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Konkle-Parker D, Cleveland JD, Long D, Nair V, Fischl M, Wingood G, Edmonds A. Population Density and Health Outcomes in Women with HIV in the Southern United States: A Retrospective Longitudinal Analysis. J Womens Health (Larchmt) 2024. [PMID: 38864119 DOI: 10.1089/jwh.2023.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Purpose: Published studies have revealed challenges for people with human immunodeficiency virus (HIV) living in rural areas compared to those in urban areas, such as poor access to HIV care, insufficient transportation, and isolation. The purpose of this study was to examine associations between population density and multiple psychosocial and clinical outcomes in the largest cohort of women with HIV (WWH) in the United States. Methods: Women's Interagency HIV Study (WIHS) participants from Southern sites (n = 561) in 2013-2018 were categorized and compared by population density quartiles. The most urban quartile was compared with the most rural quartile in several psychosocial and clinical variables, including HIV viral load suppression, HIV medication adherence, HIV care attendance, depression, internalized HIV stigma, and perceived discrimination in healthcare settings. Results: Although women in the lowest density quartile were unexpectedly more highly resourced, women in that quartile had greater odds of not attending an HIV care visit in the last six months (odds ratio [OR] = 0.64, 95% confidence interval [CI] [0.43-0.95]), yet higher odds for having fully suppressed HIV when compared to women in the highest density quartile (OR = 1.64, 95% CI [1.13-2.38]). Highly urban WWH had greater likelihood of unsuppressed HIV, even after controlling for income, employment, and health insurance, despite reporting greater HIV care adherence and similar medication adherence. Discussion: Further investigation into the reasons for these disparities by population density is needed, and particular clinical attention should be focused on individuals from high population density areas to help maximize their health outcomes.
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Affiliation(s)
- D Konkle-Parker
- Schools of Medicine, Nursing, Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - J D Cleveland
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - V Nair
- School of Population Health, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - M Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - G Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chang MH, Moonesinghe R, Truman BI. Emergency department claims among Medicare beneficiaries with HIV, STDs, viral hepatitis or tuberculosis before and during the COVID-19 pandemic. J Public Health (Oxf) 2023; 45:e417-e425. [PMID: 36626306 DOI: 10.1093/pubmed/fdac165] [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: 05/05/2022] [Revised: 10/05/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Changes in emergency department (ED) usage among US Medicare beneficiaries (MB) with fee-for-service claims for HIV, viral hepatitis, sexually transmitted diseases (STDs) or tuberculosis (TB) (HHST) services have not been assessed since the COVID-19 pandemic. METHODS During 2006-20, we assessed the annual number of MB with each HHST per 1000 persons with ED claims for all conditions, and changes in demographic and geographic distribution of ED claimants for each HHST condition. RESULTS Of all persons who attended an ED for any condition, 10.5 million (27.5%) were MB with ≥1 ED claim in 2006; that number (percentage) increased to 11.0 million (26.7%) in 2019 and decreased to 9.2 million (22.7%) in 2020; < 5 MB per 1000 ED population had HHST ED claims in 2020. The percentage increase in ED claims was higher for MB with STDs than for those with other HHST conditions, including a 10% decrease for MB with TB in 2020. CONCLUSIONS Trends in ED usage for HHST conditions were associated with changes in demographic and geographic distribution among MB during 2006-20. Updated ED reimbursement policies and primary care practices among MB might improve prevention, diagnosis and treatment of HHST conditions in the future.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, CDC, Atlanta, GA, USA
| | - Benedict I Truman
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Retired in May 2022
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Guta NM, Ruksi ST, Gachana Midaksa Senbata, Seid K. Predictors of perceived poor social support status of pregnant women attending antiretroviral therapy clinics in south west Ethiopia, 2021. Heliyon 2023; 9:e18282. [PMID: 37519693 PMCID: PMC10372391 DOI: 10.1016/j.heliyon.2023.e18282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background To improve pregnancy outcomes, a pregnant mother living with HIV/AIDS requires a high level of social and emotional support. However, women from low-income countries were subjected to low social support status despite adequate counseling and health messages to increase their social support. Therefore, this study aimed to investigate the predictors of the perceived poor social support status among pregnant women attending ART clinics in Southwest Ethiopia. Methods A hospital-based cross-sectional study with consecutive sampling was conducted to enroll 265 pregnant women on antiretroviral therapy (ART) from December 1 to 30, 2021. The data were collected using an interviewer-administered questionnaire. Epidata was used for data entry and analyzed after it was exported to a statistical package for the social sciences. Binary logistic regression was used and the level of significance was declared at P-value <0.05 using Adjusted odds ratio at 95% CI after candidate variables were identified in binary logistic regression at a P-value of <0.25. Results Finding from the study figured out that low level of poor social support is found to be 47.2%. Study revealed that income level[AOR = 5.1 95% CI [1.9,13.6]], disclosure status[AOR: 1.9 95% CI [1.1,3.3]], unwanted pregnancy [AOR = 2.3 CI; [ 1.4,3.9]], and low adherence level[AOR: 2.1 95% CI [1.1,3.1]] were strong predictors. Conclusion This study identified high levels of poor social support. Increasing access to information education and communications focusing on stigma, disclosure & refresher training that boosts the counseling skills of health care providers to enhance adherence level is strongly recommended.
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Affiliation(s)
- Nuredin Mohammed Guta
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Sisay Tulu Ruksi
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Gachana Midaksa Senbata
- Department of Public Health, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | - Kalid Seid
- Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
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Waldron EM, Miller ES, Wee V, Statton A, Moskowitz JT, Burnett‐Zeigler I. Stress, coping and the acceptability of mindfulness skills among pregnant and parenting women living with HIV in the United States: A focus group study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6255-e6266. [PMID: 36214377 PMCID: PMC10092748 DOI: 10.1111/hsc.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Pregnant and parenting women living with HIV (WLWH) face high levels of psychological stress and mental illness but lack tailored and acceptable psychosocial treatments. The research team sought to inform the adaptation of a mindfulness intervention for pregnant and parenting WLWH through focus groups exploring psychosocial treatment needs and mindfulness intervention preferences. The research team conducted focus groups with pregnant and parenting WLWH (n = 16) and case managers (n = 6) recruited from a community-based enhanced case management program. The research team utilised an iterative inductive approach to coding of the transcripts from these focus groups. Five themes emerged: stressors, signs of stress, coping, lack of access and acceptability of care, and motivation and trust in care engagement. These focus groups revealed a desire for a group intervention that could decrease isolation while protecting against involuntary disclosure of HIV status. Participants expressed openness to mindfulness skills for coping with stress. The focus group participants' preference for a non-stigmatising group intervention supports the potential of a mindfulness-based group intervention to reduce stress and improve the mental health of pregnant and parenting women living with HIV.
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Affiliation(s)
- Elizabeth M. Waldron
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Present address:
Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Emily S. Miller
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Obstetrics and Gynecology, Division of Maternal Fetal MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Victoria Wee
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | | | - Judith T. Moskowitz
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Inger Burnett‐Zeigler
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Sanchez-Dominguez M, Leyva-Flores R, Infante-Xibille C, Texcalac-Sangrador JL, Lamadrid-Figueroa H. Use of self-help groups by people living with HIV in Central America. CAD SAUDE PUBLICA 2022; 38:e00007922. [DOI: 10.1590/0102-311xen007922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
Self-help groups (SHGs) for people living with HIV (PLHIV) are organizations created by the community to provide individuals with security, affection, improved self-esteem, and a sense of belonging. However, SHGs have also been used by the government to help implement HIV control policies. This study aimed to identify the characteristics associated with the use of SHGs by PLHIV and the routes and displacement patterns adopted by users. An analytical cross-sectional study was conducted based on data collected in six Central American countries during 2012. Using a list of SHGs, a random sampling was conducted in two stages. Firstly, the SHGs were selected. Then, the selected SHGs were visited and every third user who attended the SHG was surveyed. Logistic regression models were used to identify the characteristics associated with the use of SHGs and with attending the nearest SHGs. A spatial analysis was performed to identify the routes followed by users to reach the SHGs from their home communities. We found that the characteristics significantly associated with higher odds of SHG usage were country of residence and schooling level. The average and median distances traveled by users to attend SHGs were 20 and 5 kilometers, respectively. PLHIV do not use the SHGs closest to their locality, perhaps for fear of stigma and discrimination. We recommend that research on this topic use a mixed qualitative-quantitative methodology to better understand utilization decisions, user expectations, and the degree to which these are being met.
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Factors Affecting Social Support Status of People Living with HIV/AIDS at Selected Hospitals of North Shewa Zone, Amhara Region, Ethiopia. J Trop Med 2021; 2021:6695298. [PMID: 33884002 PMCID: PMC8041550 DOI: 10.1155/2021/6695298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/11/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Globally, millions of people are affected by human immunodeficiency virus (HIV). Acquired immunodeficiency was linked with psychosocial problems, whereby stigma and discrimination are the most common. Therefore, this study was aimed at assessing the level of the social support problem in people living with human immunodeficiency virus (PLHIV) and factors associated with it at selected hospitals of North Shewa Zone, Amhara Region, Ethiopia. Method An institution-based cross-sectional study design was employed. A total of 422 PLHIV were involved in the study. A multidimensional perceived social support scale (MPSSS) for the measurement of social support problems was implemented. Systematic random sampling was used to recruit the study population after selecting study areas by lottery methods. Multivariate logistic regression analyses were performed via SPSS software. The statistical association was declared at a p value of less than 0.05 in the final model. Result The prevalence of poor social support among study participants was 12.6%. Poor adherence to their antiretrovirus drugs was highly associated with poor social support (AOR = 2.06, 95% CI: 1.36, 3.13). Moreover, psychological distress (AOR = 4.67, 95% CI: 2.02, 10.81) and perceived stigma (AOR = 1.78, 95% CI: 1.18, 2.70) were positively associated. Conclusion The burden of poor social support is increasingly affecting the lives of PLHIV. Poor social support in PLHIV is more magnified by poor adherence, having psychological distress, and perceived stigma.
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Green DC, Wheeler EM. A Qualitative Exploration of Facilitators for Health Service Use among Aging Gay Men Living with HIV. J Int Assoc Provid AIDS Care 2020; 18:2325958219880569. [PMID: 31597513 PMCID: PMC6900671 DOI: 10.1177/2325958219880569] [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] [Indexed: 11/30/2022] Open
Abstract
Using Anderson’s Health Behavioral Model of Health Service Use, this study explores
factors facilitating health service use among aging gay men living with HIV. Qualitative
data from 10 participants recruited from a federally qualified health center were analyzed
using theoretical thematic analysis. Results shown to facilitate health service use
include an existing need for services in the form of HIV management; predisposing factors
of age and the development of resilience in the face of stigmatizing experiences related
to their sexual identity and health status; and enabling influences including comfort with
medical providers, providers knowledgeable in lesbian, gay, bisexual, transgender, and
queer issues, and sexual concordant providers. Need for services, predisposing factors,
and enabling factors are discussed in relation, as well as each factor’s unique
implications for this population. Results from this study may be used to improve service
use and provides tangible clinical recommendations.
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Affiliation(s)
- Daniel Colton Green
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Wood BR, Bell C, Carr J, Aleshire R, Behrens CB, Dunaway SB, Shah JA, Barnabas RV, Green ML, Ramers CB, Fina PL, Kim HN, Harrington RD. Washington state satellite HIV clinic program: a model for delivering highly effective decentralized care in under-resourced communities. AIDS Care 2018; 30:1120-1127. [PMID: 29852744 DOI: 10.1080/09540121.2018.1481194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
To improve access to high-quality HIV care in underserved regions of Western Washington (WA) State, we collaborated with the WA State Department of Health (DOH) and community partners to launch four satellite HIV clinics. Here, we describe this innovative clinical care model, present an estimate of costs, and evaluate patient care outcomes, including virologic suppression rates. To accomplish this, we assessed virologic suppression rates 12 months before and 12 months after the satellite clinics opened, comparing people living with HIV (PLWH) who enrolled in the satellite clinics versus all PLWH in the same regions who did not. We also determined virologic suppression rates in 2015 comparing satellite clinic versus non-satellite clinic patients and compared care quality indicators between the satellite clinics and the parent academic clinic. Results demonstrate that the change in virologic suppression rate 12 months before to 12 months after the satellite clinics opened was higher for patients who enrolled in the satellite clinics compared to all those in the same region who did not (18% versus 6%, p < 0.001). Virologic suppression in 2015 was significantly higher for satellite clinic than non-satellite clinic patients at three of four sites. Care quality indicators were met at a high level at the satellite clinics, comparable to the parent academic clinic. Overall, through community partnerships and WA DOH support, the satellite clinic program increased access to best practice HIV care and improved virologic suppression rates in difficult-to-reach areas. This model could be expanded to other regions with inadequate access to HIV practitioners, though financial support is necessary.
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Affiliation(s)
- Brian R Wood
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Christopher Bell
- b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Jason Carr
- c Infectious Disease Assessment Unit , Washington State Department of Health , Olympia , WA , USA
| | - Richard Aleshire
- c Infectious Disease Assessment Unit , Washington State Department of Health , Olympia , WA , USA
| | - Christopher B Behrens
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Shelia B Dunaway
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Javeed A Shah
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Ruanne V Barnabas
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Margaret L Green
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Christian B Ramers
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Pegi L Fina
- b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - H Nina Kim
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
| | - Robert D Harrington
- a Division of Allergy and Infectious Diseases , University of Washington , Seattle , WA , USA.,b Madison Clinic at Harborview Medical Center , Seattle , WA , USA
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Asghari S, Hurd J, Marshall Z, Maybank A, Hesselbarth L, Hurley O, Farrell A, Kendall CE, Rourke SB, Becker M, Johnston S, Lundrigan P, Rosenes R, Bibeau C, Liddy C. Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis. AIDS Care 2018; 30:963-972. [PMID: 29397762 DOI: 10.1080/09540121.2018.1435848] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.
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Affiliation(s)
- Shabnam Asghari
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Jillian Hurd
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Zack Marshall
- b School of Social Work , McGill University , Montreal , QC , Canada
| | - Allison Maybank
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Lydia Hesselbarth
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Oliver Hurley
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Alison Farrell
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Claire E Kendall
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Sean B Rourke
- d Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada
| | - Marissa Becker
- e Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada
| | - Sharon Johnston
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Phil Lundrigan
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Ron Rosenes
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Christine Bibeau
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Clare Liddy
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
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Alexandra Marshall S, Brewington KM, Kathryn Allison M, Haynes TF, Zaller ND. Measuring HIV-related stigma among healthcare providers: a systematic review. AIDS Care 2017; 29:1337-1345. [PMID: 28599599 DOI: 10.1080/09540121.2017.1338654] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.
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Affiliation(s)
- S Alexandra Marshall
- a Department of Health Behavior & Health Education , Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | | | - M Kathryn Allison
- a Department of Health Behavior & Health Education , Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Tiffany F Haynes
- a Department of Health Behavior & Health Education , Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Nickolas D Zaller
- a Department of Health Behavior & Health Education , Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock , AR , USA
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11
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Asghari S, Maybank A, Hurley O, Modir H, Farrell A, Marshall Z, Kendall C, Johnston S, Hogel M, Rourke SB, Liddy C. Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review. JMIR Res Protoc 2016; 5:e71. [PMID: 27193076 PMCID: PMC4889870 DOI: 10.2196/resprot.5263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services. Objective We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research. Methods This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms “HIV”, “patient satisfaction”, and “health services accessibility” are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed. Results A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016. Conclusions This scoping review will record and characterize the extensive body of literature on perspectives of PLHIV regarding access to health care. A literature repository will be developed to assist stakeholders, decision-makers, and PLHIV in developing and implementing patient-oriented health care programs.
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Affiliation(s)
- Shabnam Asghari
- Primary Healthcare Research Unit, Department of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
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van Veen MG, Trienekens SCM, Heijman T, Gotz HM, Zaheri S, Ladbury G, de Wit J, Fennema JSA, de Wolf F, van der Sande MAB. Delayed linkage to care in one-third of HIV-positive individuals in the Netherlands. Sex Transm Infect 2015; 91:603-9. [PMID: 25964506 DOI: 10.1136/sextrans-2014-051980] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/21/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To determine time to linkage to HIV care following diagnosis and to identify risk factors for delayed linkage. METHODS Patients newly diagnosed with HIV at sexually transmitted infections (STI) clinics in the Netherlands were followed until linkage to care. Data were collected at the time of diagnosis and at first consultation in care, including demographics, behavioural information, CD4+ counts and HIV viral load (VL) measurements. Delayed linkage to care was defined as >4 weeks between HIV diagnosis and first consultation. RESULTS 310 participants were included; the majority (90%) being men who have sex with men (MSM). For 259 participants (84%), a date of first consultation in care was known; median time to linkage was 9 days (range 0-435). Overall, 95 (31%) of the participants were not linked within 4 weeks of diagnosis; among them, 44 were linked late, and 51 were not linked at all by the end of study follow-up. Being young (<25 years), having non-Western ethnicity or lacking health insurance were independently associated with delayed linkage to care as well as being referred to care indirectly. Baseline CD4+ count, VL, perceived social support and stigma at diagnosis were not associated with delayed linkage. Risk behaviour and CD4+ counts declined between diagnosis and linkage to care. CONCLUSIONS Although most newly diagnosed patients with HIV were linked to care within 4 weeks, delay was observed for one-third, with over half of them not yet linked at the end of follow-up. Vulnerable subpopulations (young, uninsured, ethnic minority) were at risk for delayed linkage. Testing those at risk is not sufficient, timely linkage to care needs to be better assured as well.
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Affiliation(s)
- M G van Veen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Public Health Service, Amsterdam, The Netherlands
| | - S C M Trienekens
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - T Heijman
- Public Health Service, Amsterdam, The Netherlands
| | - H M Gotz
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - S Zaheri
- HIV Monitoring Foundation (SHM), Amsterdam, The Netherlands
| | - G Ladbury
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands EPIET, ECDC, Stockholm, Sweden
| | - J de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - F de Wolf
- HIV Monitoring Foundation (SHM), Amsterdam, The Netherlands
| | - M A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands
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Lorenc A, Ananthavarathan P, Lorigan J, Jowata M, Brook G, Banarsee R. The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough. LONDON JOURNAL OF PRIMARY CARE 2015; 6:84-90. [PMID: 25949722 DOI: 10.1080/17571472.2014.11493422] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background HIV has changed from a rapidly deteriorating illness to a complex chronic disease, with increasing incidences of comorbidity, including cancer, and liver, lung and cardiovascular diseases. North West London has 6719 individuals living with the human immunodeficiency virus (HIV), 873 of whom reside in the London Borough of Brent. Traditionally, commissioning services have focused on HIV therapy alone without considering how comorbidity affects treatment outcome and total service costs. Setting The setting for the study was NHS Brent Primary Care Trust, London UK. Question What associated comorbidities are present in people in Brent (London, UK) living with HIV, and how common are they? Methods A point-prevalence audit of retrospective data was conducted on all HIV-positive patients in Brent (financial year 2011/12). Data were collected from genito-urinary medicine (GUM) services, community services and general practitioners (GPs) on HIV diagnosis, patient demographics and past/current comorbidities: hepatitis B and C, cardiovascular disease, diabetes and mental health disorders. Results This study identified that 29% of people living with HIV/AIDS (PLWHA) in Brent have at least one comorbidity. The most common was hepatitis, followed by mental health disorders and cardiovascular disease (CVD). Comorbidity was more likely in older male patients (in particular CVD and diabetes) and White patients (except for diabetes which was more common in Asian groups). Discussion/Conclusion Many PLWHA in Brent suffer from a number of other conditions, which appear largely independent of HIV. Findings confirm the need to treat HIV as a long-term condition, including patient education, empowerment and encouraging self-management. The multi-morbidity of many PLWHA suggests a role for both primary care and collaborative, holistic, patient-centred and individualised healthcare. Service providers and commissioners need to consider comorbidities in their treatment of and provision of services for PLWHA. This study also highlighted the need for services to address limitations of their data collection systems.
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Affiliation(s)
- Ava Lorenc
- Research Fellow, London South Bank University, London, UK
| | | | | | | | - Gary Brook
- North West London Hospitals NHS Trust, London, UK
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Protopopescu C, Raffi F, Spire B, Hardel L, Michelet C, Cheneau C, Le Moing V, Leport C, Carrieri MP. Twelve-year mortality in HIV-infected patients receiving antiretroviral therapy: the role of social vulnerability. The ANRS CO8 APROCO-COPILOTE cohort. Antivir Ther 2015; 20:763-72. [PMID: 25859625 DOI: 10.3851/imp2960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy (ART), to date little attention has been given to the potential role of social vulnerability. This study aimed to construct an appropriate measure of social vulnerability and to evaluate whether this measure is predictive of increased mortality risk in ART-treated patients followed up in the ANRS CO8 APROCO-COPILOTE cohort. METHODS The cohort enrolled 1,281 patients initiating a protease inhibitor-based regimen in 1997-1999. Clinical/laboratory data were collected every 4 months. Self-administered questionnaires collected psycho-social/behavioural characteristics at enrolment (month [M] 0), M4 and every 8-12 months thereafter. A multiple correspondence analysis using education, employment and housing indicators helped construct a composite indicator measuring social vulnerability. The outcome studied was all-cause deaths occurring after M4. The relationship between social vulnerability and mortality, after adjustment for other predictors, was studied using a shared-frailty Cox model, taking into account informative study dropout. RESULTS Over a median (IQR) follow-up of 7.9 (3.0-11.2) years, 121 deaths occurred among 1,057 eligible patients, corresponding to a mortality rate (95% CI) of 1.64 (1.37, 1.96)/100 person-years. Leading causes of death were non-AIDS defining cancers (n=26), AIDS (n=23) and cardiovascular diseases (n=12). Social vulnerability (HR [95% CI] =1.2 [1.0, 1.5]) was associated with increased mortality risk, after adjustment for other known behavioural and bio-medical predictors. CONCLUSIONS Social vulnerability remains a major mortality predictor in ART-treated patients. A real need exists for innovative interventions targeting individuals cumulating several sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
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15
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Brennan A, Morley D, O'Leary AC, Bergin CJ, Horgan M. Determinants of HIV outpatient service utilization: a systematic review. AIDS Behav 2015; 19:104-19. [PMID: 24907780 DOI: 10.1007/s10461-014-0814-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Demands on HIV services are increasing as a consequence of the increased life-expectancy of HIV patients in the highly active antiretroviral therapy era. Understanding the factors that influence utilization of ambulatory HIV services is useful for planning service provision. This study reviewed factors associated with utilization of hospital based HIV out-patient services. Studies reporting person-based utilization rates of HIV-specific outpatient services broken down by patient or healthcare characteristics were eligible for inclusion. The Andersen Behavioral Model was used to organize the information extracted into pre-disposing, enabling and need components. Ten studies were included in the final review. Older age, private insurance, urban residence, lower CD4 counts, a diagnosis of AIDS, or anti-retroviral treatment were associated with higher utilization rates. The results of this review are consistent with existing knowledge regarding HIV patients' use of health services. Little information was identified on the influence of health service characteristics on utilization of out-patient services.
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Affiliation(s)
- Aline Brennan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland,
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16
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Leon N, Mathews C, Lewin S, Osler M, Boulle A, Lombard C. A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa. BMC Health Serv Res 2014; 14:350. [PMID: 25134822 PMCID: PMC4147183 DOI: 10.1186/1472-6963-14-350] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 08/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care. METHODS In a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms. RESULTS There was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007). CONCLUSION The PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies. TRIAL REGISTRATION Current Controlled Trials ISRCTN93692532.
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Affiliation(s)
- Natalie Leon
- Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC), P,O, Box 19070, Tygerberg, 7507 Cape Town, Western Cape Province, Republic of South Africa.
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Ohl ME, Richardson K, Kaboli PJ, Perencevich EN, Vaughan-Sarrazin M. Geographic access and use of infectious diseases specialty and general primary care services by veterans with HIV infection: implications for telehealth and shared care programs. J Rural Health 2014; 30:412-21. [PMID: 24702698 DOI: 10.1111/jrh.12070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Rural-dwelling persons with HIV infection often have limited access to HIV specialty care, and they may instead use more nearby primary care. This study described use of infectious disease (ID) specialty and general primary care services among rural compared with urban veterans with HIV in the United States and determined associations between geographic access to ID and primary care and use of care. METHODS The sample included all veterans in the national Veterans Administration (VA) HIV clinical case registry in 2009 (N = 23,669, 10.2% rural). Geographic access was measured by calculating travel times to the nearest VA primary care and ID specialty clinic. FINDINGS Rural veterans were less likely than urban to use ID clinics (82% of rural vs 87% of urban, P < .01) and more likely to use primary care (82% vs 73%, P < .01). As travel time to ID care increased from less than 15 minutes to over 90 minutes, use of ID care decreased from 88% to 71% (P < .01), while use of primary care increased from 68% to 86% (P < .0001). In multivariable models, increased travel time to ID care-but not rural residence-was associated with decreased ID and increased primary care use. CONCLUSIONS Persons with HIV who live far from ID specialty clinics are less likely to use specialty care and more likely to use primary care. Specialty clinics should consider using telehealth to deliver care over distance and programs to coordinate "shared care" relationships with distant primary care providers.
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Affiliation(s)
- Michael E Ohl
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, Iowa; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VAMC, Iowa City, Iowa; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Li H(H, Holroyd E, Li X, Lau J. A qualitative analysis of barriers to accessing HIV/AIDS-related services among newly diagnosed HIV-positive men who have sex with men in China. Int J STD AIDS 2014; 26:13-9. [DOI: 10.1177/0956462414528309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary In China, specific HIV/AIDS-related services have been in place since 2004. However, utilisation of these services remains limited among people living with HIV. We explored barriers to accessing HIV/AIDS-related services from the perspective of newly diagnosed HIV-positive men who have sex with men. We conducted repeated in-depth interviews with 31 newly diagnosed HIV-positive men who have sex with men, using the socio-ecological framework and thematic content analysis. Multiple barriers for utilisation of HIV/AIDS-related services were identified, including perceptions of subjective health and poor quality of services, mental and emotional health problems, lack of trust and understanding of the services on offer, low economic status, lack of insurance, and high medical fees, being refused access to services, and restrictive attendance policies. The findings provide information on potential multi-level obstacles preventing newly diagnosed HIV-positive men who have sex with men to use services that they need. It is recommended that policy makers should create a trustful and non-discriminating environment and services integrating physical and mental healthcare.
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Affiliation(s)
- Haochu (Howard) Li
- Pediatric Prevention Research Center, Wayne State University, Detroit, MI, USA
| | - Eleanor Holroyd
- School of Health Sciences, RMIT University, Australia and Centre for Women’s Health, Gender & Society, the University of Melbourne, Melbourne, VIC, Australia
| | - Xiaoming Li
- Pediatric Prevention Research Center, Wayne State University, Detroit, MI, USA
| | - Joseph Lau
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
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Toth M, Messer LC, Quinlivan EB. Barriers to HIV care for women of color living in the Southeastern US are associated with physical symptoms, social environment, and self-determination. AIDS Patient Care STDS 2013; 27:613-20. [PMID: 24138485 DOI: 10.1089/apc.2013.0030] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-infected women of color (WOC) face particular barriers to accessing HIV medical care. To understand the impact of physical symptoms, social support, and self-determination on barriers to care, we interviewed HIV-infected women of color. HIV-infected WOC (N=141), attending an academic infectious disease clinic for HIV care in North Carolina, completed the Barriers to Care scale and were categorized as reporting a history of low (less than four of eleven barriers) or high (five or more) barriers to care. Binomial regression was used to estimate prevalence ratios and risk differences of reported barriers to care and its correlates such as depression, anxiety, illness-severity, psychological abuse, social support, treatment-specific social support, and self-determination (autonomy, relatedness, competency). A lower risk of reporting five or more barriers to care was associated with higher levels of autonomy (PR=0.93, 95% CI: 0.89, 0.96), relatedness (PR=0.92, 95% CI: 0.89, 0.94), competency (PR=0.93, 95% CI: 0.87, 0.98), and social support (PR=0.24, 95% CI: 0.81, 0.81). Depression, illness severity, and psychological abuse were associated with a greater risk of having five or more barriers to care. There are multiple social and psychological factors that contribute to perceived barriers to HIV care among WOC in the southeastern USA. Interventions that promote social support and increase individual self-determination have the potential to improve access to HIV care for WOC.
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Affiliation(s)
- Matthew Toth
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, North Carolina
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina
| | - Lynne C. Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, Oregon
| | - E. Byrd Quinlivan
- Center for Infectious Diseases, University of North Carolina-Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, University of North Carolina-Chapel Hill, North Carolina
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Muthulingam D, Chin J, Hsu L, Scheer S, Schwarcz S. Disparities in engagement in care and viral suppression among persons with HIV. J Acquir Immune Defic Syndr 2013; 63:112-9. [PMID: 23392459 DOI: 10.1097/qai.0b013e3182894555] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Engagement across the spectrum of HIV care can improve health outcomes and prevent HIV transmission. We used HIV surveillance data to examine these outcomes. METHODS San Francisco residents who were diagnosed with HIV between 2009 and 2010 were included. We measured the characteristics and proportion of persons linked to care within 6 months of diagnosis, retained in care for second and third visits, and virally suppressed within 12 months of diagnosis. RESULTS Of 862 persons included, 750 (87%) entered care within 6 months of diagnosis; of these, 72% had a second visit in the following 3-6 months; and of these, 80% had a third visit in the following 3-6 months. Viral suppression was achieved in 50% of the total population and in 76% of those retained for 3 visits. Lack of health insurance and unknown housing status were associated with not entering care (P < 0.01). Persons with unknown insurance status were less likely to be retained for a second visit; those younger than 30 years were less likely to be retained for a third visit. Independent predictors of failed viral suppression included age <40 years, homelessness, unknown housing status, and having a single or 2 medical visits compared with 3 visits. CONCLUSIONS Socioeconomic resources and age, not race or gender, are associated with disparities in engagement in HIV care in San Francisco.
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21
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Mohareb AM, Rothman RE, Hsieh YH. Emergency department (ED) utilization by HIV-infected ED patients in the United States in 2009 and 2010 - a national estimation. HIV Med 2013; 14:605-13. [PMID: 23773723 DOI: 10.1111/hiv.12052] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of the study was to describe the emergency department (ED) resource utilization patterns of ED visits by patients reported to be HIV-infected in the USA in 2009 and 2010 and to compare them with those of the general ED patient population. METHODS We identified demographics, HIV infection status, and ED utilization patterns in 2009 and 2010 from a weighted sample of US ED visits using the National Hospital Ambulatory Medical Care Survey, a nationally representative survey. Data on visits by patients aged ≥ 13 years were analysed using procedures for multiple-stage survey data. RESULTS In 2009 and 2010, 1 192 535 visits were documented for HIV-infected patients. The estimated annual ED visit rates were 633 per 1000 known HIV-infected persons and 438 per 1000 non-HIV-infected persons [rate difference 195; 95% confidence interval (CI) 194, 197]. While no difference was recorded in the level of acuity between HIV-infected ED patients and general ED patients, the total number of diagnostic/screening services ordered and medications administered in the ED was significantly higher for visits by HIV-infected patients. HIV-infected patients making ED visits also had a longer duration of stays [mean 5.4 h (95% CI 4.6, 6.2 h) vs. 3.6 h (95% CI 3.5, 3.8 h) for HIV-uninfected patients] and were more likely to be admitted [28% (95% CI 22, 34%) vs. 15% (95% CI 14, 16%), respectively] than their non-HIV-infected counterparts. CONCLUSIONS ED visits by HIV-infected individuals occur at rates higher than those of visits by the general population, and consume significantly more ED resources than visits by the general population. These national findings represent baseline prior to full implementation of the 2010 Patient Protection and Affordable Care Act.
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Affiliation(s)
- A M Mohareb
- Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
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Musheke M, Bond V, Merten S. Self-care practices and experiences of people living with HIV not receiving antiretroviral therapy in an urban community of Lusaka, Zambia: implications for HIV treatment programmes. AIDS Res Ther 2013; 10:12. [PMID: 23675734 PMCID: PMC3657294 DOI: 10.1186/1742-6405-10-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 05/07/2013] [Indexed: 11/29/2022] Open
Abstract
Background Despite the increasingly wider availability of antiretroviral therapy (ART), some people living with HIV (PLHIV) and eligible for treatment have opted to adopt self-care practices thereby risking early AIDS-related mortality. Methods A qualitative study was conducted in urban Zambia to gain insights into PLHIV self-care practices and experiences and explore the implications for successful delivery of ART care. Between March 2010 and September 2011, in-depth interviews were conducted with PLHIV who had dropped out of treatment (n=25) and those that had opted not to initiate medication (n=37). Data was entered into and managed using Atlas ti, and analysed inductively using latent content analysis. Results PHIV used therapeutic and physical health maintenance, psychological well-being and healthy lifestyle self-care practices to maintain physical health and mitigate HIV-related symptoms. Herbal remedies, faith healing and self-prescription of antibiotics and other conventional medicines to treat HIV-related ailments were used for therapeutic and physical health maintenance purposes. Psychological well-being self-care practices used were religiosity/spirituality and positive attitudes towards HIV infection. These practices were modulated by close social network relationships with other PLHIV, family members and peers, who acted as sources of emotional, material and financial support. Cessations of sexual relationships, adoption of safe sex to avoid re-infections and uptake of nutritional supplements were the commonly used risk reduction and healthy lifestyle practices respectively. Conclusions While these self-care practices may promote physical and psychosocial well-being and mitigate AIDS-related symptoms, at least in the short term, they however undermine PLHIV access to ART care thereby putting PLHIV at risk of early AIDS-related mortality. The use of scientifically unproven herbal remedies raises health and safety concerns; faith healing may create fatalism and resignation with death while the reported self-prescription of antibiotics to treat HIV-related infections raises concerns about future development of microbial drug resistance amongst PLHIV. Collectively, these self-care practices undermine efforts to effectively abate the spread and burden of HIV and reduce AIDS-related mortality. Therefore, there is need for sensitization campaigns on the benefits of ART and the risks associated with widespread self-prescription of antibiotics and use of scientifically unproven herbal remedies.
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Goswami ND, Hecker EJ, Vickery C, Ahearn MA, Cox GM, Holland DP, Naggie S, Piedrahita C, Mosher A, Torres Y, Norton BL, Suchindran S, Park PH, Turner D, Stout JE. Geographic information system-based screening for TB, HIV, and syphilis (GIS-THIS): a cross-sectional study. PLoS One 2012; 7:e46029. [PMID: 23056227 PMCID: PMC3462803 DOI: 10.1371/journal.pone.0046029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/27/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the feasibility and case detection rate of a geographic information systems (GIS)-based integrated community screening strategy for tuberculosis, syphilis, and human immunodeficiency virus (HIV). DESIGN Prospective cross-sectional study of all participants presenting to geographic hot spot screenings in Wake County, North Carolina. METHODS The residences of tuberculosis, HIV, and syphilis cases incident between 1/1/05-12/31/07 were mapped. Areas with high densities of all 3 diseases were designated "hot spots." Combined screening for tuberculosis, HIV, and syphilis were conducted at the hot spots; participants with positive tests were referred to the health department. RESULTS AND CONCLUSIONS Participants (N = 247) reported high-risk characteristics: 67% previously incarcerated, 40% had lived in a homeless shelter, and 29% had a history of crack cocaine use. However, 34% reported never having been tested for HIV, and 41% did not recall prior tuberculin skin testing. Screening identified 3% (8/240) of participants with HIV infection, 1% (3/239) with untreated syphilis, and 15% (36/234) with latent tuberculosis infection. Of the eight persons with HIV, one was newly diagnosed and co-infected with latent tuberculosis; he was treated for latent TB and linked to an HIV provider. Two other HIV-positive persons had fallen out of care, and as a result of the study were linked back into HIV clinics. Of 27 persons with latent tuberculosis offered therapy, nine initiated and three completed treatment. GIS-based screening can effectively penetrate populations with high disease burden and poor healthcare access. Linkage to care remains challenging and will require creative interventions to impact morbidity.
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Affiliation(s)
- Neela D. Goswami
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Emily J. Hecker
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carter Vickery
- Wake County Community Services, Raleigh, North Carolina, United States of America
| | - Marshall A. Ahearn
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gary M. Cox
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David P. Holland
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Susanna Naggie
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carla Piedrahita
- Wake County Human Services, Raleigh, North Carolina, United States of America
| | - Ann Mosher
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Yvonne Torres
- Wake County Human Services, Raleigh, North Carolina, United States of America
| | - Brianna L. Norton
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Sujit Suchindran
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Paul H. Park
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Debbie Turner
- Wake County Human Services, Raleigh, North Carolina, United States of America
| | - Jason E. Stout
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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McGrath JW, Kaawa-Mafigiri D, Bridges S, Kakande N. 'Slipping through the cracks': policy implications of delays in HIV treatment seeking. Glob Public Health 2012; 7:1095-108. [PMID: 22813066 PMCID: PMC3505559 DOI: 10.1080/17441692.2012.701318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Public health initiatives to 'test and treat' HIV-infected persons require understanding HIV care seeking. A study of 101 HIV-infected women receiving anti-retroviral medications in Kampala, Uganda, examined barriers to HIV care. Participants entered HIV/AIDS care late, despite knowing their risk and having sought care for symptoms. Over half of the participants (51%) reported delays of up to 5 years from when they suspected they were infected to seeking an HIV test. Some women reported that they did not perceive a need to be tested because they 'knew' they had HIV due to their partner's death from AIDS. Once tested, delays in entering HIV specific care ranged from less than 6 months to over 5 years. The most common reason reported for entering HIV care was the occurrence of serious or persistent symptoms. Late presentation for HIV care in this cohort is due to the inability of the medical system to link women to appropriate care. Women 'slip through the cracks' of this system, despite their care seeking behaviours. The inability to provide linkage to care is a challenge at the health system level that threatens the success of 'test and treat' protocols.
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Affiliation(s)
- Janet W McGrath
- Department of Anthropology, Center for Social Sciences Research on AIDS, Case Western Reserve University, Cleveland, OH, USA.
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Smith LR, Fisher JD, Cunningham CO, Amico KR. Understanding the behavioral determinants of retention in HIV care: a qualitative evaluation of a situated information, motivation, behavioral skills model of care initiation and maintenance. AIDS Patient Care STDS 2012; 26:344-55. [PMID: 22612447 DOI: 10.1089/apc.2011.0388] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The current study provides a qualitative test of a recently proposed application of an Information, Motivation, Behavioral Skills (IMB) model of health behavior situated to the social-environmental, structural, cognitive-affective, and behavioral demands of retention in HIV care. Mixed-methods qualitative analysis was used to identify the content and context of critical theory-based determinants of retention in HIV care, and to evaluate the relative fit of the model to the qualitative data collected via in-depth semi-structured interviews with a sample of inner-city patients accessing traditional and nontraditional HIV care services in the Bronx, NY. The sample reflected a diverse marginalized patient population who commonly experienced comorbid chronic conditions (e.g., psychiatric disorders, substance abuse disorders, diabetes, hepatitis C). Through deductive content coding, situated IMB model-based content was identified in all but 7.1% of statements discussing facilitators or barriers to retention in HIV care. Inductive emergent theme identification yielded a number of important themes influencing retention in HIV care (e.g., acceptance of diagnosis, stigma, HIV cognitive/physical impairments, and global constructs of self-care). Multiple elements of these themes strongly aligned with the model's IMB constructs. The convergence of the results from both sets of analysis demonstrate that participants' experiences map well onto the content and structure of the situated IMB model, providing a systematic classification of important theoretical and contextual determinants of retention in care. Future intervention efforts to enhance retention in HIV care should address these multiple determinants (i.e., information, motivation, behavioral skills) of self-directed retention in HIV care.
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Affiliation(s)
- Laramie R. Smith
- University of Connecticut, Center for Health, Intervention and Prevention, Storrs, Connecticut
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Jeffrey D. Fisher
- University of Connecticut, Center for Health, Intervention and Prevention, Storrs, Connecticut
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | | | - K. Rivet Amico
- University of Connecticut, Center for Health, Intervention and Prevention, Storrs, Connecticut
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daCosta DiBonaventura M, Gupta S, Cho M, Mrus J. The association of HIV/AIDS treatment side effects with health status, work productivity, and resource use. AIDS Care 2012; 24:744-55. [PMID: 22292729 DOI: 10.1080/09540121.2011.630363] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Due to stable incidence and improved survival rates, there are an increasing number of patients living with HIV/AIDS in the USA. Although highly effective, current antiretroviral therapies are associated with a variety of side effects. The role side effects play on health outcomes has not been fully examined. The current study assessed the association of medication side effects with (1) self-assessed health status; (2) work productivity and activity impairment; and (3) healthcare resource utilization. Data were from a cross-sectional patient-reported survey fielded in the USA using a dual methodology of Internet and paper questionnaires. A total of 953 patients living with HIV/AIDS who were currently taking a medication for their condition were included in the analyses. The most frequent side effects reported by patients were fatigue (70.72%), diarrhea (62.96%), insomnia (58.97%), dizziness (52.78%), neuropathy (52.68%), joint pain (52.36%), nausea (51.63%), and abdominal pain (50.37%). The presence of each side effect was associated with reduced self-assessed health status, increased productivity loss, increased activity impairment, and increased healthcare resource use. Controlling for CD4 cell counts in regression modeling did little to diminish the impact of side effects. Although not all side effects were associated with all outcomes, every side effect was associated with worse health status, some measure of increased work productivity loss, and/or some measure of increased healthcare resource use. Patients are living longer with HIV and, therefore, spending a greater length of time on treatment. The results of the current study suggest that many of these patients are experiencing a wide array of side effects from these therapies. These side effects have demonstrated a profound association with self-assessed health, work productivity, and healthcare resource use. Improved management of these side effects or development of treatments with a better side effect profile may have a substantial humanistic and economic benefit.
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Soong TR, Jung JJ, Kelen GD, Rothman RE, Burah A, Shahan JB, Hsieh YH. Is inadequate human immunodeficiency virus care associated with increased ED and hospital utilization? A prospective study in human immunodeficiency virus-positive ED patients. Am J Emerg Med 2012; 30:1466-73. [PMID: 22244221 DOI: 10.1016/j.ajem.2011.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 10/26/2011] [Accepted: 11/30/2011] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is a lack of data on the effect(s) of suboptimal human immunodeficiency virus (HIV) care on subsequent health care utilization among emergency department (ED) patients with HIV. Findings on their ED and inpatient care utilization patterns will provide information on service provision for those who have suboptimal access to HIV-related care. METHODS A pilot prospective study was conducted on HIV-positive patients in an ED. At enrollment, participants were interviewed regarding health care utilization. Participants were followed up for 1 year, during which time data on ED visits and hospitalizations were obtained from their patient records. Inadequate HIV care (IHC) was defined according to Infectious Diseases Society of America recommendations as less than 3 scheduled clinic visits for HIV care in the year before enrollment. Cox regression models were used to evaluate whether IHC was associated with increased hazard of health care utilization. RESULTS Of 107 subjects, 36% were found to have IHC. Inadequate HIV care did not predict more frequent ED visits but was significantly associated with fewer hospitalizations (adjusted incidence rate ratio, 0.61 [95% CI: 0.43-0.86]). Inadequate HIV care did not significantly increase the hazard for earlier ED visit or hospitalization. However, further stratification analysis found that IHC increased the hazard of hospitalization for subjects without comorbid diseases (adjusted hazard ratio, 2.50 [95% CI: 1.10-5.68]). CONCLUSIONS In our setting, IHC does not appear to be associated with earlier or more frequent ED visits but may lead to earlier hospitalization, particularly among those without other chronic diseases.
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Affiliation(s)
- T Rinda Soong
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA
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Moshabela M, Pronyk P, Williams N, Schneider H, Lurie M. Patterns and implications of medical pluralism among HIV/AIDS patients in rural South Africa. AIDS Behav 2011; 15:842-52. [PMID: 20628898 PMCID: PMC4790116 DOI: 10.1007/s10461-010-9747-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In some societies, medical pluralism has been demonstrated to delay access to care. We identified sources of health care, and explored utilization patterns and triggers of care-seeking behavior among HIV/AIDS patients in rural South Africa. A longitudinal qualitative study consisting of in-depth interviews was conducted. We purposively sampled thirty-two adult HIV clinic attendees. A high degree of medical pluralism occurred among participants before initiation of antiretroviral treatment (ART). After ART initiation, participants predominantly used the HIV/ART clinic, and utilization of private and traditional facilities decreased. Patterns included both concurrent and sequential pathways to public, private and traditional health sectors. HIV diagnosis and treatment were delayed despite early contact with health systems. Therefore, use of multiple health care modalities before ART initiation can lead to delayed HIV testing and ART initiation. Integrated-care has the potential to mitigate the impact of medical pluralism on access to HIV-related services over the longer term.
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Affiliation(s)
- M Moshabela
- Rural AIDS and Development Action Research, University of Witwatersrand, Johannesburg, South Africa.
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Tsarenko Y, Polonsky MJ. ‘You can spend your life dying or you can spend your life living’: Identity transition in people who are HIV-positive. Psychol Health 2011; 26:465-83. [DOI: 10.1080/08870440903521761] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hsu LC, Chen M, Kali J, Pipkin S, Scheer S, Schwarcz S. Assessing receipt of medical care and disparity among persons with HIV/AIDS in San Francisco, 2006–2007. AIDS Care 2011; 23:383-92. [DOI: 10.1080/09540121.2010.507740] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ling C. Hsu
- a San Francisco Department of Public Health , San Francisco , USA
| | - Mi Chen
- a San Francisco Department of Public Health , San Francisco , USA
| | - Jessica Kali
- a San Francisco Department of Public Health , San Francisco , USA
| | - Sharon Pipkin
- a San Francisco Department of Public Health , San Francisco , USA
| | - Susan Scheer
- a San Francisco Department of Public Health , San Francisco , USA
| | - Sandy Schwarcz
- a San Francisco Department of Public Health , San Francisco , USA
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Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005-2009: Do patients who initiate care stay in care? AIDS Patient Care STDS 2011; 25:79-88. [PMID: 21284498 DOI: 10.1089/apc.2010.0151] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this era of effective antiretroviral therapy, early diagnosis of HIV and timely linkage to and retention in care are vital to survival and quality of life. Federal guidelines recommend regular monitoring of HIV-related laboratory parameters and initiation of antiretroviral treatment at specified thresholds. We used routinely reported laboratory data to measure intervals between visits by New York City residents newly diagnosed with HIV July 1 to September 30, 2005, and initiating care within 3 months of diagnosis. We measured regular care (≥1 visit every 6 months) and retention in care (last visit ≤6 months before close of analysis) through June 30, 2009. Patients were followed for 45-48 months. Seventy-seven percent (650/842) of patients initiated care within 3 months of diagnosis; 609 (93.7%) made at least one subsequent visit; 45.4% had regular care. Risk factors for not receiving regular care included age 13-24 versus 50+ (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.5, 6.0), black race (AOR 2.0, 95% CI 1.4,2.8), eligibility for antiretroviral treatment (AOR 1.5, 95% CI 1.1, 2.2), and injection drug use (IDU; AOR = 2.7. 95% CI 1.0, 7.1). In a time-to-event analysis, risk factors for loss to care were age 13-24 versus 50+ at diagnosis (adjusted hazard ratio [AHR] 1.9, 95% CI 1.1, 3.4), non-hospital site of care (AHR 1.4, 95% CI 1.0, 2.0) and early stage (non-AIDS) disease (AHR 1.4, 95% CI 1.0, 2.0). The analysis demonstrates how mandated reporting of HIV-related laboratory tests provides surveillance systems with the capacity to monitor utilization of care, identify deficits, and evaluate progress in programs designed to facilitate retention in care.
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Affiliation(s)
- Lucia V. Torian
- The New York City Department of Health and Mental Hygiene, New York, New York
| | - Ellen W. Wiewel
- The New York City Department of Health and Mental Hygiene, New York, New York
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Merighi JR, Chassler D, Lundgren L, Inniss HW. Substance use, sexual identity, and health care provider use in men who have sex with men. Subst Use Misuse 2011; 46:452-9. [PMID: 20735201 DOI: 10.3109/10826084.2010.502208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article describes the association between substance use, sexual identity, and seeing a health care provider on a regular basis for 257 men who have sex with men (MSM). Data from in-person interviews were gathered from MSM who resided in Massachusetts between 2003 and 2007. A logistic regression analysis that controlled for demographic characteristics, health insurance status, HIV/AIDS status, drug use, and social support revealed that MSM who identified as heterosexual, compared with those who identified as gay or bisexual, were 60% less likely to access a health care provider on a regular basis. Further, the likelihood of seeing a provider regularly was 54% lower for MSM who had used illegal drugs in the past 30 days and 32% higher for MSM who had more social support. Study limitations and implications are discussed.
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Affiliation(s)
- Joseph R Merighi
- School of Social Work, Boston University, Boston, Massachusetts 02215, USA.
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George S, Garth B, Wohl AR, Galvan FH, Garland W, Myers HF. Sources and types of social support that influence engagement in HIV care among Latinos and African Americans. J Health Care Poor Underserved 2010; 20:1012-35. [PMID: 20168014 DOI: 10.1353/hpu.0.0210] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The change in HIV from acute to chronic disease due to the introduction of HAART in the mid-1990s increased the importance of its successful management and imposed substantial lifestyle adjustments on HIV-positive people and their support networks. Few studies have examined the sources and types of social support and the areas of care relevant for engagement in HIV treatment among HIV-positive Latinos and African Americans. This paper reports the results of 24 semi-structured in-depth interviews that were conducted with HIV-positive African American and Latino women and men who have sex with men. Formal networks were found to be more critical for engagement in HIV-specific medical care; specifically, study participants relied primarily on health care providers for support in accessing and maintaining illness-specific care. In contrast, informal networks (family and friends) were crucial for other general subsistence care, such as emotional, household-related, and financial support.
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Affiliation(s)
- Sheba George
- Biomedical Research Center, Charles Drew University of Medicine and Science, Los Angeles, CA, USA.
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Luseno WK, Wechsberg WM, Kline TL, Ellerson RM. Health services utilization among South African women living with HIV and reporting sexual and substance-use risk behaviors. AIDS Patient Care STDS 2010; 24:257-64. [PMID: 20377433 DOI: 10.1089/apc.2009.0213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV health services are critical in sub-Saharan African where the burden of the HIV pandemic is devastating. Existing studies suggest that HIV-infected individuals from marginalized populations who know their status do not seek health services because they are unaware of available treatment and care options, may not understand how to access services, or have poor access to and utilization of health care services. This study examined factors associated with health service utilization in a sample of poor, underserved recently diagnosed HIV-positive South African women with sexual and substance use risk behaviors. The data were collected between June 2004 and May 2008. Primary outcomes included consultation with a medical professional and utilization of any health services since learning of HIV status at 3- and 6-month follow-up assessments. The study findings suggest that denial of HIV status may be a barrier to care, leading study participants to avoid utilizing health services specific to their disease and to prefer more general medical care services. In multivariate analyses, prior use of health services, financially supporting others, and sex trading were strongly associated with health service use at follow-up assessments. The study findings suggest a reduced likelihood of health services utilization among participants who met DSM-IV criteria for drug abuse as well as participants with greater numbers of poor physical health symptoms. As an important preliminary step in examining the issue of health services utilization in sub-Saharan Africa, the findings suggest an urgent need to promote HIV prevention and early testing, to strengthen long-term HIV care services, and to increase access to services.
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Affiliation(s)
- Winnie K. Luseno
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Wendee M. Wechsberg
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Tracy L. Kline
- Research Triangle Institute International, Research Triangle Park, North Carolina
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Grace C, Kutzko D, Alston WK, Ramundo M, Polish L, Osler T. The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics. J Rural Health 2010; 26:113-9. [DOI: 10.1111/j.1748-0361.2010.00272.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sohler NL, Coleman SM, Cabral H, Naar-King S, Tobias C, Cunningham CO. Does self-report data on HIV primary care utilization agree with medical record data for socially marginalized populations in the United States? AIDS Patient Care STDS 2009; 23:837-43. [PMID: 19803677 PMCID: PMC2859764 DOI: 10.1089/apc.2009.0056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To test whether self-report data agree with medical record data in marginalized, HIV-infected populations, we collected information about HIV primary care visits over a 6-month period from both sources. Patients were drawn from a large study of engagement and retention in care conducted between 2003 and 2005. Self-report data were collected in face-to-face interviews and medical records were extracted using a rigorous, standardized protocol with multiple quality checks. We found poor overall agreement (weighted kappa = 0.36, 95% confidence interval = 0.28, 0.43). Factors associated with disagreement included younger age (adjusted odds ratio for 20 versus 40 years = 1.25, 95% confidence interval = 0.98, 1.60), non-Hispanic black race/ethnicity (adjusted odds ratio for non-Hispanic blacks versus non-Hispanic whites = 1.48, 95% confidence interval = 1.03, 2.13), lower education (adjusted odds ratio for high school education, GED, or less versus some college or college graduate = 1.43, 95% confidence interval = 0.96, 2.13), and substance use (adjusted odds ratio for any illicit drug/heavy alcohol use in the past 6 months versus no use = 1.39, 95% confidence interval = 1.02, 1.90). These findings do not support a conclusion that unconfirmed self-report data of HIV primary care visits are a sufficient substitute for rigorously collected medical record data in studies focusing on marginalized populations. Use of other data sources (e.g., administrative data), use of other self-reported outcome measures that have better concordance with medical records/administrative data (e.g., CD4 counts), or incorporation of rigorous measures to increase reliability of self-report data may be needed. Limitations of this study include the lack of a true gold standard with which to compare self-report data.
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Affiliation(s)
- Nancy L Sohler
- Sophie Davis School of Biomedical Education, City College of New York , New York, NY 10031, USA.
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Li X, He G, Wang H, Williams AB. Consequences of drug abuse and HIV/AIDS in China: recommendations for integrated care of HIV-infected drug users. AIDS Patient Care STDS 2009; 23:877-84. [PMID: 19799494 DOI: 10.1089/apc.2009.0015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Drug abuse is a complicated social phenomenon rather than a neural disease. It especially fuels the HIV/AIDS epidemic. Researchers have shown interest in HIV-infected drug users as the socially and medically marginalized population, but they did not provide good enough care. Based on published English and Chinese journal articles and official reports, this integrated literature review summarizes the epidemic of drug abuse and HIV/AIDS, and comments on the clinical and psychosocial consequences, and harm reduction measures in China. Officially registered drug users have reached more than 1 million recently. A little under half of the people living with HIV/AIDS are injection drug users, as they transmit the disease through needle sharing and unprotected sexual behavior. The main consequences of drug abuse and HIV/AIDS included high prevalence of hepatitis viruses and tuberculosis co-infections, severe mental problems and extreme poverty. Even health professionals hold discriminative attitude toward drug users because of condemnation of drug abuse behavior and fear of HIV infection. Although interventions for drug addiction and harm reduction have been scaled up quickly, such as methadone maintenance treatment and needle syringe programs, the measures should be further revised, and the effectiveness needs to be evaluated appropriately. To enhance HIV-infected drug users' quality of life and the utility of medical services, improving health care providers' attitude is the first step. Then securing good quality of integrated medical care services with multidisciplinary cooperation will be essential.
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Affiliation(s)
- Xianhong Li
- School of Nursing, Central South University, Changsha, China
| | - Guoping He
- School of Nursing, Central South University, Changsha, China
| | - Honghong Wang
- School of Nursing, Central South University, Changsha, China
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Zablotska I, Frankland A, Imrie J, Adam P, Westacott R, Canavan P, Prestage G. Current issues in care and support for HIV-positive gay men in Sydney. Int J STD AIDS 2009; 20:628-33. [DOI: 10.1258/ijsa.2008.008432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We explored current access to care among HIV-positive people in Australia. In 2006, 270 HIV-positive gay men from a community-based Positive Health cohort in Sydney were asked about their health (including medical and social) service needs and, subsequently, about difficulty in accessing services. We report the prevalence of specific needs, barriers and associated factors. Participants most commonly used general practitioners (64%) for HIV management and needed at least one HIV-related medical service (usually several: doctors experienced in HIV management, dentists and hospital pharmacies). Most participants were able to access them. Barriers in accessing services were related to their convenience rather than lack or quality. Cost emerged as a substantial barrier to dental care and psychological counselling (91% and 48% respectively of those in need). Need for an HIV-related social service was reported by 46% of respondents. Difficulties in accessing these related to poor services and staff attitudes. Income was associated with limited access to multiple services. In Australia, HIV-related medical service needs outweigh those for social services. Complex health services remain essential to HIV-positive people, but some services are currently not meeting their needs. To remain adequate, services need to understand and constantly adapt to the changing needs of HIV-positive people.
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Affiliation(s)
- I Zablotska
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | - A Frankland
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | - J Imrie
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | - P Adam
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052
| | | | - P Canavan
- National Association of People Living with HIV/AIDS
| | - G Prestage
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVE Identify factors associated with HIV care utilization in South Carolina. DESIGN Cross-sectional analysis of South Carolina nonpregnant HIV-infected individuals (N = 13,042) for the period 1 January 2004 to 31 December 2006. METHODS Reporting of HIV laboratory markers is legally mandated in South Carolina. Individuals with reported viral load tests or CD4 cell counts during a calendar year were defined as 'in HIV-medical care' that year. Care utilization categories were in care, care all 3 years; not-in-care (NIC), no care received; and transitional care, during some but not all years. Multinomial logistic regression using generalized logits was used to estimate relationships between care utilization and predictor variables. RESULTS Five thousand, two hundred and seventeen (40.0%) of South Carolina HIV-infected adults were NIC and 3300 (25.3%) were in transitional care during 2004-2006. Although a larger number of black than white HIV-infected adults were NIC, adjusted odds for NIC status were lower among blacks than whites [adjusted odds ratio (AOR), 0.82; 95% confidence interval 0.74, 0.92)]. Women had lower odds of being NIC than men (AOR, 0.66; 95% confidence interval 0.58, 0.74). Compared with individuals 55 years or older, individuals who were 25-34 years old were most likely to demonstrate both the NIC (AOR, 1.85; 95% confidence interval 1.29, 2.65) and transitional (AOR, 1.85; 95% confidence interval 1.31, 2.62) care patterns. CONCLUSION Large proportions of the South Carolina HIV-infected adult population are not consistently accessing HIV-medical care. Targeted programs are needed to improve engagement for HIV-infected adults most likely to transition or not be in care.
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Tello MA, Yeh HC, Keller JM, Beach MC, Anderson JR, Moore RD. HIV women's health: a study of gynecological healthcare service utilization in a U.S. urban clinic population. J Womens Health (Larchmt) 2009; 17:1609-14. [PMID: 19049355 DOI: 10.1089/jwh.2008.0881] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women infected with HIV have a high rate of many gynecological problems. Adherence to recommended gynecological care among women enrolled in our urban HIV clinics was hypothesized to be low. METHODS We conducted an analysis of data from the Johns Hopkins HIV Clinical Cohort Database examining demographic and clinical predictors of clinic visit adherence by women in the HIV primary care and HIV gynecological clinics. RESULTS Between January 2002 and April 2006, 1,086 women had 26,401 scheduled appointments to the two clinics, of which 21,959 were to HIV primary care and 4,442 were to HIV gynecological care. There were 12,097 (55%) completed primary care visits and 1,609 (36.2%) completed HIV gynecological visits (p < 0.001, accounting for clustering). By multivariate analysis, age <40 years (OR 0.81, 95% CI 0.70-0.94) and substance abuse (OR 0.67, 95% CI 0.61-0.73) were associated with a decreased likelihood of attending an HIV primary care appointment. African American race (OR 0.63, 95% CI 0.45-0.90), CD4 count <200 cells/mm(3) (OR 0.73, 95% CI 0.56-0.95), and substance abuse (OR 0.57, 95% CI 0.45-0.71) were associated with a decreased likelihood of attending an HIV gynecological appointment. CONCLUSIONS This analysis determined that the rate of clinic visit adherence is significantly lower for HIV gynecological care than for HIV primary care in the same population of women. Factors associated with HIV gynecological clinic visit noncompliance included African American race/ethnicity, substance use, and more advanced immunosuppression. We have planned additional quantitative and qualitative studies to examine the associations with and barriers to HIV gynecological care, with the goal of creating appropriate interventions toward improving gynecological healthcare utilization among women enrolled in urban HIV clinics.
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Affiliation(s)
- Monique A Tello
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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King WD, Minor P, Ramirez Kitchen C, Oré LE, Shoptaw S, Victorianne GD, Rust G. Racial, gender and geographic disparities of antiretroviral treatment among US Medicaid enrolees in 1998. J Epidemiol Community Health 2008; 62:798-803. [PMID: 18701730 PMCID: PMC5044867 DOI: 10.1136/jech.2005.045567] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 1998, highly active antiretroviral therapy (HAART) was widespread, but the diffusion of these life-saving treatments was not uniform. As half of all AIDS patients in the USA have Medicaid coverage, this study of a multistate Medicaid claims dataset was undertaken to assess disparities in the rates of HAART. METHODS Data came from 1998 Medicaid claims files from five states with varying HIV prevalence. ICD-9 codes were used to identify people with a diagnosis of HIV/AIDS or AIDS-defining illness. Multivariate analyses assessed associations between age, gender, race and state of residence for antiretroviral regimens consistent with HAART, as defined by 1998 Centers for Disease Control and Prevention (CDC) guidelines. RESULTS Among 7202 Medicaid enrolees with a diagnosis of HIV/AIDS or AIDS, 62% received HAART and 25% received no antiretroviral therapy. Multivariate analyses showed that age, race, gender and state were all significant predictors of receiving HAART: white, non-Hispanic patients were most likely to receive HAART (68.3%), with lower rates in Hispanic and black, non-Hispanic segments of the population (59.3% and 57.5%, respectively, p<0.001). Women were less likely to receive HAART than men (51.8% vs 69.3%, p<0.001). CONCLUSION Despite similar insurance coverage and drug benefits, life-saving treatments for HIV/AIDS diffused at widely varying rates in different segments of the Medicaid population. Research is needed to determine the extent to which racial, gender, interstate and region disparities currently correspond to barriers to such care.
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Affiliation(s)
- W D King
- Center for Health Promotion and Disease Prevention, Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90025, USA.
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Hughes A, Davies B, Gudmundsdottir M. “Can You Give Me Respect?” Experiences of the Urban Poor on a Dedicated AIDS Nursing Home Unit. J Assoc Nurses AIDS Care 2008; 19:342-56. [DOI: 10.1016/j.jana.2008.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 04/15/2008] [Accepted: 04/16/2008] [Indexed: 10/21/2022]
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Katerndahl DA. Impact of spiritual symptoms and their interactions on health services and life satisfaction. Ann Fam Med 2008; 6:412-20. [PMID: 18779545 PMCID: PMC2532769 DOI: 10.1370/afm.886] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 05/30/2008] [Accepted: 06/24/2008] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent work suggests that the biopsychosocial model should be expanded to include the spiritual dimension as well. The purpose of this study was to assess the independent effects of spiritual symptoms and their interactions with biopsychosocial symptoms on health care utilization, extreme use of services, and life satisfaction among primary care patients. METHODS Three hundred fifty-three adult waiting room patients at 2 primary care clinics completed the Biopsychosociospiritual Inventory (BioPSSI) as well as measures of life satisfaction and health care use. Hierarchical logistic regression analysis was performed with each outcome to determine whether adding spiritual symptoms and their interaction terms better accounted for outcomes than demographics, functional status, and chronic medical problems alone. RESULTS Spiritual symptoms (alone or in interaction) were associated with 7 of the 10 outcomes and were particularly important to extreme use of health care services and life satisfaction. Among best-fit models, spiritual symptoms alone were significantly associated with any mental health use (beta =0.694, P < or = .05), fair-poor health status (beta =0.837, P < or = .05), and life lacking meaning (beta =1.214, P < or = .001). CONCLUSIONS This study has shown the relevance of spiritual symptoms and their interactions to understanding health outcomes. Extreme utilization outcomes were related to the number of chronic problems, as well as to the social-spiritual interaction. Satisfaction outcomes were associated with physical and spiritual symptoms. These findings may have important implications for providing comprehensive, outcome-based care, as well as for modeling of research findings.
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Affiliation(s)
- David A Katerndahl
- Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, Texas 78229-3900, USA.
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Accurate monitoring of the HIV epidemic in the United States: case duplication in the national HIV/AIDS surveillance system. J Acquir Immune Defic Syndr 2008; 47:391-6. [PMID: 18176325 DOI: 10.1097/qai.0b013e318160d52a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the degree of duplicate reporting in the US HIV/AIDS surveillance system as compared with a performance standard of <5%, and to assess the effect of duplicate removal on epidemiologic trends. METHODS Multistate evaluation of HIV/AIDS case surveillance. Potential duplicate HIV or AIDS case reports in the national surveillance system matched on Soundex, birth date, and sex were assessed for duplication by state and territorial health departments. RESULTS Of the 990,175 cases of HIV infection and AIDS in the surveillance system on December 31, 2001, 44,945 (4.5%) were identified as duplicate reports. The duplication rate was higher for HIV cases (8.2%) than for AIDS cases (3.8%). The median of 322 duplicate AIDS reports per area (range: 1 to 3947) represented a median of 5% of all AIDS reports per area (range: 1% to 11%). The median of 369 duplicate HIV reports per area (range: 1 to 1247) represented a median of 11% of all HIV reports per area (range: 1% to 30%). DISCUSSION The overall duplication rate was within acceptable limits in the national HIV/AIDS surveillance system but did not meet the standard for HIV cases. Ongoing centrally coordinated efforts are necessary to minimize duplicate reporting in the future.
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Hanna DB, Pfeiffer MR, Torian LV, Sackoff JE. Concurrent HIV/AIDS diagnosis increases the risk of short-term HIV-related death among persons newly diagnosed with AIDS, 2002-2005. AIDS Patient Care STDS 2008; 22:17-28. [PMID: 18095838 DOI: 10.1089/apc.2007.0042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the overall effectiveness and availability of highly active antiretroviral therapy (HAART), 1500 HIV-related deaths still occur annually in New York City. In considering ways to further reduce deaths, we assessed the contribution of concurrent HIV/AIDS diagnosis to HIV-related mortality in New York City among persons newly diagnosed with AIDS. We used Cox regression to conduct a retrospective cohort analysis of HIV-related mortality among 15,211 residents age 13+ reported with AIDS to the population-based HIV/AIDS registry between January 2002 and June 2005. Concurrent HIV/AIDS diagnosis was defined as a diagnosis of AIDS occurring within 1 month of initial diagnosis of HIV. HIV-related mortality was 20.2% among persons diagnosed concurrently and 12.2% among those diagnosed nonconcurrently (p < 0.0001). Concurrent HIV/AIDS was associated with more than twice the risk of HIV-related death within the 4 months after diagnosis (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.94-2.65) but no increased risk thereafter (HR 1.12, 95% CI 0.77-1.61). Other significant predictors of death included injection drug use and birth in the Caribbean or Latin America. After 4 years 11.9% of all HIV-related deaths were attributable to a concurrent HIV/AIDS diagnosis. Public health initiatives that facilitate early diagnosis of HIV may reduce HIV-related mortality by giving people the opportunity to initiate care and begin treatment with HAART before immunosuppression places them at risk for opportunistic illness and death.
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Affiliation(s)
- David B. Hanna
- HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Melissa R. Pfeiffer
- HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Lucia V. Torian
- HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Judith E. Sackoff
- HIV Epidemiology Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
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Scott A, Ellen J, Clum G, Leonard L. HIV and housing assistance in four U.S. cities: variations in local experience. AIDS Behav 2007; 11:140-8. [PMID: 17510787 DOI: 10.1007/s10461-007-9247-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Abstract
This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women's engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or "double up" with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.
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Affiliation(s)
- Alison Scott
- Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 30460, USA.
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47
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Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav 2007; 11:101-15. [PMID: 17768674 DOI: 10.1007/s10461-007-9276-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 06/28/2007] [Indexed: 11/30/2022]
Abstract
HIV infection has become a chronic condition that for most persons can be effectively managed with regular monitoring and appropriate medical care. However, many HIV positive persons remain unconnected to medical care or have less optimal patterns of health care utilization than recommended by good clinical practice standards. This paper investigates housing status as a contextual factor affecting access and maintenance in appropriate HIV medical care. Data provided from 5,881 interviews conducted from 1994 to 2006 with a representative sample of 1,661 persons living with HIV/AIDS in New York City demonstrated a strong and consistent relationship between housing need and remaining outside of or marginal to HIV medical care. In contrast, housing assistance increased access and retention in medical care and appropriate treatment. The relationship between housing and medical care outcomes remain controlling for client demographics, health status, insurance coverage, co-occurring mental illness, and problem drug use and the receipt of supportive services to address co-occurring conditions. Findings provide strong evidence that housing needs are a significant barrier to consistent, appropriate HIV medical care, and that receipt of housing assistance has an independent, direct impact on improved medical care outcomes.
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Affiliation(s)
- Angela A Aidala
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Rosenberg R, Devenney W, Siegel S, Dan N. Anomalous Release of Hydrophilic Drugs from Poly(ϵ-caprolactone) Matrices. Mol Pharm 2007; 4:943-8. [DOI: 10.1021/mp700097x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. Rosenberg
- Department of Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania 19104, and Stanley Center for Experimental Therapeutics and Division of Neuropsychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - W. Devenney
- Department of Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania 19104, and Stanley Center for Experimental Therapeutics and Division of Neuropsychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - S. Siegel
- Department of Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania 19104, and Stanley Center for Experimental Therapeutics and Division of Neuropsychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - N. Dan
- Department of Chemical and Biological Engineering, Drexel University, Philadelphia, Pennsylvania 19104, and Stanley Center for Experimental Therapeutics and Division of Neuropsychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Vidrine DJ, Arduino RC, Gritz ER. The effects of smoking abstinence on symptom burden and quality of life among persons living with HIV/AIDS. AIDS Patient Care STDS 2007; 21:659-66. [PMID: 17919093 DOI: 10.1089/apc.2007.0022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Persons living with HIV/AIDS who are current smokers are more likely to develop disease-related adverse health outcomes compared to nonsmokers with HIV/AIDS. However, the impact of smoking cessation on health outcomes such as symptom status and health-related quality of life (HRQOL) has not yet been assessed within this population. This study examined the effects of changes in smoking status on HIV-related symptom burden and health-related quality of life outcomes in a multiethnic, low-income population of persons living with HIV/AIDS. Patients (n = 95) from a large, inner city HIV/AIDS clinic were enrolled in a smoking cessation trial providing nicotine replacement therapy, counseling, and self-help written materials. Biochemically verified smoking status, length of smoking abstinence, HIV-related symptom burden, and HRQOL were assessed approximately 3-months posttrial enrollment. A series of multiple linear regression models was performed to assess the associations between the smoking status variables and the health outcomes at follow-up while controlling for baseline levels. Length of smoking abstinence was significantly associated (p = 0.02) with HIV-related symptom burden. Specifically, increasing number of consecutive days of smoking abstinence during the 3-month follow-up period was associated with lower levels of HIV-related symptom burden at the time of follow-up. However, 24-hour smoking prevalence was not significantly (p > 0.05) associated with changes in either HIV-related symptom burden or HRQOL. These findings suggest that smoking cessation can significantly improve symptom burden for individuals living with HIV/AIDS. Moreover, these benefits are observable as early as 3 months after quitting and are positively correlated with the length of abstinence.
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Affiliation(s)
- Damon J. Vidrine
- The University of Texas M. D. Anderson Cancer Center, Department of Behavioral Science, Houston, Texas
| | - Roberto C. Arduino
- The University of Texas Health Science Center at Houston Medical School, Division of Infectious Diseases, Houston, Texas
| | - Ellen R. Gritz
- The University of Texas M. D. Anderson Cancer Center, Department of Behavioral Science, Houston, Texas
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Nosyk B, Li X, Sun H, Anis AH. The effect of homelessness on hospitalisation among patients with HIV/AIDS. AIDS Care 2007; 19:546-53. [PMID: 17453596 DOI: 10.1080/09540120701235669] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine the effect of homelessness on the costs and patterns of hospitalisation in patients with HIV/AIDS. A retrospective longitudinal study design, based on medical records data covering 2,768 person-years of observation between 1997 and 2003 on patients with HIV/AIDS, was employed. A contextual measure of neighbourhood socioeconomic status (SES) was also used to uncover differences among low- and high-SES neighbourhood dwellers. The association of homelessness and neighbourhood SES with total annual hospitalisation costs, length of stay, numbers of hospital and emergency department admissions and the probability of an operating room procedure, controlling for other covariates, was assessed using multivariate regression analysis. Our results suggest that the homeless and low-SES neighbourhood residents had a large proportion of total costs attributable to admissions for acute events related to the progression of disease. Hospitalisations for planned operating room procedures comprised a relatively larger proportion of hospitalisation costs for high-SES neighbourhood residents. One implication of our findings is that improvements in the continuity of care and cost savings on inpatient care may be realised through further development of social assistance programs aimed at reaching the homeless and residents of low-SES neighbourhoods.
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Affiliation(s)
- B Nosyk
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
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