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Bwambale MF, Bukuluki P, Moyer CA, van den Borne BHW. Demographic and behavioural drivers of intra-urban mobility of migrant street children and youth in Kampala, Uganda. PLoS One 2021; 16:e0247156. [PMID: 33600461 PMCID: PMC7891785 DOI: 10.1371/journal.pone.0247156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53-0.96), sex work (aIRR = 1.38, 95%CI 1.01-1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16-2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17-2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended.
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Affiliation(s)
- Mulekya Francis Bwambale
- Department of Health Education & Promotion, University of Maastricht Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, College of Humanities and Social Sciences, Kampala, Uganda
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, College of Humanities and Social Sciences, Kampala, Uganda
| | - Cheryl A. Moyer
- Departments of Learning Health Sciences and Obstetrics and Gynaecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Bart H. W. van den Borne
- Department of Health Education & Promotion, University of Maastricht Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands
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DeShields RD, Lucas JP, Turner M, Amola K, Hunter V, Lykes S, Rompalo AM, Vermund SH, Fischer S, Haley DF. Building Partnerships and Stakeholder Relationships for HIV Prevention: Longitudinal Cohort Study Focuses on Community Engagement. Prog Community Health Partnersh 2021; 14:29-42. [PMID: 32280121 DOI: 10.1353/cpr.2020.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND African American women bear disproportionate human immunodeficiency virus (HIV) burden in the United States, yet are often underrepresented in clinical research. Community engagement may decrease research mistrust and increase participation. We describe strategies used to engage community partners and female participants in a multisite HIV incidence study, HIV Prevention Trials Network (HPTN) 064. OBJECTIVES HPTN 064 assessed HIV incidence among women in 10 geographic areas chosen for both high prevalence of HIV and poverty. METHODS Women were recruited using venue-based sampling and followed for six to 12 months. Recruitment and engagement approaches aligned with the National Institutes of Health (NIH) Director's Council of Public Representatives (COPR) Community Engagement Framework's. RESULTS Results showed engagement activities increased rapport and established new partnerships with community stakeholders. Study sites engaged 56 community organizations with 2,099 women enrolled in 14 months. Final retention was 94%. CONCLUSIONS The COPR model maximized inclusiveness and participation of African American women impacted by HIV, supported recruitment and retention, and was the cornerstone of community engagement.
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3
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Beasley LO, Ciciolla L, Jespersen JE, Chiaf AL, Schmidt M, Shreffler KM, Breslin FJ, Bakhireva LN, Sanjuan PM, Stephen JM, Coles CD, Chambers CD, Kable JA, Leeman L, Singer LT, Zellner J, Morris AS, Croff JM. Best Practices for Engaging Pregnant and Postpartum Women at Risk of Substance Use in Longitudinal Research Studies: a Qualitative Examination of Participant Preferences. ACTA ACUST UNITED AC 2020; 1:235-246. [PMID: 33134976 PMCID: PMC7592139 DOI: 10.1007/s42844-020-00019-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
There are significant barriers in engaging pregnant and postpartum women that are considered high-risk (e.g., those experiencing substance use and/or substance use disorders (SUD)) into longitudinal research studies. To improve recruitment and retention of this population in studies spanning from the prenatal period to middle childhood, it is imperative to determine ways to improve key research engagement factors. The current manuscript uses a qualitative approach to determine important factors related to recruiting, enrolling, and retaining high-risk pregnant and postpartum women. The current sample included 41 high-risk women who participated in focus groups or individual interviews. All interviews were analyzed to identify broad themes related to engaging high-risk pregnant and parenting women in a 10-year longitudinal research project. Themes were organized into key engagement factors related to the following: (1) recruitment strategies, (2) enrollment, and (3) retention of high-risk pregnant and parenting women in longitudinal research studies. Results indicated recruitment strategies related to ideal recruitment locations, material, and who should share research study information with high-risk participants. Related to enrollment, key areas disclosed focused on enrollment decision-making, factors that create interest in joining a research project, and barriers to joining a longitudinal research study. With regard to retention, themes focused on supports needed to stay in research, barriers to staying in research, and best ways to stay in contact with high-risk participants. Overall, the current qualitative data provide preliminary data that enhance the understanding of a continuum of factors that impact engagement of high-risk pregnant and postpartum women in longitudinal research with current results indicating the need to prioritize recruitment, enrollment, and retention strategies in order to effectively engage vulnerable populations in research.
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Affiliation(s)
- Lana O Beasley
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Lucia Ciciolla
- Department of Psychology, Oklahoma State University, Stillwater, OK USA
| | - Jens E Jespersen
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Ashleigh L Chiaf
- National Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | - Mallory Schmidt
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Karina M Shreffler
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | | | - Ludmila N Bakhireva
- Department of Pharmacy Practice, University of New Mexico School of Pharmacy, Albuquerque, NM USA.,Department of Family and Community Medicine, and Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Pilar M Sanjuan
- Department of Psychology, University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Julia M Stephen
- Department of Neurosciences, University of New Mexico School of Medicine, & The Mind Research Network, Albuquerque, NM USA
| | - Claire D Coles
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Lawrence Leeman
- Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Lynn T Singer
- Departments of Pediatrics, Psychiatry and Psychology, School of Medicine at Case Western Reserve University, Cleveland, OH USA
| | - Jennifer Zellner
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
| | - Amanda S Morris
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Julie M Croff
- National Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK USA.,Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
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4
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Comins CA, Rucinski KB, Baral S, Abebe SA, Mulu A, Schwartz SR. Vulnerability profiles and prevalence of HIV and other sexually transmitted infections among adolescent girls and young women in Ethiopia: A latent class analysis. PLoS One 2020; 15:e0232598. [PMID: 32407394 PMCID: PMC7224533 DOI: 10.1371/journal.pone.0232598] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Adolescent girls and young women (AGYW) aged 15–24 years have among the highest risk for HIV and other sexually transmitted infections (STI) across sub-Saharan Africa. A latent class analysis (LCA) was conducted to identify intersecting social- and structural-level determinants of HIV/STI acquisition among AGYW in Ethiopia. Methods AGYW were recruited from venues using time-location sampling, completing an interviewer-administered behavioral survey and biological testing for HIV, syphilis, and chlamydia. LCA was used to identify distinct groups, defined by social- and structural-level determinants of HIV/STI risk, among AGYW. Prevalence ratios (PR) and 95% confidence intervals (CI) compared differences in HIV/STI prevalence by group. Results A total of 1,501 AGYW were enrolled across Addis Ababa (March–May 2018) and Gambella (June–July 2019). We identified three patterns of vulnerability defined by schooling status, migration history, food insecurity, orphan status, social support, and employment. We labeled these groups as “highly vulnerable” (representing ~21% of the population), “stable, out-of-school, migrated” (~42%), and “stable, in-school, never migrated” (~37%). STI prevalence was nearly two-fold higher among AGYW in the “highly vulnerable” group compared to AGYW in the “stable, in-school, never migrated” group (PR 1.93; 95% CI 1.33, 2.80). Conclusions Characterizing patterns of vulnerability among AGYW that reflect higher-level social and structural factors can help facilitate early identification of AGYW at the highest risk of HIV/STI acquisition, thus differentiating groups of AGYW who may most benefit from targeted HIV prevention interventions during adolescence and early adulthood.
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Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Katherine B. Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Sheree R. Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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5
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Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia. AIDS Behav 2019; 23:183-193. [PMID: 31134462 PMCID: PMC6773675 DOI: 10.1007/s10461-019-02537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February–June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia.
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6
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Khan B, Lee HW, Fellows I, Dombrowski K. One-step estimation of networked population size: Respondent-driven capture-recapture with anonymity. PLoS One 2018; 13:e0195959. [PMID: 29698493 PMCID: PMC5919671 DOI: 10.1371/journal.pone.0195959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/31/2018] [Indexed: 11/25/2022] Open
Abstract
Size estimation is particularly important for populations whose members experience disproportionate health issues or pose elevated health risks to the ambient social structures in which they are embedded. Efforts to derive size estimates are often frustrated when the population is hidden or hard-to-reach in ways that preclude conventional survey strategies, as is the case when social stigma is associated with group membership or when group members are involved in illegal activities. This paper extends prior research on the problem of network population size estimation, building on established survey/sampling methodologies commonly used with hard-to-reach groups. Three novel one-step, network-based population size estimators are presented, for use in the context of uniform random sampling, respondent-driven sampling, and when networks exhibit significant clustering effects. We give provably sufficient conditions for the consistency of these estimators in large configuration networks. Simulation experiments across a wide range of synthetic network topologies validate the performance of the estimators, which also perform well on a real-world location-based social networking data set with significant clustering. Finally, the proposed schemes are extended to allow them to be used in settings where participant anonymity is required. Systematic experiments show favorable tradeoffs between anonymity guarantees and estimator performance. Taken together, we demonstrate that reasonable population size estimates are derived from anonymous respondent driven samples of 250-750 individuals, within ambient populations of 5,000-40,000. The method thus represents a novel and cost-effective means for health planners and those agencies concerned with health and disease surveillance to estimate the size of hidden populations. We discuss limitations and future work in the concluding section.
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Affiliation(s)
- Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Hsuan-Wei Lee
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Ian Fellows
- Fellow Statistics, San Diego, California, United States of America
| | - Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
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7
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Zhong L, Zhang Q, Li X. Modeling the Intervention of HIV Transmission across Intertwined Key Populations. Sci Rep 2018; 8:2432. [PMID: 29402964 PMCID: PMC5799486 DOI: 10.1038/s41598-018-20864-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/26/2018] [Indexed: 11/23/2022] Open
Abstract
The HIV transmissions between multiple key populations make interventions difficult, particularly with multiple transmission behaviors. It remains unclear how significant the role of bridge individuals (who connect multiple communities) is in HIV transmission, and how to develop more effective intervention strategies targeting different transmission modes across key populations. In this research, we proposed a 2-layer social network framework to simulate the HIV transmissions across female sex workers (FSWs) and persons who inject drugs (PWID) through two behaviors: unprotected sex and needle-sharing. We proposed a set of intervention strategies based on the topological properties of individuals in the social network and estimated the efficacy of these strategies. Simulation studies demonstrated that bridge individuals played a significant role in HIV transmissions across the two networks. Prevention on such bridge individuals could help reduce both the scale and speed of HIV transmissions.
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Affiliation(s)
- Lu Zhong
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong, SAR, China
| | - Qingpeng Zhang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong, SAR, China.
- Shenzhen Research Institute of City University of Hong Kong, Shenzhen, Guangdong, China.
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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8
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Graves SK, Little SJ, Hoenigl M. Risk profile and HIV testing outcomes of women undergoing community-based testing in San Diego 2008-2014. Sci Rep 2017; 7:42183. [PMID: 28165056 PMCID: PMC5292713 DOI: 10.1038/srep42183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/06/2017] [Indexed: 11/09/2022] Open
Abstract
Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing.
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Affiliation(s)
- Susannah K. Graves
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
| | - Susan J. Little
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California San Diego, San Diego, California, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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9
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Frew PM, Parker K, Vo L, Haley D, O'Leary A, Diallo DD, Golin CE, Kuo I, Soto-Torres L, Wang J, Adimora AA, Randall LA, Del Rio C, Hodder S. Socioecological factors influencing women's HIV risk in the United States: qualitative findings from the women's HIV SeroIncidence study (HPTN 064). BMC Public Health 2016; 16:803. [PMID: 27530401 PMCID: PMC4988035 DOI: 10.1186/s12889-016-3364-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. Methods We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18–44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices. Results The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. Conclusions Multilevel syndemic factors contribute to women’s vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk. Trial registration Clinicaltrials.gov, NCT00995176
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Affiliation(s)
- Paula M Frew
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA. .,Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA. .,Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA. .,Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA.
| | - Kimberly Parker
- Department of Health Studies, Texas Woman's University, CFO Bldg - 1007, PO Box 425499, Denton, TX, 76204, USA
| | - Linda Vo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA
| | - Danielle Haley
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA
| | - Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | | | - Carol E Golin
- Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA
| | - Irene Kuo
- George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, Washington, DC, USA
| | - Jing Wang
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA
| | - Laura A Randall
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA.,Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.,Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA
| | - Sally Hodder
- West Virginia University School of Medicine, One Medical Center Drive, HSC-South 2244, Morgantown, WV, 26506, USA
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Golin CE, Haley DF, Wang J, Hughes JP, Kuo I, Justman J, Adimora AA, Soto-Torres L, O'Leary A, Hodder S. Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S. J Health Care Poor Underserved 2016; 27:891-910. [PMID: 27180715 PMCID: PMC4970215 DOI: 10.1353/hpu.2016.0093] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods.
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11
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Antiretroviral Drug Use in a Cohort of HIV-Uninfected Women in the United States: HIV Prevention Trials Network 064. PLoS One 2015; 10:e0140074. [PMID: 26445283 PMCID: PMC4596522 DOI: 10.1371/journal.pone.0140074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
Antiretroviral (ARV) drug use was analyzed in HIV-uninfected women in an observational cohort study conducted in 10 urban and periurban communities in the United States with high rates of poverty and HIV infection. Plasma samples collected in 2009–2010 were tested for the presence of 16 ARV drugs. ARV drugs were detected in samples from 39 (2%) of 1,806 participants: 27/181 (15%) in Baltimore, MD and 12/179 (7%) in Bronx, NY. The ARV drugs detected included different combinations of non-nucleoside reverse transcriptase inhibitors and protease inhibitors (1–4 drugs/sample). These data were analyzed in the context of self-reported data on ARV drug use. None of the 39 women who had ARV drugs detected reported ARV drug use at any study visit. Further research is needed to evaluate ARV drug use by HIV-uninfected individuals.
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12
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Hughes JP, Haley DF, Frew PM, Golin CE, Adimora AA, Kuo I, Justman J, Soto-Torres L, Wang J, Hodder S. Regression to the mean and changes in risk behavior following study enrollment in a cohort of U.S. women at risk for HIV. Ann Epidemiol 2015; 25:439-44. [PMID: 25883065 PMCID: PMC4433583 DOI: 10.1016/j.annepidem.2015.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/04/2015] [Accepted: 03/14/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Reductions in risk behaviors are common following enrollment in human immunodeficiency virus (HIV) prevention studies. We develop methods to quantify the proportion of change in risk behaviors that can be attributed to regression to the mean versus study participation and other factors. METHODS A novel model that incorporates both regression to the mean and study participation effects is developed for binary measures. The model is used to estimate the proportion of change in the prevalence of "unprotected sex in the past 6 months" that can be attributed to study participation versus regression to the mean in a longitudinal cohort of women at risk for HIV infection who were recruited from ten U.S. communities with high rates of HIV and poverty. HIV risk behaviors were evaluated using audio computer-assisted self-interviews at baseline and every 6 months for up to 12 months. RESULTS The prevalence of "unprotected sex in the past 6 months" declined from 96% at baseline to 77% at 12 months. However, this change could be almost completely explained by regression to the mean. CONCLUSIONS Analyses that examine changes over time in cohorts selected for high- or low- risk behaviors should account for regression to the mean effects.
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Affiliation(s)
- James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Danielle F Haley
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA; Family Health International-FHI360, Durham, NC
| | - Paula M Frew
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA; Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Carol E Golin
- School of Medicine, University of North Carolina, Chapel Hill, NC; Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
| | - Adaora A Adimora
- School of Medicine, University of North Carolina, Chapel Hill, NC; Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC
| | - Jessica Justman
- Departments of Epidemiology and Medicine, ICAP at Columbia, Columbia University, New York, NY
| | | | - Jing Wang
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sally Hodder
- West Virginia University Clinical and Translational Science Institute, Morgantown, WV
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13
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Gesink D, Mihic A, Antal J, Filsinger B, Racey CS, Perez DF, Norwood T, Ahmad F, Kreiger N, Ritvo P. Who are the under- and never-screened for cancer in Ontario: a qualitative investigation. BMC Public Health 2014; 14:495. [PMID: 24885998 PMCID: PMC4229738 DOI: 10.1186/1471-2458-14-495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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14
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Haley DF, Lucas J, Golin CE, Wang J, Hughes JP, Emel L, El-Sadr W, Frew PM, Justman J, Adimora AA, Watson CC, Mannheimer S, Rompalo A, Soto-Torres L, Tims-Cook Z, Carter Y, Hodder SL. Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064). AIDS Patient Care STDS 2014; 28:206-17. [PMID: 24697160 DOI: 10.1089/apc.2013.0366] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18-44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts.
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Affiliation(s)
- Danielle F. Haley
- FHI 360, Durham, North Carolina
- Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia
| | | | - Carol E. Golin
- University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jing Wang
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - James P. Hughes
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Lynda Emel
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wafaa El-Sadr
- ICAP-Columbia University, Mailman School of Public Health, New York, New York
| | - Paula M. Frew
- Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Justman
- ICAP-Columbia University, Mailman School of Public Health, New York, New York
| | - Adaora A. Adimora
- University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Sharon Mannheimer
- ICAP-Columbia University, Mailman School of Public Health, New York, New York
- Harlem Hospital Center, New York, New York
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | - Yvonne Carter
- University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina
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