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Rutledge SE, Zhang J, Icard LD, Jemmott JB. Do syndemic conditions predict HIV medication adherence among urban African American men? AIDS Care 2024; 36:781-789. [PMID: 38387445 DOI: 10.1080/09540121.2024.2305149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024]
Abstract
Much progress has been made in advancing antiretroviral (ART) adherence, yet disparities remain. To explore relationships of syndemic conditions - co-occurring health conditions caused by combinations of biological, social, and structural factors - to ART adherence among African American men, we used data from longitudinal assessments of 302 African American men enrolled in a study designed to increase physical activity and healthy eating. Syndemic conditions included alcohol dependency, drug dependency, depression, post-traumatic stress disorder, and unstable housing. A syndemic conditions variable was operationalized to indicate the presence of 0-5 conditions. About 55% of participants had 1 or more syndemic conditions. Age and marriage were positively associated with ART adherence, whereas number of syndemic conditions was negatively associated with adherence during the 12-month period. The interaction of being married and the syndemic conditions variable significantly predicted greater adherence. Similarly, the interaction of more education and the syndemic conditions variable predicted greater adherence. In multiple regression models, the syndemic conditions variable remained significant (-0.018) in predicting adherence; however, there was no significant interaction among the 5 conditions. This study lends evidence to syndemics literature indicating deleterious consequences of negative life experiences on health outcomes.
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Affiliation(s)
| | - Jingwen Zhang
- Department of Communication, University of California, Davis, CA, USA
| | - Larry D Icard
- School of Social Work, Temple University, Philadelphia, PA, USA
- Centre for Community Technologies, Nelson Mandela University, Port Elizabeth, South Africa
| | - John B Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Aswani-Omprakash T, Balasubramaniam M, McGarva J, Pandit A, Mutlu EA, Hanauer SB, Taft TH. Post-traumatic stress disorder symptoms are frequent among inflammatory bowel disease patients of South Asian descent-A case-control study. Indian J Gastroenterol 2024; 43:244-253. [PMID: 37823984 DOI: 10.1007/s12664-023-01424-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/27/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Post-traumatic stress (PTS) is the psycho-physiological response to a traumatic or life-threatening event and is implicated in inflammatory bowel disease (IBD). IBD-PTS is present in up to 30% of white, non-Hispanic patients. The rates of IBD in Asian populations are expanding, making the exploration of IBD-PTS in this population imperative. METHODS Adult patients of South/Southeast (S/SE) Asian decent with IBD for more than 6 months were recruited online via social media and patient-support groups. Participants completed the post-traumatic stress disorder (PTSD) Checklist-5 (PCL-5), the United States National Institutes of Health's Patient-Reported Outcomes Measurement Information System (NIH-PROMIS) -43 profile and demographics. S/SE Asian participants were age and sex matched (1:2) with randomly selected white, non-Hispanic controls. Statistical analyses evaluated differences in IBD-PTS symptoms between groups, the relationship between disease severity and health-related quality of life (HRQoL) and predictors of IBD-PTS severity. RESULTS Forty-seven per cent of the 51 S/SE Asian participants met the diagnostic cut-off for PTSD on the PCL-5 compared to 13.6% of 110 IBD controls. The mean global score on the PCL-5 was three times higher in S/SE Asians. Patients of S/SE Asian decent were over five times more likely to have PTSD due to their IBD experiences than controls, nearly doubling when controlling for disease activity. More severe IBD-PTS was present in S/SE Asian patients with active disease and those with extraintestinal manifestations. Higher global levels of IBD-PTS were associated with poorer HRQoL in S/SE Asians where increased hyperarousal from IBD-PTS predicted more sleep disturbance. CONCLUSIONS S/SE Asian patients are five times more likely to experience IBD-PTS than their white, non-Hispanic counterparts. Several cultural factors lead to IBD-PTS in S/SE Asian patients that must be considered by IBD providers. Preventing, screening for and treating IBD-PTS in this population appears warranted.
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Affiliation(s)
- Tina Aswani-Omprakash
- Mount Sinai Icahn School of Medicine, School of Public Health, New York, NY, USA
- South Asian IBD Alliance, New York, NY, USA
| | - Madhura Balasubramaniam
- South Asian IBD Alliance, New York, NY, USA
- Department of Humanities and Social Sciences, Indian Institute of Technology, Madras, Chennai, 600 036, India
| | - Josie McGarva
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Anjali Pandit
- South Asian IBD Alliance, New York, NY, USA
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Ece A Mutlu
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois College of Medicine, Chicago, IL, USA
- Rush University, The Graduate College, Chicago, IL, USA
| | - Stephen B Hanauer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Tiffany H Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA.
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Sterrett-Hong EM, Smith AB, Bullock NA, Combs RM, Krigger K, Kerr J. Post-traumatic stress disorder symptoms and PrEP intentions among Black American young adults at high-risk for HIV. ETHNICITY & HEALTH 2024; 29:100-111. [PMID: 37743543 DOI: 10.1080/13557858.2023.2259639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Black Americans bear the greatest burden of HIV, accounting for 43% of new diagnoses. Yet Black Americans also evidence the lowest utilization rates of Pre-Exposure Prophylaxis (PrEP), a highly effective biomedical strategy for preventing HIV infection. Predictors of PrEP acceptance vary; however, little is known about psychological distress, such as post-traumatic stress disorder (PTSD) symptoms, as a predictor. DESIGN In this cross-sectional study, n = 195 Black Americans, evidencing behaviors found in the research literature to heighten risk for contracting HIV (e.g. sex work, injection drug use) ages 18-29, 55% cisgender women, 39.5% cisgender men, 3% transgender/non-binary, completed audio-computer-assisted self-interviews. RESULTS Bivariate analyses indicated significant positive associations between PTSD symptoms and PrEP acceptance and self-confidence. In multinomial logistic regression analyses, after controlling for Perceived HIV Risk, participants had a higher likelihood of responding they 'probably would' take PrEP (as opposed to 'definitely would not' take PrEP) if they reported higher levels of PTSD symptoms. Post-hoc analyses revealed a curvilinear relationship between PTSD symptoms and PrEP acceptance with those reporting the highest level of PTSD in the sample having slightly lower PrEP acceptance than those reporting moderately high levels of PTSD. CONCLUSION Findings are discussed in the context of the negative impacts of high levels of PTSD and potential positive adaptations subsequent to moderate levels of PTSD that could be relevant to advances in HIV prevention efforts.
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Affiliation(s)
- Emma M Sterrett-Hong
- Kent School of Social Work and Family Science, University of Louisville, Louisville, USA
| | - Adrienne B Smith
- School of Public Health and Information Sciences, University of Louisville, Louisville, USA
| | - Nana Ama Bullock
- School of Public Health and Information Sciences, University of Louisville, Louisville, USA
| | - Ryan M Combs
- School of Public Health and Information Sciences, University of Louisville, Louisville, USA
| | - Karen Krigger
- School of Medicine, University of Louisville, Louisville, USA
| | - Jelani Kerr
- School of Public Health and Information Sciences, University of Louisville, Louisville, USA
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Goldbach JT, Kipke MD. What affects timely linkage to HIV Care for Young Men of Color who have sex with Men? Young Men's Experiences Accessing HIV Care after Seroconverting. AIDS Behav 2022; 26:4012-4025. [PMID: 35672551 DOI: 10.1007/s10461-022-03727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
The HIV care continuum provides intervention points that should be addressed to optimally identify, engage, and retain populations in HIV care. This study addressed the lack of research into barriers and facilitators of linkage to care for HIV-positive young men who have sex with men (YMSM) of color. Data were collected using a qualitative timeline follow-back interview approach with YMSM who had seroconverted in the last 6 months. Interviews were conducted with 15 YMSM from April 2017 to April 2018. This study provides important information about what can delay linkage to care for YMSM of color. These delays include fractured referrals to care providers via mobile HIV testing vans, adapting to an HIV diagnosis and integrating it into their lives, and finding caring and competent providers that offer wraparound services, specifically mental health services, as soon as possible after an HIV diagnosis. Addressing these issues is imperative to optimize YMSM's engagement in the HIV care continuum and work toward ending the epidemic.
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Affiliation(s)
- Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, 63130, St. Louis, MO, United States.
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
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Jones DL, Zhang Y, Rodriguez VJ, Haberlen S, Ramirez C, Adimora AA, Merenstein D, Aouizerat B, Sharma A, Wilson T, Mimiaga MJ, Sheth AN, Plankey M, Cohen MH, Stosor V, Kempf MC, Friedman MR. Association of PTSD With Longitudinal COVID-19 Burden in a Mixed-Serostatus Cohort of Men and Women: Weathering the Storm. J Acquir Immune Defic Syndr 2022; 90:567-575. [PMID: 35585664 PMCID: PMC9283230 DOI: 10.1097/qai.0000000000003006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study of people with HIV (PWH) and those without HIV conducted during the COVID-19 pandemic in the United States in 2020 examines the impact of posttraumatic stress disorder (PTSD) on COVID-19 burden, defined as pandemic-related disruptions. METHODS Data consisted of survey responses on PTSD among participants (N = 2434) enrolled in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV (WIHS) cohorts. Unadjusted and adjusted regression models were used to examine the association of PTSD with COVID-19 burden (overall and domain-specific burdens). Quasi-Poisson regression models were used to assess associations with the COVID-19 burden score and 2 domain-specific burdens: (1) changes in resources and (2) interruptions in health care. Analyses was adjusted for age, race/ethnicity, HIV serostatus, current smoking status, number of comorbidities, education, and study regions. RESULTS Study participants were a median age of 58 (interquartile range, 52-65) years. In both bivariate and multivariable models, PTSD severity was associated with greater overall COVID-19 burden. PTSD severity was associated with the number of resource changes and number of interruptions in medical care. These findings were also consistent across cohorts (MACS/WIHS) and across HIV serostatus, suggesting a greater risk for COVID-19 burden with greater PTSD severity, which remained significant after controlling for covariates. CONCLUSIONS This study builds on emerging literature demonstrating the impact of mental health on the burden and disruption associated with the COVID-19 pandemic, providing context specific to PWH. The ongoing pandemic requires structural and social interventions to decrease disruption to resources and health resource needs among these vulnerable populations.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Department of Psychology, University of Georgia, Athens, GA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catalina Ramirez
- Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel Merenstein
- Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Bradley Aouizerat
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York City, New York
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine
| | - Tracey Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago IL
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Evanston, IL
| | - Mirjam-Colette Kempf
- Department of Family, Community & Health Systems, Schools of Nursing, Medicine and Public Health, University of Alabama at Birmingham, Birmingham, AL; and
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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Abstract
After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.
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Kekibiina A, Adong J, Fatch R, Emenyonu NI, Marson K, Beesiga B, Lodi S, Muyindike WR, Kamya M, Chamie G, McDonell MG, Hahn JA. Post-traumatic stress disorder among persons with HIV who engage in heavy alcohol consumption in southwestern Uganda. BMC Psychiatry 2021; 21:457. [PMID: 34535103 PMCID: PMC8449437 DOI: 10.1186/s12888-021-03464-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to describe the prevalence of PTSD symptoms and its associated factors in persons living with HIV (PLWH) in Uganda who engage in heavy alcohol use. METHODS We analyzed baseline data from the Drinkers Intervention to Prevent Tuberculosis study which enrolls PLWH with latent tuberculosis who engage in heavy alcohol consumption. Using the primary care Post Traumatic Stress Disorder (PTSD) screening scale from the DSM-5 (PC-PTSD-5), probable PTSD was defined as reporting ≥3 of 5 assessed symptoms. We conducted the Alcohol Use Disorders Identification Test-Consumption and assessed demographics, smoking, symptoms of depression, and spirituality/religiosity. RESULTS Of 421 participants enrolled from 2018 through 2020, the majority (68.2%) were male, median age was 40 years (interquartile range [IQR]: 32-47), and median AUDIT-C score was 6 [IQR: 4-8]. Half (50.1%) of the participants reported ever experiencing a traumatic event, and 20.7% reported ≥3 symptoms of PTSD. The most commonly reported PTSD symptoms in the past 1 month in the entire sample were avoidance (28.3%), nightmares (27.3%), and being constantly on guard (21.6%). In multivariable logistic regression analyses, level of alcohol use was not associated with probable PTSD (adjusted odds ratio [AOR] for each AUDIT-C point: (1.02; 95% CI: 0.92-1.14; p = 0.69); however, lifetime smoking (AOR 1.89; 95% CI: 1.10-3.24) and reporting symptoms of depression (AOR 1.89; 95% CI: 1.04-3.44) were independently associated with probable PTSD. CONCLUSIONS AND RECOMMENDATIONS A history of traumatic events and probable PTSD were frequently reported among persons who engage in heavy drinking, living with HIV in Uganda. Level of alcohol use was not associated with probable PTSD in this sample of PLWH with heavy alcohol use, however other behavioral and mental health factors were associated with probable PTSD. These data highlight the high prevalence of PTSD in this group, and the need for screening and interventions for PTSD and mental health problems.
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Affiliation(s)
- Allen Kekibiina
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Nneka I. Emenyonu
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Kara Marson
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Brian Beesiga
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Sara Lodi
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Winnie R. Muyindike
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.459749.20000 0000 9352 6415Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moses Kamya
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Michael G. McDonell
- grid.30064.310000 0001 2157 6568Elson S Floyd College of Medicine, Washington State University, Spokane, WA USA
| | - Judith A. Hahn
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
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Nguyen AL, Davtyan M, Taylor J, Christensen C, Plankey M, Karpiak S, Brown B. Living With HIV During the COVID-19 Pandemic: Impacts for Older Adults in Palm Springs, California. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:265-275. [PMID: 34370567 PMCID: PMC8496895 DOI: 10.1521/aeap.2021.33.4.265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We conducted surveys in March 2020 with 100 older adults living in Palm Springs, CA, to (1) report the impact of the COVID-19 pandemic on their day-to-day well-being and (2) describe the factors related to missing HIV medication during the pandemic. Respondent's mean age was 64.2 and the majority identified as White, men, and gay. The majority stated that the pandemic had impacted their lives "much," "very much," or "extremely." One-third experienced financial challenges and 46.0% experienced disruptions to health care. Almost a quarter (24.0%) reported missing a dose of their HIV medication during the pandemic. Compared to those ages 64+, younger respondents were more likely to report some negative impacts like changes in sleep patterns, financial challenges, and missed HIV medication doses, and had higher PTSD severity scores. In adjusted logistic regression, higher PTSD severity scores and disruption to health care were associated with missed doses of medications (ps < .05).
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Affiliation(s)
- Annie L Nguyen
- University of Southern California, Los Angeles, California
| | - Mariam Davtyan
- University of Southern California, Los Angeles, California
| | - Jeff Taylor
- HIV + Aging Research Project-Palm Springs (HARP-PS), Palm Springs, California
| | | | | | - Stephen Karpiak
- HIV and Aging Center, ACRIA Center on HIV & Aging at GMHC, New York, New York
| | - Brandon Brown
- University of California, Riverside School of Medicine
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Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, Weiser SD. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS One 2021; 16:e0252338. [PMID: 34038490 PMCID: PMC8153505 DOI: 10.1371/journal.pone.0252338] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States. Methods We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach. Results A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence. Conclusions Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jennifer M Zakaras
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jacqueline Shieh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Amy A Conroy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, United States of America
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America.,Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
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11
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Meng J, Tang C, Xiao X, Välimäki M, Wang H. Co-occurrence Pattern of Posttraumatic Stress Disorder and Depression in People Living With HIV: A Latent Profile Analysis. Front Psychol 2021; 12:666766. [PMID: 34025528 PMCID: PMC8131520 DOI: 10.3389/fpsyg.2021.666766] [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: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The comorbidity of posttraumatic stress disorder (PTSD) and depression is common among people living with the HIV (PLWH). Given the high prevalence and serious clinical consequences of the comorbidity of these two disorders, we conducted a latent profile analysis to examine the co-occurrence pattern of PTSD and depression in PLWH. Methods: The data for this cross-sectional study of PLWH were collected from 602 patients with HIV in China. A secondary analysis using latent profile analysis was conducted to examine HIV-related PTSD and depression symptoms. Results: A four-class solution fits the data best, with the four classes characterized as asymptomatic (42.9%), mild symptoms (33.9%), low to moderate symptoms (19.8%), and high to moderate symptoms (3.4%). The severity of PTSD and depression symptoms was comparable in this solution, and no group was dominated by PTSD or depression. Conclusion: The absence of a distinct subcluster of PLWH with only PTSD or depression symptoms supports that PTSD and depression in PLWH are psychopathological manifestations after traumatic exposures. Health care staff should pay more attention to the existence of comorbid symptoms of individuals, develop integrated interventions for the symptoms cluster, and evaluate their effectiveness in clinical practice.
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Affiliation(s)
- Jingjing Meng
- Xiangya Nursing School of Central South University, Changsha, China
| | - Chulei Tang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xueling Xiao
- Xiangya Nursing School of Central South University, Changsha, China
| | - Maritta Välimäki
- Xiangya Nursing School of Central South University, Changsha, China.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Honghong Wang
- Xiangya Nursing School of Central South University, Changsha, China
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12
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Li C, Giovenco D, Dong W, Smith MK, Golin CE, Fisher EB, Lei G, Jiang H, Tang PY, Muessig KE. Understanding How Gay, Bisexual, and Other Men Who Have Sex With Men in China Cope With HIV Care-Related Stressors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:46-61. [PMID: 33617323 PMCID: PMC10552686 DOI: 10.1521/aeap.2021.33.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Understanding how Chinese gay, bisexual, and other men who have sex with men (GBMSM) cope with HIV care-related stressors could improve their care engagement. Qualitative semistructured interviews were conducted with 30 GBMSM living with HIV recruited through clinics and a community-based organization (CBO) in Chengdu, China. Interviews focused on treatment-related stress, coping strategies, social support, and well-being. Half reported symptoms consistent with mild or moderate depression as measured by the PHQ-9 scale. HIV care-related stressors included side effects, difficulty with adherence, and fear of drug resistance. Challenges to coping include navigating contradictory information about HIV and treatment, experiencing stigma and discrimination within medical and nonmedical settings, and managing financial concerns. CBOs, peer groups, and providers were salient sources of social support benefitting coping. To improve sustained HIV care that meets the needs of Chinese GBMSM living with HIV, tailored interventions that address the above-mentioned stressors and coping challenges are likely needed.
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Affiliation(s)
- Chunyan Li
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Danielle Giovenco
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Willa Dong
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Kumi Smith
- University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Carol E Golin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edwin B Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gang Lei
- Aibai Culture and Education Center, Chengdu, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine and Sichuan Provincial People's Hospital and Sichuan Academy of Medical Sciences, Chengdu, China
| | - Patrick Y Tang
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn E Muessig
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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13
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The Effects of Perceived Stress and Cortisol Concentration on Antiretroviral Adherence When Mediated by Psychological Flexibility Among Southern Black Men Living with HIV. AIDS Behav 2021; 25:645-652. [PMID: 32902770 DOI: 10.1007/s10461-020-03016-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This pilot study investigates the correlation between psychological stress and antiretroviral therapy (ART) adherence and plasma HIV RNA (viral load) as mediated by psychological flexibility among Black men in the south. Data were collected from 48 HIV-positive, low income Black men. Results indicate a strong positive correlation between perceived stress and psychological inflexibility (adjusted for age and income rs = 0.67; p < 0.001), a negative correlation between psychological inflexibility and ART adherence (adjusted rs = - 0.32; p = 0.03), a negative correlation between perceived stress and ART adherence (adjusted rs = - 0.45; p = 0.006), and a negative correlation between ART adherence and viral load (adjusted rs = - 0.37; p = 0.04). Our findings suggest stress decreases adherence to ART and viral suppression among Black men living with HIV. However, psychological flexibility did not mediate the relationship between stress and treatment adherence. Hair cortisol concentrations were high (mean of 34.2 pg/mg), but uncorrelated with adherence.
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14
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Houston E, Fadardi JS, Harawa NT, Argueta C, Mukherjee S. Individualized Web-Based Attention Training With Evidence-Based Counseling to Address HIV Treatment Adherence and Psychological Distress: Exploratory Cohort Study. JMIR Ment Health 2021; 8:e18328. [PMID: 33507152 PMCID: PMC7878104 DOI: 10.2196/18328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders. OBJECTIVE The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes. METHODS Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers. RESULTS Of the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants' attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0. CONCLUSIONS Our findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.
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Affiliation(s)
- Eric Houston
- Claremont Graduate University, Claremont, CA, United States.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Nina T Harawa
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Chris Argueta
- California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Sukrit Mukherjee
- Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
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15
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Glynn TR, Mendez NA, Jones DL, Dale SK, Carrico AW, Feaster DJ, Rodriguez AE, Safren SA. Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami. J Behav Med 2020; 44:147-158. [PMID: 33098541 DOI: 10.1007/s10865-020-00191-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Individuals living with HIV report disproportionately high levels of trauma exposure and PTSD symptoms, both which have been associated with suboptimal ART adherence. Often conflated, the question arises as to which construct is driving subsequent HIV self-care behavior. Given the HIV disparities among Black and Hispanic/Latinx individuals, and that Miami is a geographic region with a high racial/ethnic minority make up and a unique socioeconomic environment, it is important to explore factors related to HIV outcomes in Miami to mitigate its uncontrolled epidemic. This study aimed to examine the association of trauma exposure, PTSD symptoms, and relevant additional key factors with adherence to ART among a sample of majority Black and Hispanic/Latinx individuals who are economically marginalized receiving public HIV care in Miami, FL (N = 1237) via a cross-sectional survey. Sequential linear regression was used to examine the study aim in four blocks: (1) trauma, (2) PTSD symptoms, and key covariates of ART adherence including (3) depression and substance use (potential psychological covariates), and (4) indicators of socioeconomic status (potential structural covariates). In the first block, trauma exposure was associated with worse adherence. However, in the second block, the association with trauma dropped and PTSD was significantly associated with worse adherence. Of note, for those experiencing high levels of trauma exposure, adherence was negatively impacted regardless of PTSD. When other key factors associated with adherence were entered in the third and fourth blocks, neither trauma exposure nor PTSD were uniquely significant. In this final model, depression, substance use, and unstable housing were uniquely associated with worse adherence. Trauma-informed models of HIV care that holistically address co-occurring factors are warranted to cater to communities with HIV health disparities and keep them from falling off the HIV care continuum.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
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16
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Desilet LW, England BR, Michaud K, Barton JL, Mikuls TR, Baker JF. Posttraumatic Stress Disorder, Depression, Anxiety, and Persistence of Methotrexate and TNF Inhibitors in Patients with Rheumatoid Arthritis. ACR Open Rheumatol 2020; 2:555-564. [PMID: 32921004 PMCID: PMC7571399 DOI: 10.1002/acr2.11175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/26/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine the relationship of posttraumatic stress disorder (PTSD) with earlier treatment discontinuation and medication adherence in US veterans with rheumatoid arthritis (RA). METHODS Veterans Affairs (VA) administrative data (2005-2014) were used to define unique dispensing episodes of methotrexate (MTX) and tumor necrosis factor inhibitors (TNFi) for veterans with RA. Diagnosis codes were used to categorize patients into mutually exclusive groups: PTSD (with/without depression/anxiety), depression/anxiety without PTSD, and neither psychiatric diagnosis. Multivariable Cox proportional hazards models were used to evaluate associations between psychiatric diagnoses and time to disease-modifying antirheumatic drug discontinuation (lapse in refill >90 days). Multivariable logistic regression was used to examine associations of diagnoses with medication nonadherence (proportion of days covered <0.8). RESULTS There were 15 081 dispensing episodes of MTX and 8412 dispensing episodes of TNFi. PTSD was independently associated with a greater likelihood of earlier discontinuation of both MTX (hazard ratio [HR] 1.15 [1.10-1.21]) and TNFi (HR 1.20 [1.13-1.28]). Depression/anxiety had a comparable risk of discontinuation for both MTX (HR 1.14 [1.10-1.19]) and TNFi (HR 1.16 [1.10-1.22]). Depression/anxiety, but not PTSD, was associated with higher odds of MTX (odds ratio [OR] 1.12 [1.03-1.22]) and TNFi (OR 1.14 [1.02-1.27]) nonadherence. CONCLUSION Veterans with RA and comorbid PTSD, depression, or anxiety had poor persistence of MTX and TNFi therapies. These results suggest that earlier discontinuation and low adherence to therapy among patients with RA with these psychiatric comorbidities may contribute to worse disease outcomes. Mechanisms by which these comorbidities contribute to lower adherence deserve further investigation and may lead to targeted interventions to improve disease outcomes.
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Affiliation(s)
- Luke W Desilet
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Kaleb Michaud
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, and Forward, The National Databank for Rheumatic Diseases, Wichita, KS
| | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Joshua F Baker
- Corporal Michael C. Crescenz VA Medical Center and University of Pennsylvania, Philadelphia, PA
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17
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Aloyce Z, Larson E, Komba A, Mwimba A, Kaale A, Minja A, Siril H, Kamala J, Somba M, Ngakongwa F, Kaaya S, Fawzi MCS. Prevalence and factors associated with intimate partner violence after HIV status disclosure among pregnant women with depression in Tanzania. AIDS Care 2020; 33:1009-1015. [PMID: 32741204 DOI: 10.1080/09540121.2020.1799921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intimate partner violence (IPV) exacts a heavy burden on women, resulting in poor health outcomes. This study had the following aims: (1) estimate the prevalence of IPV post-disclosure of HIV status among pregnant women living with HIV and depression; and (2) evaluate risk and protective factors for IPV post-disclosure. Participants were women accessing PMTCT services at 16 health facilities in Dar es Salaam and screened at the threshold of 9 on the PHQ-9. Generalized linear equations with a log link and standard errors clustered at the facility level were used to calculate associations between predictors and IPV post-disclosure. Among 659 women who were in an intimate relationship, 10.2% had experienced physical violence and 11.6% had reported sexual violence from their partner in the past six months; 327 had disclosed their HIV status to their partners. After disclosure to their partners 279 women (85.3%) experienced IPV. HIV-related stigma was associated with increased risk of IPV following disclosure and appreciative relationships with partners and higher hope were associated with reduced risk of IPV. There is a need to identify and advance approaches to HIV disclosure that prevent IPV. Interventions should be developed based on known risk and protective factors for IPV following HIV disclosure in Tanzania and similar settings.
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Affiliation(s)
- Zenaice Aloyce
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Elysia Larson
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Amina Komba
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | - Anna Kaale
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Anna Minja
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Janeth Kamala
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Magreat Somba
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Fileuka Ngakongwa
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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18
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Wagner GJ, Ghosh-Dastidar B, Mukasa B, Linnemayr S. Changes in ART Adherence Relate to Changes in depression as Well! Evidence for the Bi-directional Longitudinal Relationship Between Depression and ART Adherence from a Prospective Study of HIV Clients in Uganda. AIDS Behav 2020; 24:1816-1824. [PMID: 31813077 PMCID: PMC7228829 DOI: 10.1007/s10461-019-02754-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Studies have documented how levels and change in depression correspond to ART non-adherence. However, few studies have examined how levels of and change in adherence may relate to levels of and change in depression, although one might expect mental health to be related to physical health and how successful one is in managing disease. To assess the bidirectional nature of the association between these two constructs, we examined data from a prospective trial of an ART adherence intervention in Uganda that followed 143 participants over 20 months. Adherence was measured using electronic monitoring caps; non-adherence was defined as missing > 10% of prescribed doses; self-reported depression was measured using the Patient Health Questionnaire (PHQ-9), and PHQ-9 > 4 defined the presence of at least minor depression. Adjusted linear and logistic regression models were used to examine the longitudinal relationships between depression and non-adherence. At baseline, 40.6% had at least minor depression and 37.1% were non-adherent. Time varying change in the classification of depression (e.g., becoming depressed) predicted change in non-adherence status (e.g., becoming non-adherent), and this association remained when examining continuous measures of the constructs. Similarly, time varying measures of increases in non-adherence predicted increases in depression, regardless of whether continuous or binary classification measures were used. A temporal trend of increased non-adherence over time was observed, and this was accelerated by an increase in depression. Furthermore, those who had at least minor depression at baseline were more likely to be non-adherent at follow-up. These findings support the potential benefits of depression care and adherence support for improving adherence and mental health, respectively, and call for further research to examine such benefits.The trial has been registered with ClinicalTrials.gov (NCT02503072).
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401-3201, USA.
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19
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Lacombe-Duncan A, Warren L, Kay ES, Persad Y, Soor J, Kia H, Underhill A, Logie CH, Kazemi M, Kaida A, de Pokomandy A, Loutfy M. Mental health among transgender women living with HIV in Canada: findings from a national community-based research study. AIDS Care 2020; 33:192-200. [PMID: 32172609 DOI: 10.1080/09540121.2020.1737640] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antiretroviral therapy adherence among transgender (trans) women living with HIV (WLWH) is negatively impacted by depression and post-traumatic stress disorder (PTSD). Yet, little is known about factors associated with depression or PTSD among trans WLWH. Using cross-sectional data from a national community-based study of 1422 WLWH (n = 53 trans women), we characterized the prevalence of depressive and PTSD symptoms among trans WLWH and examined associations between factors (e.g., Trans stigma) and depressive and PTSD symptoms. Nearly half of participants reported clinically significant PTSD (45.3%) and depressive symptoms (45.3%) [mean Post-traumatic Stress Disorder Civilian Checklist Version-C score 13.8 (SD = 5.8); mean Center for Epidemiological Studies - Depression score 9.4 (SD = 8.0)]. Univariate linear regression analyses showed that <95% adherence, higher internalized HIV-related stigma, frequency of past-month hazardous alcohol use, and current injection drug use were significantly associated with both higher PTSD and depressive symptom scores, and higher resilience and social support with lower scores. A history of violence in adulthood was associated with higher depressive symptoms scores, whereas sexual relationship power and less difficulty meeting housing costs were associated with lower scores. Findings suggest a need for multi-level interventions to reduce barriers to mental wellbeing while fostering resilience and social support.
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Affiliation(s)
| | - Laura Warren
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Emma Sophia Kay
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Jaspreet Soor
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, Canada
| | - Angela Underhill
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Center, Montreal, Canada.,Department of Family Medicine, McGill University, Montreal, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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20
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Oates GR, Juarez LD, Hansen B, Kiefe CI, Shikany JM. Social Risk Factors for Medication Nonadherence: Findings from the CARDIA Study. Am J Health Behav 2020; 44:232-243. [PMID: 32019655 DOI: 10.5993/ajhb.44.2.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.
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Affiliation(s)
- Gabriela R. Oates
- Assistant Professor of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL.,
| | - Lucia D. Juarez
- Scientist III, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara Hansen
- Scientist I, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Catarina I. Kiefe
- Professor and Chair, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - James M. Shikany
- Professor of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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21
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Hou J, Fu J, Meng S, Jiang T, Guo C, Wu H, Su B, Zhang T. Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis. Front Psychiatry 2020; 11:834. [PMID: 32973579 PMCID: PMC7466667 DOI: 10.3389/fpsyt.2020.00834] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/31/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a commonly reported and serious complication among people living with HIV (PLWH). PTSD may significantly increase unintentional non-adherence to antiretroviral therapy. In this systematic review and meta-analysis, we aimed to pool the observational studies exploring the association between PTSD and medication adherence among PLWH. METHODS Comprehensive searches were conducted in PubMed/Medline, Web of Science, PsycINFO, Google Scholar, and ProQuest to identify relevant articles and dissertations. A random effects meta-analysis with inverse variance weighting was used to summarize the odds ratio (OR) across studies. Meta-regression and subgroup analyses were also carried out to assess the moderation effects for potential factors. RESULTS By synthesizing 12 studies comprising 2489 participants, the pooled odd ratio of non-adherence to antiretroviral therapy was 1.19 (95% confidential interval (CI), 1.03-1.37, p = 0.02). No significant publication bias was detected by Egger's test (Intercept = 0.842, p = 0.284). Factors moderating the association were mean age of participants, depression adjustment, and depression (all p < 0.05). CONCLUSIONS This meta-analysis supports that PTSD is related to adherence in PLWH. The hypothesized mechanisms (avoidant behavior and cognitive impairment) underlying this association need further investigation. Overall, this study highlights that clinicians should thoughtfully integrate timely mental health intervention into routine care.
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Affiliation(s)
- Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Jiangning Fu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Siyan Meng
- School of Public Health, Yale University, New Haven, CT, United States
| | - Taiyi Jiang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Caiping Guo
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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22
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Levy ME, Monroe AK, Horberg MA, Benator DA, Molock S, Doshi RK, Powers Happ L, Castel AD. Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort. J Acquir Immune Defic Syndr 2019; 82:329-341. [PMID: 31356466 PMCID: PMC6791752 DOI: 10.1097/qai.0000000000002138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH). SETTING The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC. METHODS Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations. RESULTS Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder). CONCLUSIONS PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.
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Affiliation(s)
- Matthew E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Debra A Benator
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC
| | - Rupali K Doshi
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Lindsey Powers Happ
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
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Cuca YP, Shumway M, Machtinger EL, Davis K, Khanna N, Cocohoba J, Dawson-Rose C. The Association of Trauma with the Physical, Behavioral, and Social Health of Women Living with HIV: Pathways to Guide Trauma-informed Health Care Interventions. Womens Health Issues 2019; 29:376-384. [PMID: 31303419 DOI: 10.1016/j.whi.2019.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trauma is increasingly recognized as a near-universal experience among women living with HIV (WLHIV) and a key contributor to HIV acquisition, morbidity, and mortality. METHODS We present data from the baseline analysis of a planned intervention trial of the impact of trauma-informed health care on physical, behavioral, and social health outcomes of WLHIV in one clinic, with a particular focus on quality of life and viral suppression. Data were collected through interviewer-administered surveys and electronic health record data abstraction. RESULTS Among 104 WLHIV, 97.1% of participants reported having experienced lifetime trauma, and participants had experienced on average 4.2 out of 10 Adverse Childhood Experiences. WLHIV with more lifetime trauma were significantly more likely to report post-traumatic stress disorder, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had a significantly poorer quality of life. In addition, women who had experienced more lifetime trauma were significantly less likely to report being on and adhering to HIV medications, although trauma was not significantly associated with having an undetectable HIV viral load. CONCLUSIONS These data suggest that trauma is associated with much of the morbidity and mortality experienced by WLHIV. The results of this study support the implementation and study of trauma-informed approaches to health care for WLHIV.
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Affiliation(s)
- Yvette P Cuca
- Department of Community Health Systems, UCSF School of Nursing, San Francisco, California.
| | - Martha Shumway
- UCSF School of Medicine, Department of Psychiatry, San Francisco, California
| | - Edward L Machtinger
- UCSF Women's HIV Program, San Francisco, California; UCSF Center to Advance Trauma-informed Health Care, UCSF Department of Medicine, San Francisco, California
| | - Katy Davis
- UCSF Women's HIV Program, San Francisco, California
| | - Naina Khanna
- Positive Women's Network-USA, Oakland, California
| | - Jennifer Cocohoba
- UCSF Women's HIV Program, San Francisco, California; UCSF School of Pharmacy, San Francisco, California
| | - Carol Dawson-Rose
- Department of Community Health Systems, UCSF School of Nursing, San Francisco, California
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24
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Mao Y, Qiao S, Li X, Zhao Q, Zhou Y, Shen Z. Depression, Social Support, and Adherence to Antiretroviral Therapy Among People Living With HIV in Guangxi, China: A Longitudinal Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:38-50. [PMID: 30742482 DOI: 10.1521/aeap.2019.31.1.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Depression can result in poor adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV), and social support can help mitigate the negative relationship. However, little is known about how depression and social support synergistically influence ART adherence over time. The current study aims to explore longitudinal associations between them and examine which sources of social support can play a mediating role between depression and ART adherence over time. A randomized controlled clinical trial was conducted between 2013 and 2016 in Guangxi, China. The study sample was composed of 319 PLHIV who were randomized into control condition and provided data at baseline and at least one of the six follow-ups. The results revealed negative associations of depression with ART adherence over time, and a mediating effect of perceived support from spouse/partner or children. Interventions to promote ART adherence should focus on strengthening PLHIV's relationships with their spouse/partner and children, promoting collaborative provider-patient relationships, and enhancing peer support among PLHIV.
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Affiliation(s)
- Yuchen Mao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
- School of Law and Public Affairs, Nanjing University of Information Science and Technology, Nanjing, China
| | - Qun Zhao
- School of Law and Public Affairs, Nanjing University of Information Science and Technology, Nanjing, China
| | - Yuejiao Zhou
- Institute of HIV/AIDS Control and Prevention, Guangxi CDC, Nanning, China
| | - Zhiyong Shen
- Institute of HIV/AIDS Control and Prevention, Guangxi CDC, Nanning, China
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25
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Pednekar PP, Ágh T, Malmenäs M, Raval AD, Bennett BM, Borah BJ, Hutchins DS, Manias E, Williams AF, Hiligsmann M, Turcu-Stiolica A, Zeber JE, Abrahamyan L, Bunz TJ, Peterson AM. Methods for Measuring Multiple Medication Adherence: A Systematic Review-Report of the ISPOR Medication Adherence and Persistence Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:139-156. [PMID: 30711058 DOI: 10.1016/j.jval.2018.08.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/29/2018] [Accepted: 08/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications. OBJECTIVES To identify and characterize the multiple medication adherence (MMA) methods used in the literature. METHODS A literature search was conducted using PubMed, PsycINFO, the International Pharmaceutical Abstracts, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library databases on methods used to measure MMA published between January 1973 and May 2015. A two-step screening process was used; all abstracts were screened by pairs of researchers independently, followed by a full-text review identifying the method for calculating MMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic review. For studies that met the eligibility criteria, general study and adherence-specific characteristics and the number and type of MMA measurement methods were summarized. RESULTS The 147 studies that were included originated from 32 countries, in 13 disease states. Of these studies, 26 used proportion of days covered, 23 used medication possession ratio, and 72 used self-reported questionnaires (e.g., the Morisky Scale) to assess MMA. About 50% of the studies included more than one method for measuring MMA, and different variations of medication possession ratio and proportion of days covered were used for measuring MMA. CONCLUSIONS There appears to be no standardized method to measure MMA. With an increasing prevalence of polypharmacy, more efforts should be directed toward constructing robust measures suitable to evaluate adherence to complex regimens. Future research to understand the validity and reliability of MMA measures and their effects on objective clinical outcomes is also needed.
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Affiliation(s)
- Priti P Pednekar
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA.
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | - Maria Malmenäs
- Real World Strategy & Analytics, Mapi Group, Stockholm, Sweden
| | | | | | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia
| | - Allison F Williams
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Mickaël Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Adina Turcu-Stiolica
- Department of Pharmaceutical Marketing and Management, University of Medicine and Pharmacy, Craiova, Romania
| | - John E Zeber
- Central Texas Veterans Health Care System, Scott & White Healthcare, Center for Applied Health Research, Temple, TX, USA
| | | | | | - Andrew M Peterson
- Mayes College of Healthcare Business and Policy, University of the Sciences, Philadelphia, PA, USA
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26
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Wagner AC, Jaworsky D, Logie CH, Conway T, Pick N, Wozniak D, Rana J, Tharao W, Kaida A, de Pokomandy A, Ion A, Chambers LA, Webster K, MacGillivray SJ, Loutfy M. High rates of posttraumatic stress symptoms in women living with HIV in Canada. PLoS One 2018; 13:e0200526. [PMID: 30024901 PMCID: PMC6053147 DOI: 10.1371/journal.pone.0200526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/28/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Women living with HIV experience high levels of trauma exposure before and after diagnosis. One of the most challenging outcomes following trauma exposure is posttraumatic stress disorder. Despite high exposure to traumatic events, the presence and contributors to posttraumatic stress disorder symptoms have not been examined in women living with HIV in Canada. METHODS The current study examines the presence of, contributors to, and geographical regions associated with self-reported posttraumatic stress symptoms (PTSS) among 1405 women enrolled in the Canadian HIV Women's Sexual & Reproductive Health Cohort Study (CHIWOS). RESULTS Separate linear regression models were run for the three provinces in the cohort: British Columbia, Ontario and Québec. Scores consistent with posttraumatic stress disorder were reported by 55.9%, 39.1% and 54.1% of the participants in each province, respectively (F(2, 1402) = 13.53, p < .001). CONCLUSIONS The results demonstrate that women living with HIV have high rates of PTSS, and that rates and variables associated with these symptoms vary by province. These results suggest the need for trauma-informed practices and care for women living with HIV in Canada, which may need to be tailored for the community and identities of the women.
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Affiliation(s)
- Anne C. Wagner
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Denise Jaworsky
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Denise Wozniak
- CHIWOS Community Advisory Board, Mission, British Columbia, Canada
| | - Jesleen Rana
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Allyson Ion
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Lori A. Chambers
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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27
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Wasson LT, Shaffer JA, Edmondson D, Bring R, Brondolo E, Falzon L, Kronish IM, Kronish IM. Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis. J Psychiatr Res 2018; 102:102-109. [PMID: 29631190 PMCID: PMC6124486 DOI: 10.1016/j.jpsychires.2018.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with posttraumatic stress disorder (PTSD) are at increased risk for adverse consequences from comorbid medical conditions. Nonadherence to medications prescribed to treat those comorbid conditions may help explain this increased risk. We sought to determine the association between PTSD and medication nonadherence and whether it varied according to the type of event inducing the PTSD. METHODS Prospective observational cohort or cross-sectional studies relating PTSD and nonadherence among adults prescribed medications for a chronic medical illness were identified by searching MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, SCOPUS, and the PILOTS Database and by hand-searching bibliographies from selected articles. Individual estimates of odds ratios were pooled using random effects meta-analysis with inverse variance weighting. Articles were pooled separately according to whether PTSD was induced by a medical versus non-medical event. OUTCOMES Sixteen articles comprising 4483 patients met eligibility criteria. The pooled effect size of the risk of PTSD to medication nonadherence was OR 1.22 (95% CI, 1.06-1.41). Among the 6 studies of medical event-induced PTSD, the OR was 2.08 (95% CI, 1.03-4.18); p = 0.04. Among the 8 studies in which PTSD was not induced by a medical event, the OR was 1.10 (95% CI, 0.99-1.24); p = 0.09. INTERPRETATION Patients with PTSD were more likely to be nonadherent to medications prescribed for chronic medical conditions - an association that may exist specifically when PTSD was induced by a medical event. Medications may serve as aversive reminders among survivors of acute medical events, magnifying avoidance behaviors characteristic of PTSD. FUNDING NHLBI.
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Affiliation(s)
- Lauren Taggart Wasson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032,Corresponding Author: Lauren Taggart Wasson, MD MPH; Columbia University Medical Center, 622 West 168 Street, PH9-319, New York, NY 10032; Phone: 212-304-5215; Fax 212-342-3431;
| | - Jonathan A. Shaffer
- Department of Psychology, College of Liberal Arts and Sciences University of Colorado at Denver, PO Box 173364, Denver, CO 80217
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Rachel Bring
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Elena Brondolo
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
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Negi BS, Joshi SK, Nakazawa M, Kotaki T, Bastola A, Kameoka M. Impact of a massive earthquake on adherence to antiretroviral therapy, mental health, and treatment failure among people living with HIV in Nepal. PLoS One 2018; 13:e0198071. [PMID: 29889840 PMCID: PMC5995447 DOI: 10.1371/journal.pone.0198071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/13/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The April 2015 Nepal earthquake resulted in more than 8,700 deaths and 22,000 casualties including damage to health facilities. The impact of this situation on chronic conditions such as human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) may become a long-lasting public health threat. Therefore, the objectives of this study were i) to assess the association of antiretroviral therapy (ART) adherence with mental health problems, and social behaviors, ii) to examine factors affecting treatment failure, and iii) to investigate changes in ART adherence and post-traumatic stress disorder (PTSD) among people living with HIV 6 and 12 months after the disaster. METHODS Study was conducted 6 months after the earthquake in 2015 with a sample size of 305 earthquake victims with HIV and followed after 12 months of the earthquake. A logistic regression analysis was used to examine relationships, while a paired t-test analysis was conducted to assess changes in adherence to ART and PTSD level at 6 months and 12 months after earthquake. RESULTS In the earthquake, 5.2% of the participants lost their family member. Approximately 44% of participants had earthquake-PTSD symptoms and 50% experienced HIV stigma. PTSD and HIV status disclosure were significantly associated with adherence to ART, while HIV stigma and religion were associated with treatment failure. PTSD and adherence levels to ART were significantly improved over the 6-month period. CONCLUSION Awareness programs for general public to eliminate HIV stigma; promote psychosocial counseling to earthquake victims living with HIV in order to reduce PTSD will contribute to maintaining optimal ART adherence and to prevent treatment failure.
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Affiliation(s)
- Bharat Singh Negi
- Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
- * E-mail:
| | - Sunil Kumar Joshi
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Minato Nakazawa
- Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Tomohiro Kotaki
- Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Anup Bastola
- Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal
| | - Masanori Kameoka
- Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
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Kagee A, Bantjes J, Saal W, Sefatsa M. Utility of the Posttraumatic Stress Scale–Self-report version in screening for posttraumatic stress disorder among persons seeking HIV testing. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318779191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The literature on the utility of self-report instruments in determining caseness for posttraumatic stress disorder in South Africa is sparse. We administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders–Research Version and the Posttraumatic Stress Scale–Self-report version to a sample of 500 South African community members seeking HIV testing. Of our original sample of 500, 306 (61.2%) reported an index event for posttraumatic stress disorder and 25 (5.0%) met the criteria for this diagnosis. The Posttraumatic Stress Scale–Self-report displayed internal consistency of .95 as measured by Cronbach’s alpha. Using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders as a gold standard, we conducted receiver operating curve analysis among the 306 participants who reported an index traumatic event to determine the extent to which the Posttraumatic Stress Scale–Self-report as a screening instrument successfully discriminated between participants who did and did not meet the diagnostic criteria for posttraumatic stress disorder. The Posttraumatic Stress Scale–Self-report yielded sensitivity of .76 and specificity of .78, with an area under the curve of .837. Positive and negative predictive values were .24 and .97, respectively. Our findings suggest that the Posttraumatic Stress Scale–Self-report may be effectively used to screen for posttraumatic stress disorder among community samples, including persons seeking HIV testing.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, South Africa
| | - Wylene Saal
- Department of Psychology, Stellenbosch University, South Africa
| | - Mpho Sefatsa
- Department of Psychology, Stellenbosch University, South Africa
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30
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Barriers to Adherence to Antiretroviral Treatment Among Inmates of a Prison in Tehran, Iran: A Qualitative Study. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.57911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Terloyeva D, Nugmanova Z, Akhmetova G, Akanov A, Patel N, Lazariu V, Norelli L, McNutt LA. Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study. PLoS One 2018; 13:e0193976. [PMID: 29590151 PMCID: PMC5873996 DOI: 10.1371/journal.pone.0193976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/22/2018] [Indexed: 12/17/2022] Open
Abstract
Background In Kazakhstan, scarce official prevalence data exists for mood disorders. This study investigates the occurrence of depressive symptoms among people living with HIV/AIDS (PLWHA), and the relationship between depressive symptoms, HIV treatment initiation and antiretroviral treatment (ART) adherence. Methods A cross-sectional study was conducted among patients seen at the Almaty AIDS Center between April and December 2013. Two data sources were used: 1) self-administered survey that included the Patient Health Questionnaire (PHQ-9) to capture depression symptoms and 2) medical record review. Two primary outcomes were evaluated with log-binomial models and Fisher’s exact test: the relationship between depression symptoms and 1) HIV treatment group, and 2) HIV adherence. Results Of the 564 participants, 9.9% reported symptoms consistent with a depressive disorder. None had received treatment for depression. Among those not on ART, a relationship between depressive symptoms and low CD4 counts (≤ 350 cells/mm3) was evident (7.1% for CD4 ≤ 350 cells/mm3 vs. 0.9% for CD4 > 350 cells/mm3, p = 0.029). In multivariable analysis, a higher prevalence of depressive symptoms was statistically associated with ART treatment, positive hepatitis C virus (HCV) status, and being unmarried. For those taking ART, treatment adherence was not statistically associated with a lower prevalence of depressive symptoms (12.5% vs 20.0%, p = 0.176); limited power may have impacted statistical significance. Conclusions Untreated depression was found among PLWHA suggesting the need to evaluate access to psychiatric treatment. A collaborative strategy may be helpful to optimize HIV treatment outcomes.
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Affiliation(s)
- Dina Terloyeva
- Department of HIV infection and Infection Control, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Zhamilya Nugmanova
- Department of HIV infection and Infection Control, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
| | | | - Aikan Akanov
- Department of Public Health, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
| | - Nimish Patel
- Albany College of Pharmacy & Health Sciences, Albany, New York, United States of America
| | - Victoria Lazariu
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States of America
| | - Lisa Norelli
- Department of Psychiatry, Albany Medical College, Albany, New York, United States of America
| | - Louise-Anne McNutt
- Institute for Health and the Environment, University at Albany, State University of New York, Rensselaer, New York, United States of America
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Kagee A, Bantjes J, Saal W. Prevalence of Traumatic Events and Symptoms of PTSD Among South Africans Receiving an HIV Test. AIDS Behav 2017; 21:3219-3227. [PMID: 28224321 DOI: 10.1007/s10461-017-1730-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We studied posttraumatic stress disorder (PTSD) among a community sample of 500 persons seeking an HIV test. The majority of participants (62.2%) indicated that they had experienced at least one index event that qualified for PTSD, even though a small proportion (5%) actually met the diagnostic criteria for the disorder. Of those who reported an index event, 25 (8.04%) met the diagnostic criteria for PTSD while 286 (91.96%) did not. On average about one-third of participants who did not meet the criteria for PTSD endorsed PTSD symptoms whereas more than three quarters of those who met the full criteria did so. No demographic factors were associated with PTSD caseness, except number of traumatic events. These results are discussed in the context of the need to address traumatic events and PTSD among persons who undergo HIV testing.
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Scott TM, Byrd D, Arce Rentería M, Coulehan K, Miranda C, Fuentes A, Rivera Mindt M. The Combined Roles of Nonsomatic Depressive Symptomatology, Neurocognitive Function, and Current Substance Use in Medication Adherence in Adults Living With HIV Infection. J Assoc Nurses AIDS Care 2017; 29:178-189. [PMID: 28988793 DOI: 10.1016/j.jana.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/10/2017] [Indexed: 01/01/2023]
Abstract
Depression, global neurocognitive (GNC) function, and substance use disorders (SUDs) are each associated with medication adherence in persons living with HIV (PLWH). Because somatic symptoms can inflate depression scores in PLWH, the role of nonsomatic depressive symptomatology (NSDS) should be considered in adherence. However, the combined roles of NSDS, GNC function, and current SUDs in predicting combined antiretroviral therapy (cART) adherence remain poorly understood. Forty PLWH (70% Latina/o; 30% non-Hispanic White) completed psychiatric/SUD, neurocognitive, and self-report cART adherence evaluations. Higher NSDS was associated with suboptimal adherence (p < .01), but optimal and suboptimal adherers did not differ in GNC function or current SUDs. Only NSDS was associated with suboptimal adherence, after accounting for GNC function and SUDs (p = .01). NSDS uniquely predicted self-reported adherence, beyond GNC function and current SUDs among ethnically diverse PLWH. Methodological issues between present and prior studies should also be considered.
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Batchelder AW, Safren S, Mitchell AD, Ivardic I, O’Cleirigh C. Mental health in 2020 for men who have sex with men in the United States. Sex Health 2017; 14:59-71. [PMID: 28055823 PMCID: PMC5953431 DOI: 10.1071/sh16083] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Steven Safren
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Avery D. Mitchell
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
- Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, Chapel Hill, NC 27599, USA
| | - Ivan Ivardic
- Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
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FitzHarris LF, Hollis ND, Nesheim SR, Greenspan JL, Dunbar EK. Pregnancy and linkage to care among women diagnosed with HIV infection in 61 CDC-funded health departments in the United States, 2013. AIDS Care 2017; 29:858-865. [PMID: 28132520 DOI: 10.1080/09540121.2017.1282107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Timely linkage to HIV care (LTC) following an HIV diagnosis is especially important for pregnant women with HIV to prevent perinatal transmission and improve maternal health. However, limited data are available on LTC among U.S. pregnant women. Our analysis aimed to identify HIV diagnoses among childbearing age (CBA) women (15-44 years old) by pregnancy status and to compare LTC of HIV-infected pregnant women to HIV-infected non-pregnant women. We analyzed 2013 CDC-funded HIV testing data from 61 health departments and 151 directly funded community-based organizations among CBA women. LTC includes linkage at any time after an HIV diagnosis and within 90 days after HIV diagnosis. Pearson's chi-square was used to compare LTC of pregnant and non-pregnant women. Data were analyzed using SAS v9.3. Among the 1,379,860 HIV testing events among CBA women in 2013, 0.3% (n = 3690) were HIV-positive. Among all HIV-positive diagnoses with an available pregnancy status (n = 1987), 7%, (n = 138) were pregnant. Among women with pregnancy status data, LTC any time after an HIV-positive diagnosis was 73.2% for pregnant women and 60.7% for non-pregnant women. LTC within 90 days was 71.7% for pregnant women and 56.2% for non-pregnant women. Pregnancy was associated with LTC any time (p < 0.01) and within 90 days of diagnosis (p < 0.01). Compared with non-pregnant women, a higher proportion of pregnant women with HIV were linked to care overall, and linked within 90 days. Pregnancy appears to facilitate better LTC, but improvements are needed for women overall and pregnant women specifically.
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Affiliation(s)
- Lauren F FitzHarris
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA.,b ICF International , Atlanta , USA
| | - Natasha D Hollis
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA
| | - Steven R Nesheim
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA
| | - Julia L Greenspan
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA.,c Rollins School of Public Health , Emory University , Atlanta , USA
| | - Erica K Dunbar
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA
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Prevalence of Depression and Posttraumatic Stress Disorder After Acute Orthopaedic Trauma: A Systematic Review and Meta-Analysis. J Orthop Trauma 2017; 31:47-55. [PMID: 27997466 DOI: 10.1097/bot.0000000000000664] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aims to systematically assess the existing literature and to derive a pooled estimate of the prevalence of depression and posttraumatic stress disorder (PTSD) in adult patients after acute orthopaedic trauma. DATA SOURCES A comprehensive search of databases, including MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials databases was conducted through June 2015. STUDY SELECTION We included studies that assessed the prevalence of depression or PTSD in patients who experienced acute orthopaedic trauma to the appendicular skeleton or pelvis. Studies with a sample size of ≤10 were excluded. DATA EXTRACTION Two authors independently extracted data from the selected studies and the data collected were compared with verify agreement. DATA SYNTHESIS Twenty-seven studies and 7109 subjects were included in the analysis. Using a random-effects model, the weighted pooled prevalence of depression was 32.6% (95% CI, 25.0%-41.2%) and the weighted pooled prevalence of PTSD was 26.6% (95% CI, 19.0%-35.9%). Six studies evaluated the prevalence of both depression and PTSD in patients with acute orthopaedic injuries. The weighted pooled prevalence of both depression and PTSD for those patients was 16.8% (95% CI, 9.0%-29.4%). CONCLUSIONS Nearly one-third of patients suffer from depression and more than one-quarter of patients suffer from PTSD after an acute orthopaedic injury suggesting that strategies to address both the mental and physical rehabilitation after an orthopaedic injury should be considered to optimize patient recovery. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Wagner GJ, Slaughter M, Ghosh-Dastidar B. Depression at Treatment Initiation Predicts HIV Antiretroviral Adherence in Uganda. J Int Assoc Provid AIDS Care 2016; 16:91-97. [PMID: 28084190 DOI: 10.1177/2325957416677121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined the relationship between depression (symptom type, diagnostic severity, and change over time) and adherence to HIV antiretroviral therapy (ART) with data from 3 longitudinal studies (N = 1021) of patients starting ART in Uganda. The Patient Health Questionnaire was used to assess depressive symptoms (total score; somatic and cognitive subscales) and categorize severity level. At baseline, 9% had major depression and 30% had minor depression; 82% were adherent (reported no missed ART doses in the past 7 days) at month 6 and 85% at month 12. Controlling for demographic and medical covariates, multivariate random-effects logistic regression models revealed that change in depression was not related to adherence; however, baseline total depression symptoms and cognitive symptoms in particular as well as major and minor depression were significant predictors of adherence. These findings highlight the need for early identification and aggressive treatment of depression to optimize ART adherence.
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van den Berg JJ, Neilands TB, Johnson MO, Chen B, Saberi P. Using Path Analysis to Evaluate the Healthcare Empowerment Model Among Persons Living with HIV for Antiretroviral Therapy Adherence. AIDS Patient Care STDS 2016; 30:497-505. [PMID: 27849372 DOI: 10.1089/apc.2016.0159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Healthcare empowerment (HCE) is patient controlled and includes the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty. Understanding psychosocial factors that impact HCE for persons living with HIV is critical for their treatment and care. A sample of 1494 male and female participants living with HIV in the United States with a mean age of 45.6 (standard deviation = 11.4) completed a one-time online survey about their demographic characteristics, social support, healthcare provider relationship, HIV treatment knowledge, perceived HIV-related stigma, lifetime trauma, depressive symptoms, HCE, and antiretroviral therapy (ART) adherence. A path analysis was conducted using structural equation modeling software to fit a theory-based model of HCE. Results included statistically significant direct pathways between depressive symptoms, healthcare provider relationship, lifetime trauma, and ART adherence, as well as between healthcare provider relationship, HIV treatment knowledge, and HCE. Specifically, ART adherence was positively linked to healthcare provider relationship and negatively linked to depressive symptoms and lifetime trauma. In addition, healthcare provider relationship and HIV treatment knowledge were positively associated with HCE. The indirect effects of healthcare provider relationship and HIV treatment knowledge on adherence through HCE were also significant. In particular, ART adherence was indirectly and positively affected by healthcare provider relationship and HIV treatment knowledge through HCE. Multi-level interventions are urgently needed to address the effects of these psychosocial factors on ART adherence.
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Affiliation(s)
- Jacob J. van den Berg
- Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, School of Public Health, Providence, Rhode Island
| | | | - Mallory O. Johnson
- Department of Medicine, University of California, San Francisco, California
| | - Bing Chen
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island
| | - Parya Saberi
- Department of Medicine, University of California, San Francisco, California
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Ebrahimzadeh Z, Goodarzi MA, Joulaei H. The Clarification of Depression and Social Support's Contribution to the Prediction of Antiretroviral Medication Adherence and the Rate of CD4 in People with HIV. Glob J Health Sci 2016; 8:54842. [PMID: 27157183 PMCID: PMC5064086 DOI: 10.5539/gjhs.v8n9p165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/06/2016] [Accepted: 12/20/2015] [Indexed: 11/12/2022] Open
Abstract
With the development of the antiretroviral therapy, the number of the people with HIV is increasing; therefore, identifying the factors affecting HIV is of great importance. This study aimed to investigate the relationship between the antiretroviral medication adherence and the rate of CD4 with depression and social support in the people with HIV. The research method was a descriptive study kind of correlation. The statistical population included all patients with HIV in Shiraz, of whom, 220 people who had referred to the Behavioral Diseases Consultation Center were selected using the available sampling method. Philips et al.'s Social Support Questionnaire, Beck's Depression Questionnaire II, and ACTG Medication Adherence Questionnaire were used as the research tools. Results were analyzed using the stepwise regression and stepwise hierarchical multiple regression. Regression analysis showed that social support and depression variables could predict totally 47% (P<0.001) of changes of medication adherence variable, and depression could predict only 2% (P<0.01) of rate variance of CD4.
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Shin S, Muñoz M, Caldas A, Ying Wu, Zeladita J, Wong M, Espiritu B, Sanchez E, Callacna M, Rojas C, Arevalo J, Sebastian JL, Bayona J. Mental Health Burden Among Impoverished HIV-Positive Patients in Peru. ACTA ACUST UNITED AC 2016; 10:18-25. [PMID: 21368011 DOI: 10.1177/1545109710385120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV and poor mental health are intricately related. In settings of poverty, both are often rooted in structural factors related to material and social deprivation. We performed a qualitative analysis to understand factors contributing to poor emotional health and its impact among impoverished Peruvian HIV-infected individuals. We conducted focus group discussions with patients and providers consisting of semistructured, open-ended questions. Qualitative analysis provided insight into the profound impact of depression, isolation, stigma, and lack of social support among these patients. Living with HIV contributed significantly to mental health problems experienced by HIV-positive individuals; furthermore, long-standing stressors-such as economic hardship, fragmented family relationships, and substance use-shaped patients' outlooks, and may have contributed not only to current emotional hardship but to risk factors for contracting HIV as well. Once diagnosed with HIV/AIDS, many patients experienced hopelessness, stigma, and socioeconomic marginalization. Patients tended to rely on informal sources of support, including peers and community health workers, and rarely used formal mental health services. In resource-poor settings, the context of mental health problems among HIV-positive individuals must be framed within the larger structural context of poverty and social exclusion. Optimal strategies to address the mental health problems of these individuals should include integrating mental health services into HIV care, task shifting to utilize community health workers where human resources are scarce, and interventions aimed at poverty alleviation.
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Affiliation(s)
- Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Socios En Salud Sucursal Perú, Lima, Peru, Harvard Medical School, Boston, MA, USA, Division of Infectious Diseases, Brigham and Women's Hospital, Boston MA, USA,
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Hergenrather KC, Zeglin RJ, Conyers L, Misrok M, Rhodes SD. Persons Living With HIV/AIDS: Employment as a Social Determinant of Health. REHABILITATION RESEARCH POLICY AND EDUCATION 2016. [DOI: 10.1891/2168-6653.30.1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: For persons living with HIV/AIDS (PLWHA), the advent of highly active antiretroviral therapy has increased their longevity and quality of life. As HIV progresses, many PLWHA present declined domains of functioning that impede their ability to work. The authors explore employment as a social determinant of health to identify issues impacting employment outcomes for PLWHA.Methods: The authors reviewed the literature addressing HIV across the domains of mental health functioning, neurocognitive functioning, and physical function and employment.Results: When providing employment services to PLWHA, considerations for rehabilitation practitioners and educators include HIV/AIDS education, functional assessment, social support, considerations for women with HIV, highly active antiretroviral therapy (HAART), HIV/AIDS stigma, and employment resources for PLWHA.Conclusion: With more than 1.2 million PLWHA in the United States, and most of new infections among persons 25–44 years of age, the prevalence of PLWHA seeking employment and inclusive of the U.S. workforce will continue to increase. Proving employment services for PLWHA is a complex process that is best served by an integrative service approach.
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Tillery R, Howard Sharp KM, Okado Y, Long A, Phipps S. Profiles of Resilience and Growth in Youth With Cancer and Healthy Comparisons. J Pediatr Psychol 2015; 41:290-7. [PMID: 26423321 DOI: 10.1093/jpepsy/jsv091] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/25/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Inconsistent links between posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in youth following a stressful life event have been observed in previous literature. Latent profile analysis (LPA) provides a novel approach to examine the heterogeneity of relations between these constructs. METHOD Participants were 435 youth (cancer group=253; healthy comparisons = 182) and one parent. Children completed measures of PTS, PTG, and a life-events checklist. Parents reported on their own PTS and PTG. LPA was conducted to identify distinct adjustment classes. RESULTS LPA revealed three profiles. The majority of youth (83%) fell into two resilient groups differing by levels of PTG. Several factors predicted youth's profile membership. CONCLUSIONS PTS and PTG appear to be relatively independent constructs, and their relation is dependent on contextual factors. The majority of youth appear to be resilient, and even those who experience significant distress were able to find benefit.
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Affiliation(s)
- Rachel Tillery
- Department of Psychology, St. Jude Children's Research Hospital and Department of Psychology, The University of Memphis
| | - Katianne M Howard Sharp
- Department of Psychology, St. Jude Children's Research Hospital and Department of Psychology, The University of Memphis
| | - Yuko Okado
- Department of Psychology, St. Jude Children's Research Hospital and
| | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital and
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital and
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Adejumo O, Oladeji B, Akpa O, Malee K, Baiyewu O, Ogunniyi A, Evans S, Berzins B, Taiwo B. Psychiatric disorders and adherence to antiretroviral therapy among a population of HIV-infected adults in Nigeria. Int J STD AIDS 2015; 27:938-49. [PMID: 26384949 DOI: 10.1177/0956462415600582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/22/2015] [Indexed: 12/12/2022]
Abstract
Psychiatric disorders are common among people living with HIV in Nigeria. Adherence is necessary to optimise the outcome of antiretroviral therapy. In this study, we aimed to identify associations between antiretroviral adherence, measured by one-week and one-month self-reported missed doses, and psychiatric illness in a cohort previously assessed for psychiatric disorders using the Composite International Diagnostic Interview. The study participants comprised 151 adults with major depression, anxiety or suicidal symptoms, and 302 matched-control participants. Two controls were randomly selected for each case within the same gender and education level. We compared participants with psychiatric disorders (WPDs) and no psychiatric disorders (NPDs) on selected demographic and clinical variables, in addition to adherence. Participants with one or more missed doses in the preceding month had twice the odds of having a major depressive episode as those with no missed doses during this period (OR 2.22, 95% CI 1.03, 4.79). This association remained significant after adjusting for selected risk factors. There was no statistically significant difference between WPD and NPD groups on either one-week or one-month adherence, or on age, marital status, occupational class, HIV viral load at enrolment or current CD4 cell count. Among Nigerian adults with HIV, suboptimal antiretroviral adherence is associated with, and could be a sign of, depression. Routine self-report adherence assessments may potentially be utilised in identifying individuals at risk among this population.
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Affiliation(s)
| | | | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | - Kay Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Scott Evans
- Harvard School of Public Health, Boston, MA, USA
| | - Baiba Berzins
- Center for Global Health, Northwestern University, USA
| | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wagner GJ, Ghosh-Dastidar B, Slaughter ME, Akena D, Nakasujja N, Musisi S. Changes in condom use during the first year of HIV treatment in Uganda and the relationship to depression. Ann Behav Med 2015; 48:175-83. [PMID: 24504978 DOI: 10.1007/s12160-013-9586-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE We examined the effect of antiretroviral therapy (ART), and the predictive role of depression, on condom use with primary partners. METHODS Data from three studies in Uganda were combined into a sample of 750 patients with a primary sex partner, with 502 starting ART and 248 entering HIV care, and followed for 12 months. Random-effects logistic regression models were used to examine the impact of ART, and the influence of baseline level and change in depression, on condom use with primary partners. RESULTS At month 12, 61 % ART and 67 % non-ART patients were consistent condom users, compared to 44 and 41 % at baseline, respectively. Multivariate analysis revealed that consistent condom use increased similarly for ART and non-ART patients, and that minor depression at baseline and increased depression over time predicted inconsistent condom use. CONCLUSIONS Improved depression diagnosis and treatment could benefit HIV prevention.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA,
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Blashill AJ, Ehlinger PP, Mayer KH, Safren SA. Optimizing adherence to preexposure and postexposure prophylaxis: the need for an integrated biobehavioral approach. Clin Infect Dis 2015; 60 Suppl 3:S187-90. [PMID: 25972502 PMCID: PMC4551106 DOI: 10.1093/cid/civ111] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) has been shown to be effective in preventing transmission of human immunodeficiency virus (HIV). A dose-response relationship between adherence and HIV transmission is illustrated in the current PrEP literature, and adherence interventions for PrEP may be useful, although currently few effective programs have been developed and tested. There is a paucity of randomized controlled trials testing PEP adherence interventions, and further research is needed. We conclude by proposing the importance of tailoring adherence counseling to address psychosocial factors and mental health stressors that may negatively affect adherence.
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Affiliation(s)
- Aaron J. Blashill
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- Fenway Health
| | | | - Kenneth H. Mayer
- Harvard Medical School
- Fenway Health
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Steven A. Safren
- Department of Psychiatry, Massachusetts General Hospital
- Harvard Medical School
- Fenway Health
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Santillán Torres Torija C, Villagrán Vázquez G, Robles Montijo SS, de Lourdes Eguiluz Romo L. The Information and Motivation and Behavioral Skills Model of ART Adherence among HIV-Positive Adults in Mexico. J Int Assoc Provid AIDS Care 2015; 14:335-42. [PMID: 25979257 DOI: 10.1177/2325957415581903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Middle-income countries are in need of research that uses theoretical-based models to assess factors that predict adherence to antiretroviral therapy (ART) and help in the design, implementation, and evaluation of interventions for nonadherent populations. In Mexico, the Information and Motivation and Behavioral Skills (IMB) Model of ART Adherence constructs is useful in describing and predicting adherence behaviors in various samples but has not been articulated to people living with HIV (PLWH) on ART. The aim of this was to characterize the IMB core constructs and identify correlates of ART adherence in an HIV-positive clinic sample in Mexico. METHODS A convenience sample of 109 HIV-positive patients attending their monthly visits at a local public hospital were interviewed with the Spanish version of the LifeWindows IMB ART Adherence Questionnaire (LW-IMB-AAQ) as well as a sociodemographic questionnaire. All participants were recruited from a hospital-based outpatient clinical care site. RESULTS Partial confirmation of the relationships proposed by the IMB Model of ART Adherence was found. As predicted by the model, only behavioral skills had direct association with all measures of self-reported adherence, and motivation was associated with behavioral skills. Information did not demonstrate significant relations to either motivation or behavioral skills, nor did it directly associate with adherence. Self-reported adherence did not associate with CD4 counts, nor did any of the IMB model core constructs. CONCLUSION Applicability of the IMB Model of ART Adherence in this setting is discussed. The IMB Model of ART Adherence offered promise in this population and could help tailor population-specific interventions to promote high rates of ART adherence.
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Coe AB, Moczygemba LR, Gatewood SBS, Osborn RD, Matzke GR, Goode JVR. Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic. Res Social Adm Pharm 2015; 11:e110-20. [PMID: 23218849 PMCID: PMC3733792 DOI: 10.1016/j.sapharm.2012.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/16/2012] [Accepted: 11/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. OBJECTIVES To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. METHODS The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008-September 2009. Patients experiencing or at risk of homelessness who were ≥18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient's reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. RESULTS A total of 426 individuals met study criteria. The mean age was 44.7 ± 10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients' medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19-0.87) were less likely to have a medication adherence problem identified during the medication review. CONCLUSIONS The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.
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Affiliation(s)
- Antoinette B Coe
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States.
| | - Leticia R Moczygemba
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | - Sharon B S Gatewood
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | | | - Gary R Matzke
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | - Jean-Venable R Goode
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
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Mehari D, Mache T, Hailemariam L. Predictors of lost to follow up to antiretroviral therapy in primary public hospital of Wukro, Tigray, Ethiopia: A case control study. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/jahr2014.0315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Tavakkoli M, Cohen MA, Alfonso CA, Batista SM, Tiamson-Kassab MLA, Meyer P. Caring for persons with early childhood trauma, PTSD, and HIV: a curriculum for clinicians. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:696-700. [PMID: 25005006 DOI: 10.1007/s40596-014-0186-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
Access and adherence to medical care enable persons with HIV to live longer and healthier lives. Adherence to care improves quality of life, prevents progression to AIDS, and also has significant public health implications. Early childhood trauma-induced posttraumatic stress disorder (PTSD) is one factor that has been identified as an obstacle to adherence to both risk reduction and HIV care. The authors developed a 4-h curriculum to provide clinicians with more confidence in their ability to elicit a trauma history, diagnose PTSD, and address trauma and its sequelae in persons with HIV to improve adherence to medical care, antiretroviral medications, and risk reduction. The curriculum was designed to address the educational needs of primary care physicians, infectious disease specialists, psychiatrists, other specialists, psychologists, social workers, nurses, residents, medical students, and other trainees who provide care for persons infected with and affected by HIV.
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Abara WE, Smith L, Zhang S, Fairchild AJ, Heiman HJ, Rust G. The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS. Am J Public Health 2014; 104:e135-41. [PMID: 25211735 DOI: 10.2105/ajph.2014.302227] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). METHODS We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). RESULTS Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. CONCLUSIONS Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.
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Affiliation(s)
- Winston E Abara
- Winston E. Abara is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Lerissa Smith and Harry J. Heiman are with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta. Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine. Amanda J. Fairchild is with the Department of Psychology, University of South Carolina, Columbia
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