, Fenway Health, Boston, MA,Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA
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30
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Cronin TJ, Pepping CA, Halford WK, Lyons A. Minority Stress and Psychological Outcomes in Sexual Minorities: The Role of Barriers to Accessing Services. JOURNAL OF HOMOSEXUALITY 2021; 68:2417-2429. [PMID: 32815799 DOI: 10.1080/00918369.2020.1804264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lesbian, gay, and bisexual (LGB) individuals are at higher risk for poor mental health than their heterosexual counterparts, and these disparities are largely accounted for by minority stressors. Less is known about the mechanisms underlying associations between minority stress and mental health. In a sample of 592 LGB adults (Mage = 29.39), we tested a model in which minority stress (internalized stigma, stigma consciousness, and lived discrimination) was associated with poor mental health when mediated by stigma-related barriers to accessing psychological services. Structural equation modeling revealed that minority stressors predicted more barriers to service use which, in turn, predicted poorer mental health outcomes. Internalized stigma was also directly associated with poor mental health. Results suggest that links between minority stress and poorer mental health in LGB individuals are at least partly explained by stigma-related barriers to accessing services. Future research is needed to investigate methods which may ameliorate these barriers.
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Affiliation(s)
- Timothy J Cronin
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - W Kim Halford
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia
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Cronin TJ, Pepping CA, Halford WK, Lyons A. Mental health help-seeking and barriers to service access among lesbian, gay, and bisexual Australians. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1890981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Timothy J. Cronin
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - W. Kim Halford
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia
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Hutson SP, Golden A, Odoi A. Geographic distribution of hospice, homecare, and nursing home facilities and access to end-of-life care among persons living with HIV/AIDS in Appalachia. PLoS One 2020; 15:e0243814. [PMID: 33315923 PMCID: PMC7735579 DOI: 10.1371/journal.pone.0243814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Access to healthcare services, from diagnosis through end of life (EOL), is important among persons living with Human Immunodeficiency Syndrome (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (PLWHA). However, little is known about the availability of hospice services in Appalachian areas. Therefore, the objective of this study is to describe the geographic distribution of hospice, homecare and nursing home facilities in order to demonstrate current existence of and access to resources for EOL care among PLWHA in the Appalachian regions of Tennessee and Alabama. METHODS This paper reports on the second aim of a larger sequential, mixed methods qualitative-quantitative (qual→quan) study. Data from advance care planning (ACP) surveys were collected by both electronic (n = 28) and paper copies (n = 201) and, among other things, obtained information on zip codes of residence of PLWHA. This enabled assessment of the geographic distribution of residences of PLWHA in relation to the distribution of healthcare services such as hospice and home healthcare services. Hospice and Home Healthcare data were obtained from the Tennessee and Alabama Departments of Health. The street addresses of these facilities were used to geocode and map the geographic distributions of the facilities using Street Map USA. Travel times to Hospice and Home Healthcare facilities were computed and mapped using ArcGIS 10.3. RESULTS We identified a total of 32 hospice and 69 home healthcare facilities in the Tennessee Appalachian region, while the Alabama Appalachian region had a total of 110 hospice and 86 home healthcare facilities. Most care facilities were located in urban centers. The distribution of care facilities was worse in Tennessee with many counties having no facilities, requiring up to an hour drive time to reach patients. A total of 86% of the PLWHA indicated preference to die at home. CONCLUSIONS Persons living with HIV/AIDS in Appalachia face a number of challenges at the end of life that make access to EOL services difficult. Although respondents indicated a preference to die at home, the hospice/homecare infrastructure and resources are overwhelmingly inadequate to meet this need. There is need to improve access to EOL care in the Appalachian regions of both Tennessee and Alabama although the need is greater in Tennessee.
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Affiliation(s)
- Sadie P. Hutson
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Ashley Golden
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee Institute of Agriculture, Knoxville, Tennessee, United States of America
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Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study. PLoS One 2020; 15:e0242844. [PMID: 33290435 PMCID: PMC7723285 DOI: 10.1371/journal.pone.0242844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. METHODS AND FINDINGS We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. CONCLUSIONS Findings highlight HCs' contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.
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Oluwagbemi OO, Oluwagbemi FE, Jatto A, Hui C. MAVSCOT: A fuzzy logic-based HIV diagnostic system with indigenous multi-lingual interfaces for rural Africa. PLoS One 2020; 15:e0241864. [PMID: 33156877 PMCID: PMC7647102 DOI: 10.1371/journal.pone.0241864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
HIV still constitutes a major public health problem in Africa, where the highest incidence and prevalence of the disease can be found in many rural areas, with multiple indigenous languages being used for communication by locals. In many rural areas of the KwaZulu-Natal (KZN) in South Africa, for instance, the most widely used languages include Zulu and Xhosa, with only limited comprehension in English and Afrikaans. Health care practitioners for HIV diagnosis and treatment, often, cannot communicate efficiently with their indigenous ethnic patients. An informatics tool is urgently needed to facilitate these health care professionals for better communication with their patients during HIV diagnosis. Here, we apply fuzzy logic and speech technology and develop a fuzzy logic HIV diagnostic system with indigenous multi-lingual interfaces, named Multi-linguAl HIV indigenouS fuzzy logiC-based diagnOstic sysTem (MAVSCOT). This HIV multilingual informatics software can facilitate the diagnosis in underprivileged rural African communities. We provide examples on how MAVSCOT can be applied towards HIV diagnosis by using existing data from the literature. Compared to other similar tools, MAVSCOT can perform better due to its implementation of the fuzzy logic. We hope MAVSCOT would help health care practitioners working in indigenous communities of many African countries, to efficiently diagnose HIV and ultimately control its transmission.
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Affiliation(s)
- Olugbenga Oluseun Oluwagbemi
- Department of Mathematical Sciences, Stellenbosch University, Matieland, Stellenbosch, South Africa
- Department of Computer Science and Information Technology, Sol Plaatje University, Kimberley, South Africa
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | | | - Abdulwahab Jatto
- Department of Computer Science, Federal University Lokoja, Lokoja, Nigeria
| | - Cang Hui
- Department of Mathematical Sciences, Stellenbosch University, Matieland, Stellenbosch, South Africa
- African Institute for Mathematical Sciences, Cape Town, South Africa
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Howren MB, Francis SL, Polgreen LA, Shafer C, Hoth A, Ohl ME. Predictors of HIV Preexposure Prophylaxis Initiation Among Public Health Clients in Rural and Small Urban Areas in Iowa. Public Health Rep 2020; 136:172-182. [PMID: 33108986 DOI: 10.1177/0033354920966026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Preexposure prophylaxis (PrEP) is a safe and effective method for HIV prevention, but little is known about PrEP uptake in rural and small urban areas. We described rates and predictors of HIV PrEP initiation among public health clients in rural and small urban areas in Iowa. METHODS This was a prospective cohort study of clients with PrEP indications served by HIV testing and disease intervention specialist/partner services (DIS/PS) programs in public health departments in Iowa from February 1, 2018, through February 28, 2019. Eligible participants were aged 18-70 and referred for PrEP by public health personnel. Participants completed surveys at enrollment addressing demographic characteristics; sexual history; previous drug use; PrEP experiences; and knowledge, attitudes, and beliefs about PrEP. A follow-up survey assessed PrEP initiation at 30 days. We compared baseline characteristics of PrEP initiators and non-initiators. RESULTS Two hundred thirty-four public health clients consented to participate in the study; 189 completed the baseline survey, and 117 (61.9%) completed the follow-up survey. The mean age of participants in the baseline survey was 30 (range, 18-68); 109 (57.7%) were male, 127 (67.2%) were White, and 169 (89.4%) lived in a rural or small urban area. Of 117 participants in the follow-up survey, those who initiated PrEP were significantly more likely than those who did not initiate PrEP to be referred by DIS/PS programs (46.7% vs 7.8%, P < .001) and to recognize that PrEP was ≥90% effective (86.7% vs 35.3%, P = .001). No PrEP initiators and 8 PrEP non-initiators agreed that PrEP is for promiscuous people (0% vs 7.8%, P = .04). Perceived PrEP stigma was low and not associated with PrEP initiation. CONCLUSIONS PrEP initiation rates were low among rural and small urban health department clients. Interventions are needed to improve linkage to PrEP among rural and small urban public health clients.
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Affiliation(s)
- M Bryant Howren
- 7823 Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.,Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University, Tallahassee, FL, USA.,12243 Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA.,VHA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, VA Iowa City Healthcare System, Iowa City, IA, USA
| | - Shelby L Francis
- 4083 Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Linnea A Polgreen
- 4083 Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA
| | - Cody Shafer
- HIV Special Projects Division, NuCara Pharmacy, Des Moines, IA, USA
| | - Angela Hoth
- 4083 Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael E Ohl
- 12243 Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA.,VHA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, VA Iowa City Healthcare System, Iowa City, IA, USA.,4083 Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Lacombe-Duncan A, Newman PA, Bauer GR, Logie CH, Persad Y, Shokoohi M, O Brien N, Kaida A, de Pokomandy A, Loutfy M. Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study. Sex Health 2020; 16:367-376. [PMID: 31283902 DOI: 10.1071/sh19011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/21/2019] [Indexed: 11/23/2022]
Abstract
Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. METHODS This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. RESULTS Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5-67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3-29.2%). Factors significantly associated with not having begun one's medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. CONCLUSIONS HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, Michigan 48109-1106, USA; and Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada; and Corresponding author.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada
| | - Greta R Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Kresge Building, London, Ontario N6A 5C1, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada; and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Kresge Building, London, Ontario N6A 5C1, Canada
| | - Nadia O Brien
- Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada; and Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, Quebec H3S 1Z1, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada; and Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, Quebec H3S 1Z1, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada; and Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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Junkins A, Psaros C, Ott C, Azuero A, Lambert CC, Cropsey K, Savage R, Haberer JE, Safren SA, Kempf MC. Feasibility, acceptability, and preliminary impact of telemedicine-administered cognitive behavioral therapy for adherence and depression among African American women living with HIV in the rural South. J Health Psychol 2020; 26:2730-2742. [PMID: 32515245 DOI: 10.1177/1359105320926526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Women living with HIV are disproportionally affected by depression and mental healthcare access. A pilot feasibility trial using videoconferencing compared cognitive behavioral therapy for antiretroviral therapy adherence and depression (N = 11) to supportive psychotherapy (N = 11). Participants completed 10-12 weekly therapy sessions and 6-month follow-up. Retention at 6 months was 95 percent. Depression symptoms significantly decreased in both arms; antiretroviral therapy adherence remained high as measured via self-report and Wisepill. Satisfaction with intervention components was high; videoconferencing was highly acceptable and comparable to face-to-face counseling. This study demonstrates the feasibility of telemedicine-administered psychotherapy addressing mental health needs among women living with HIV.
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Affiliation(s)
| | - Christina Psaros
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | - Corilyn Ott
- The University of Alabama at Birmingham, USA
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Exavery A, Charles J, Kuhlik E, Barankena A, Koler A, Kikoyo L, Jere E. Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project. BMC Health Serv Res 2020; 20:275. [PMID: 32245468 PMCID: PMC7119283 DOI: 10.1186/s12913-020-05102-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/11/2020] [Indexed: 11/22/2022] Open
Abstract
Background Tanzania has met only 50.1% of the 90% target for diagnosing HIV in children. The country’s pediatric case finding strategy uses global best practices of index testing, provider-initiated counselling and testing, and targeted community testing of at-risk populations to find about 50,000 children living with HIV (CLHIV) who are undiagnosed. However, context-specific strategies are necessary to find the hidden children to meet the full 90% target. This study assesses whether sex of the caregiver is associated with HIV status of orphans and vulnerable children (OVC) as a valuable strategy for enhanced pediatric case findings. Methods Data originate from the community-based, United States Agency for International Development (USAID)-funded Kizazi Kipya Project, which works towards increasing OVC’s and their caregivers’ uptake of HIV/AIDS and other health and social services in Tanzania. Included in this study are 39,578 OVC ages 0–19 years who the project enrolled during January through March 2017 in 18 regions of Tanzania and who voluntarily reported their HIV status. Data analysis involved multi-level logistic regression, with OVC HIV status as the outcome of interest and caregiver’s sex as the main independent variable. Results Three-quarters (74.3%) of the OVC included in the study had female caregivers, and their overall HIV prevalence was 7.1%. The prevalence was significantly higher (p < 0.001) among OVC with male caregivers (7.8%) than among OVC with female caregivers (6.8%), and indeed, multivariate analysis showed that OVC with male caregivers were significantly 40% more likely to be HIV-positive than those with female caregivers (OR = 1.40, 95% CI 1.08–1.83). This effect was the strongest among 0–4 year-olds (OR = 4.02, 95% CI 1.61–10.03), declined to 1.72 among 5–9 year-olds (OR = 1.72, 95% CI 1.02–2.93), and lost significance for children over age 9 years. Other significant factors included OVC age and nutritional status; caregiver HIV status and marital status; household health insurance status, and family size; and rural versus urban residence. Conclusions OVC in Tanzania with male caregivers have a 40% higher likelihood of being HIV-positive than those with female caregivers. HIV risk assessment activities should target OVC with male caregivers, as well as OVC who have malnutrition, HIV-positive caregivers, or caregivers who do not disclose their HIV status to community volunteers. Further, younger HIV-positive OVC are more likely to live in rural areas, while older HIV-positive OVC are more likely to live in urban areas. These factors should be integrated in HIV risk assessment algorithms to enhance HIV testing yields and pediatric case-finding in the OVC population in Tanzania.
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Affiliation(s)
| | | | - Erica Kuhlik
- Pact, Inc., 1828 L Street NW, Suite 300, Washington, DC, 20036, USA
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Mimiaga MJ, August Oddleifson D, Meersman SC, Silvia A, Hughto JMW, Landers S, Brown E, Loberti P. Multilevel Barriers to Engagement in the HIV Care Continuum Among Residents of the State of Rhode Island Living with HIV. AIDS Behav 2020; 24:1133-1150. [PMID: 31563986 PMCID: PMC7085442 DOI: 10.1007/s10461-019-02677-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An estimated 1.2 million people in the United States are living with HIV. Of those living with HIV, only 40% are engaged in HIV care, 37% are prescribed antiretroviral therapy (ART), and 30% are virally suppressed. Individual-, interpersonal-, and structural-level factors that represent barriers to engagement along the HIV care continuum are important to identify in order to inform priority areas and interventions. 296 adult residents of Rhode Island living with HIV between November 2015 and January 2016 were asked to participate in an observational study (Ryan White Part B Health Resources and Services Administration-funded consumer needs assessment) to identify the multilevel factors associated with engagement in the HIV care continuum outcomes (i.e., being retained in care, being prescribed ART, adhering to ART, and achieving viral suppression-all in the past 12 months). Multivariable logistic regression models were fit to model the four HIV care continuum outcomes. The majority of participants were over age 30 (92.5%), racial/ethnic minorities (67.1%), cisgender men (56.9%), and identified as straight/heterosexual (60.5%). Overall, 95.2% of participants were retained in care in the past 12 months, 93.0% were prescribed ART, 87.1% were currently adherent to ART, and 68.2% were virally suppressed. Factors positively associated with not being retained in HIV care in the past 12 months included having no income and challenges navigating the HIV care system. Being age 18-29 and having a provider who does not know how to treat people with HIV/AIDS were each positively associated with not being prescribed ART. Factors positively associated with not being adherent to ART included being age 18-29 and substance use in the past 12 months. Finally, having private insurance and having a provider who is not trustworthy were each positively associated with not being virally suppressed. Regardless of the fact that many of the individuals living with HIV in this sample are able to achieve an undetectable viral load, challenges with retention in HIV care and ART adherence threaten to undermine the clinical and public health benefits of treatment as prevention. Future longitudinal research conducted to better understand how to boost the effectiveness of treatment as prevention in this population should focus on examining the unique multilevel factors, polymorbidities, and conditions (mostly social determinants of health including housing, socioeconomic position, etc.) associated with suboptimal engagement across the stages of the HIV care continuum.
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Affiliation(s)
- Matthew J Mimiaga
- Center for Health Equity Research, Brown University, 121 South Main Street, 8th Floor, Providence, RI, 02903, USA.
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | | | | | | | - Jaclyn M W Hughto
- Center for Health Equity Research, Brown University, 121 South Main Street, 8th Floor, Providence, RI, 02903, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Emily Brown
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Paul Loberti
- Rhode Island Executive Office of Health and Human Services, HIV Provision of Care & Special Populations Unit, Providence, RI, USA
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Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP. J Racial Ethn Health Disparities 2020; 7:913-927. [PMID: 32078743 DOI: 10.1007/s40615-020-00715-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP.
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Arya S, Wilton P, Page D, Boma-Fischer L, Floros G, Dainty KN, Winikoff R, Sholzberg M. Healthcare provider perspectives on inequities in access to care for patients with inherited bleeding disorders. PLoS One 2020; 15:e0229099. [PMID: 32078655 PMCID: PMC7032703 DOI: 10.1371/journal.pone.0229099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The ways in which social determinants of health affect patients with inherited bleeding disorders remains unclear. The objective of this study was to understand healthcare provider perspectives regarding access to care and diagnostic delay amongst this patient population. METHODS A healthcare provider survey comprising 24 questions was developed, tested, and subsequently disseminated online with recruitment to all members of The Association of Hemophilia Clinic Directors of Canada (N = 73), members of the Canadian Association of Nurses in Hemophilia Care (N = 40) and members of the Canadian Physiotherapists in Hemophilia Care (N = 44). RESULTS There were 70 respondents in total, for a total response rate of 45%. HCPs felt that there were diagnostic delays for patients with mild symptomatology (71%, N = 50), women presenting with abnormal uterine bleeding as their only or primary symptom (59%, N = 41), and patients living in rural Canada (50%, N = 35). Fewer respondents felt that factors such as socioeconomic status (46%, N = 32) or race (21%, N = 15) influenced access to care, particularly as compared to the influence of rural location (77%, N = 54). DISCUSSION We found that healthcare providers identified patients with mild symptomatology, isolated abnormal uterine bleeding, and residence in rural locations as populations at risk for inequitable access to care. These factors warrant further study, and will be investigated further by our group using our nation-wide patient survey and ongoing in-depth qualitative patient interviews.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Pamela Wilton
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - David Page
- Canadian Hemophilia Society, Montreal, Quebec, Canada
| | - Laurence Boma-Fischer
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Hematology, St. Michael's Hospital, Toronto, Canada
| | - Georgina Floros
- Department of Hematology, St. Michael's Hospital, Toronto, Canada
- Department of Nursing, St. Michael’s Hospital, Toronto, Canada
| | - Katie N. Dainty
- North York General Hospital, Toronto, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Michelle Sholzberg
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Canada
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Patel D, Taylor-Aidoo N, Marandet A, Heitgerd J, Maciak B. Assessing Differences in CDC-Funded HIV Testing by Urbanicity, United States, 2016. J Community Health 2020; 44:95-102. [PMID: 30069826 DOI: 10.1007/s10900-018-0558-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV prevention efforts have contributed to a decline in annual HIV infections in the United States. However, progress has been uneven and certain groups and geographic areas continue to be disproportionately affected. Subsequent to implementation of CDC's high-impact HIV prevention approach to reducing new infections, we analyzed national-level CDC-funded HIV test data from 2016 to describe the population being reached in three urbanicity settings (metropolitan: ≥ 1,000,000 population; urban: 50,000-999,999; rural: < 50,000). Over 70% of CDC-funded HIV tests and almost 80% of persons newly diagnosed with HIV as a result of CDC-funded testing occurred in metropolitan areas. Nonetheless, CDC-funded testing efforts are reaching urban and rural areas, especially in the South, providing opportunities to identify persons unaware of their HIV status and link those with newly diagnosed HIV to medical care and prevention services. While CDC-funded testing efforts have continued to focus on population subgroups and geographic areas at greatest risk, efforts should also continue in rural areas and among groups in need with a low national burden.
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Affiliation(s)
- Deesha Patel
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA.
| | - Nicole Taylor-Aidoo
- Keymind, A Division of Axiom Resource Management, Inc., 2941 Fairview Park Drive, Suite 900, Falls Church, VA, 22042, USA
| | - Angèle Marandet
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA
| | - Janet Heitgerd
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA
| | - Barbara Maciak
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E59, Atlanta, GA, 30333, USA
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Shokoohi M, Bauer GR, Kaida A, Logie CH, Carter A, Lacombe-Duncan A, Loutfy M. A Latent Class Analysis of the Social Determinants of Health Impacting Heavy Alcohol Consumption Among Women Living with HIV in Canada: The Canadian HIV Women's Sexual and Reproductive Health Cohort Study. AIDS Behav 2019; 23:3226-3236. [PMID: 30863979 DOI: 10.1007/s10461-019-02454-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We used longitudinal data from the 2013-2017 Canadian HIV Women's Sexual and Reproductive Health Cohort Study (N = 1422) to assess the clustered impact of social determinants of health (SDoH) on hazardous drinking. Two measures of alcohol use were defined: (i) weekly alcohol use, with > 7 drinks/week as heavy drinking, and (ii) monthly binge drinking (≥ 6 drinks at one sitting), with ≥ 1/month as frequent binging. Twelve SDoH indicators were classified using latent class analysis: no/least adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted multinomial logistic regression was used to report relative-risk ratio (RRR). Women living with HIV (WLWH) in no/least adversity class had a substantially lower likelihood of both heavy weekly alcohol use and frequent binging than those in discrimination/stigma, economic hardship, and most SDoH adversities classes, with RRR estimates ranging from 0.02 to 0.18. Findings indicate the need to address SDoH to reduce hazardous drinking among WLWH.
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Abstract
There has been limited study of the syndemic link between HIV and intimate partner violence (IPV) among rural populations in the United States. We utilized the Revised Conflict Tactics Scale-2 to examine the past year prevalence, type (psychological aggression, physical assault, and sexual assault), and the impact of IPV on HIV clinical outcomes among men living with HIV in rural Appalachia. Approximately 39% of participants experienced some type of IPV in the preceding year, with 67% of those individuals experiencing more than 1 type of IPV. Approximately 77% of participants endorsing IPV exposure experienced psychological aggression. Most participants exposed to psychological aggression (70%) and/or physical assault (57%) were both victims and perpetrators, and those experiencing sexual assault reported being exclusively victims (65%). There were no significant differences in clinical outcomes including viral load and CD4 count, which may be secondary to small sample size derived from a clinic population with a high rate of virologic suppression (94%). This study demonstrates the need to assess IPV exposure in men living with HIV and further highlights the intricacies of relationship violence in these individuals.
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Heckman TG, Markowitz JC, Heckman BD, Woldu H, Anderson T, Lovejoy TI, Shen Y, Sutton M, Yarber W. A Randomized Clinical Trial Showing Persisting Reductions in Depressive Symptoms in HIV-Infected Rural Adults Following Brief Telephone-Administered Interpersonal Psychotherapy. Ann Behav Med 2019; 52:299-308. [PMID: 30084893 DOI: 10.1093/abm/kax015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Rural areas account for 5% to 7% of all HIV infections in the USA, and rural people living with HIV (PLHIV) are 1.3 times more likely to receive a depression diagnosis than their urban counterparts. A previous analysis from our randomized clinical trial found that nine weekly sessions of telephone-administered interpersonal psychotherapy (tele-IPT) reduced depressive symptoms and interpersonal problems in rural PLHIV from preintervention through postintervention significantly more than standard care but did not increase perceived social support compared to standard care. Purpose To assess tele-IPT's enduring effects at 4- and 8-month follow-up in this cohort. Methods Tele-IPT's long-term depression treatment efficacy was assessed through Beck Depression Inventory self-administrations at 4 and 8 months. Using intention-to-treat and completer-only approaches, mixed models repeated measures, and Cohen's d assessed maintenance of acute treatment gains. Results Intention-to-treat analyses found fewer depressive symptoms in tele-IPT patients than standard care controls at 4 (d = .41; p < .06) and 8-month follow-up (d =.47; p < .05). Completer-only analyses found similar patterns, with larger effect sizes. Tele-IPT patients used crisis hotlines less frequently than standard care controls at postintervention and 4-month follow-up (ps < .05). Conclusions Tele-IPT provides longer term depression relief in depressed rural PLHIV. This is also the first controlled trial to find that IPT administered over the telephone provides long-term depressive symptom relief to any clinical population. Trial Registration ClinicalTrials.gov Identifier: NCT02299453.
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Affiliation(s)
- Timothy G Heckman
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA
| | - John C Markowitz
- Columbia University College of Physicians & Surgeons, New York, NY
| | - Bernadette D Heckman
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA
| | - Henok Woldu
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA
| | | | | | - Ye Shen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA
| | - Mark Sutton
- Columbia University College of Physicians & Surgeons, New York, NY
| | - William Yarber
- Department of Applied Health and Science, Indiana University, Bloomington, IN USA
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Griffin JA, Casanova TN, Eldridge-Smith ED, Stepleman LM. Gender Minority Stress and Health Perceptions Among Transgender Individuals in a Small Metropolitan Southeastern Region of the United States. Transgend Health 2019; 4:247-253. [PMID: 31641691 PMCID: PMC6802727 DOI: 10.1089/trgh.2019.0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Transgender individuals continue to face wide-ranging health disparities, which may be due in part to unique and chronic gender identity-related stressors. The present study assessed the relationships between barriers to health care, proximal minority stress related to perceived community safety, and overall health perceptions of transgender individuals living in a small metropolitan region of the Southern United States. Methods: Participants included 66 transgender individuals who took part in a larger lesbian, gay, bisexual, transgender, and queer (LGBTQ) community needs assessment study. Participants completed measures of barriers to health care, inclusive of medical access barriers, psychosocial needs barriers, and personal resource barriers, perceptions of LGBTQ safety within the region, and overall perceptions of health. Results: Results revealed that psychosocial needs barriers, personal needs barriers, and perceived lack of community safety were correlated with poorer self-perceptions of overall health, with psychosocial needs barriers and perceived lack of community safety independently predictive of poor health perceptions. Conclusions: The study demonstrates the need for greater health resources and access to care, as well as improved community conditions for transgender individuals, particularly those in less populated, Southern regions of the United States, to improve health quality and ultimately reduce community health disparities.
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Affiliation(s)
- James A Griffin
- LGBT Health Resource Center, Chase Brexton Health Care, Baltimore, Maryland
| | - Tracy N Casanova
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Elizabeth D Eldridge-Smith
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lara M Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
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Repeat Human Immunodeficiency Virus Testing by Transmission Risk Group and Rurality of Residence in North Carolina. Sex Transm Dis 2019; 45:684-689. [PMID: 29771865 DOI: 10.1097/olq.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding of repeat human immunodeficiency virus (HIV) testing (RHT) is limited and the impact of rural residence as a potential barrier to RHT is unknown. Rural populations are of particular interest in the Southeastern United States because of their disproportionate HIV burden. METHODS We used HIV surveillance data from publicly funded HIV testing sites in North Carolina to assess repeat testing by transmission risk group and residential rurality in a retrospective cohort study. Linear binomial regression models were used to estimate adjusted, 1-year cumulative incidences and cumulative incidence differences comparing RHT within transmission risk populations by level of rurality. RESULTS In our total study population of 600,613 persons, 19,275 (3.2%) and 9567 (1.6%) self-identified as men who have sex with men (MSM) and persons who inject drugs (PWID), respectively. A small minority, 13,723 (2.3%) resided in rural ZIP codes. Men who have sex with men were most likely to repeat test (unadjusted, 1-year cumulative incidence after an initial negative test, 16.4%) compared with PWID (13.2%) and persons who did not identify as either MSM or PWID (13.6%). The greatest effect of rurality was within PWID; the adjusted, 1-year cumulative incidence of RHT was 6.4 (95% confidence interval, 1.4-11.4) percentage points higher among metropolitan versus rural PWID. CONCLUSIONS One-year cumulative incidence of RHT was low among all clients of publicly funded HIV testing sites in North Carolina, including MSM and PWID for whom annual testing is recommended. Our findings suggest a need for public health efforts to increase access to and support for RHT, particularly among rural PWID.
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Lacombe-Duncan A, Bauer GR, Logie CH, Newman PA, Shokoohi M, Kay ES, Persad Y, O'Brien N, Kaida A, de Pokomandy A, Loutfy M. The HIV Care Cascade Among Transgender Women with HIV in Canada: A Mixed-Methods Study. AIDS Patient Care STDS 2019; 33:308-322. [PMID: 31260342 DOI: 10.1089/apc.2019.0013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Scant research has explored the engagement of transgender (trans) women living with HIV (WLWH) in the HIV care cascade, particularly in universal health care settings like Canada. This convergent parallel, mixed-methods study drew on cross-sectional quantitative data from 50 trans WLWH in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) and qualitative semistructured interview data from a subsample of 11 participants. Descriptive analyses were used to describe proportions of trans WLWH at five steps of the HIV care cascade and bivariate analyses to determine associations between hypothesized barriers/facilitators and HIV care cascade outcomes. Framework analysis was used to describe barriers and facilitators to HIV care engagement. Quantitative and qualitative data were then compared and contrasted. While use of purposive sampling, including recruitment through AIDS Service Organizations and HIV clinics, may have led to oversampling of trans WLWH who already had access to care, gaps were still seen in antiretroviral therapy (ART) outcomes (current ART use: 78%; ≥95% adherence among those currently taking ART: 67%). The number of years living with HIV was positively associated with HIV care cascade engagement. Factors associated with lower engagement included: higher health-related quality of life, depressive and post-traumatic stress disorder symptoms, barriers to access to care, transphobia, HIV-related stigma, and housing insecurity. Qualitative findings converged and expanded on how physical health, and social and structural marginalization, influence trans WLWH's engagement in HIV care. Qualitative findings elaborated on the importance of ART-related factors in impeding or facilitating engagement, including concerns about feminizing hormone-ART drug-drug interactions. Mixed-methods findings reveal how trans WLWH experience barriers common to other people living with HIV, and also experience unique barriers as a result of trans and HIV experiences.
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Affiliation(s)
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Emma Sophia Kay
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Center, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Center, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Shokoohi M, Bauer GR, Kaida A, Logie CH, Lacombe-Duncan A, Milloy MJ, Lloyd-Smith E, Carter A, Loutfy M. Patterns of social determinants of health associated with drug use among women living with HIV in Canada: a latent class analysis. Addiction 2019; 114:1214-1224. [PMID: 30698902 PMCID: PMC6992379 DOI: 10.1111/add.14566] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/13/2018] [Accepted: 01/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Identifying typologies of social determinants of health (SDoH) vulnerability influencing drug use practices among women living with HIV (WLWH) can help to address associated harms. This research aimed to explore the association of SDoH clusters with drug use among WLWH. DESIGN Latent class analysis (LCA) was used to identify the distinct clusters of SDoH. Inverse probability weighting (IPW) was employed to account for confounding and potential selection bias. Associations were analyzed using generalized linear model with log link and Poisson distribution, and then weighted risk ratio (RR) and 95% confidence intervals (CI) were reported. SETTING AND PARTICIPANTS Data from 1422 WLWH recruited at time-point 1 of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS, 2013-15), with 1252 participants at 18 months follow-up (time-point 2). MEASUREMENTS Drug use was defined as use of illicit/non-prescribed opioids/stimulants in the past 6 months. SDoH indicators included: race discrimination, gender discrimination, HIV stigma, social support, access to care, food security, income level, employment status, education, housing status and histories of recent sex work and incarceration. FINDINGS LCA identified four SDoH classes: no/least SDoH adversities (6.6%), discrimination/stigma (17.7%), economic hardship (30.8%) and most SDoH adversities (45.0%). Drug use was reported by 17.5% and 17.2% at time-points 1 and 2, respectively. WLWH with no/least SDoH adversities were less likely to report drug use than those in economic hardship class (weighted RR = 0.13; 95% CIs = 0.03, 0.63), discrimination/stigma class (weighted RR = 0.15; 95% CIs = 0.03, 0.78), and most SDoH adversities class (weighted RR = 0.13; 95% CIs = 0.03, 0.58). CONCLUSIONS Social determinants of health vulnerabilities are associated with greater likelihood of drug use, underscoring the significance of addressing interlinked social determinants and drug use through the course of HIV care and treatment.
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Affiliation(s)
- Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | | | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Arana E, Carroll-Scott A, Massey PM, Lee NL, Klassen AC, Yudell M. Racial/Ethnic Disparities in Mammogram Frequency Among Women With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:177-187. [PMID: 31120403 PMCID: PMC8363066 DOI: 10.1352/1934-9556-57.3.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Little information exists on the associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. This study collected survey and medical record data to examine this relationship. Results indicated that Hispanic and Black women with ID were more likely than White women with ID to have mammograms every 2 years. Participants who live in a state-funded residence, were aged 50+, and had a mild or moderate level of ID impairment were more likely to undergo mammography compared to participants living with family or alone, were <50, and had severe ID impairment. Further research is needed to understand the mechanisms explaining disparities in mammograms between these racial/ethnic groups.
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Affiliation(s)
- Evelyn Arana
- Evelyn Arana, Cancer Disparities Center, Hackensack University Medical Center; and Amy Carroll-Scott, Philip Massey, Nora L. Lee, Ann C. Klassen, and Michael Yudell, Drexel University Dornsife School of Public Health
| | - Amy Carroll-Scott
- Evelyn Arana, Cancer Disparities Center, Hackensack University Medical Center; and Amy Carroll-Scott, Philip Massey, Nora L. Lee, Ann C. Klassen, and Michael Yudell, Drexel University Dornsife School of Public Health
| | - Philip M Massey
- Evelyn Arana, Cancer Disparities Center, Hackensack University Medical Center; and Amy Carroll-Scott, Philip Massey, Nora L. Lee, Ann C. Klassen, and Michael Yudell, Drexel University Dornsife School of Public Health
| | - Nora L Lee
- Evelyn Arana, Cancer Disparities Center, Hackensack University Medical Center; and Amy Carroll-Scott, Philip Massey, Nora L. Lee, Ann C. Klassen, and Michael Yudell, Drexel University Dornsife School of Public Health
| | - Ann C Klassen
- Evelyn Arana, Cancer Disparities Center, Hackensack University Medical Center; and Amy Carroll-Scott, Philip Massey, Nora L. Lee, Ann C. Klassen, and Michael Yudell, Drexel University Dornsife School of Public Health
| | - Michael Yudell
- Evelyn Arana, Cancer Disparities Center, Hackensack University Medical Center; and Amy Carroll-Scott, Philip Massey, Nora L. Lee, Ann C. Klassen, and Michael Yudell, Drexel University Dornsife School of Public Health
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