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Dlamini BP, Mtshali NG. Views of adolescents living with perinatally acquired HIV on HIV status disclosure in Eswatini. AIDS Care 2023:1-9. [PMID: 38157356 DOI: 10.1080/09540121.2023.2299334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
HIV is recognised as a multifaceted chronic disease, bearing psychosocial consequences that potentially impact on the personal and social well-being of those living with it. Adolescents and youth bear a significant proportion of the burden of the HIV epidemic but they have low rates of disclosure of their HIV status. This study aims to determine the views of adolescents living with perinatally acquired HIV on HIV status disclosure among 361 adolescents aged 15-19 in Eswatini. A cross-sectional study was conducted on adolescents who already knew their status, and data were collected using a structured questionnaire. A majority of the participants, 55% (n = 200), were females, and 44% (n = 160) were males. A low number of adolescents (22%) had disclosed their HIV status to anyone. Adolescents who found it difficult to understand disclosure themselves had low levels of onward disclosure (27%) compared to adolescents who better understood the disclosure event. Our results revealed that adolescents' prevalence of HIV status disclosure was low. This raises concerns as some of the adolescents were in relationships with partners who were not aware of their status. However, older adolescents displayed some level of disclosure self-efficacy in that a higher proportion of them disclosed better than younger adolescents.
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Affiliation(s)
- Baliwe P Dlamini
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Omanga E, Inwani I, Agot K, Buttolph J, Nduati R, Macharia P, Onyango J, Kurth A. Understanding sexual behaviors of youth from the lens of caregivers, teachers, local leaders and youth in Homabay County, Kenya. Reprod Health 2023; 20:141. [PMID: 37723500 PMCID: PMC10507942 DOI: 10.1186/s12978-023-01680-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
In Kenya similar to other countries in Eastern and Southern Africa There is a disproportionately high burden of the global HIV incidence among youth ages 15-24 years, and where adolescent girls and young women account for up to a third of all incident HIV infections and more than double the burden of HIV compared to their male peers. Previous work has shown early sexual debut as entry point into risks to sexual and reproductive health among young people including STI/HIV acquisition. This was a formative assessment of the local context of three sexual risk behaviors among youth ages of 15-24 years: early sexual debut, multiple sexual partnerships, and age-mixing /intergenerational sex for purposes of informing comprehensive combination HIV intervention program design. We conducted a cross-sectional formative qualitative study in four sub-counties within Homabay county a high HIV prevalence region of Kenya. Participants were recruited through youth groups, schools, government offices and, community gatekeepers using approved fliers, referred to a designated venue for focus group discussion (FGD). After oral informed consent, twelve FGDs of 8-10 participants were carried out. Transcripts and field notes were uploaded to Atlas.ti qualitative data analysis and research software (version 8.0, 2017, ATLAS.ti GmbH). Open coding followed by grouping, categorization of code groups, and thematic abstraction was used to draw meaning for the data. A total of 111 youth participated in the FGD, 65 males and 46 females. The main findings were that youth engaged in early sex for fear of being labeled 'odd' by their peers, belief (among both male and female) that 'practice makes perfect', curiosity about sex, media influence, need to prove if one can father a child (among male), the notion that sex equals love with some of the youth using this excuse to coerce their partners into premature sex, and the belief that sex is a human right and parents/guardians should not intervene. Male youth experienced more peer-pressure to have sex earlier. Female youths cited many reasons to delay coitarche that included fear of pregnancy, burden of taking care of a baby, and religious doctrines. Having multiple sexual partners and intergenerational sexual relationships were common among the youth driven by perceived financial gain and increased sexual prowess. HIV prevention strategies need to address gender vulnerabilities, as well as promoting a protective environment, hence application of combination prevention methods is a viable solution to the HIV pandemic.Trial registration number: The study was approved by the KNH/UoN Ethics review committee (KNH/UoN ERC-P73/03/2011) and New York University (NYU Reg no.-00000310).
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Affiliation(s)
| | - Irene Inwani
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jasmine Buttolph
- Yale University, New Haven, CT, USA
- United States Agency for International Development (USAID), Washington, DC, USA
| | - Ruth Nduati
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Paul Macharia
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - Ann Kurth
- The New York Academy of Medicin (NYAM), New York, USA
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Diura-Vere O, Mokgatle MM, Oguntibeju OO. Sexual Behaviour and Attitudes towards Safe Sex of Youth Receiving Antiretroviral Care at Public Health Facilities in Palapye District, Botswana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3790. [PMID: 36900803 PMCID: PMC10001564 DOI: 10.3390/ijerph20053790] [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: 02/01/2023] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sexual behaviour of HIV-infected youths is very important in determining the direction of the HIV epidemic, as these youths are reservoirs of HIV and can propagate its transmission if they engage in risky sexual behaviours. However, support structures for secondary prevention are weak even in healthcare settings. There is a need to understand the sexual behaviour of these youths and, in turn, tailor appropriate secondary prevention strategies, hence the current study was designed to assess sexual behaviour and attitudes towards safe sex of youth receiving antiretroviral care at public health facilities in Palapye district, Botswana. METHOD This quantitative, descriptive cross-sectional survey was used to describe the sexual behaviour and attitudes towards safe sex and identify factors associated with risky sexual behaviours among HIV-infected youths aged between 15 and 19 years receiving antiretroviral therapy (ART) care from public healthcare facilities in Palapye District, Botswana. RESULTS A total of 188 youths participated in this study, 56% being females while 44% were males. We reported that 15.4% had ever had sex. At their last sexual encounter, more than half of the youths (51.7%) had not used condoms. More than a third of the participants were under the influence of alcohol during their last sexual experience. Generally, the youths had good attitudes towards safe sex, as most youths said they would prioritise protecting their sexual partners and themselves from HIV and STIs. Alcohol use, substance use and not considering religion as important were strongly associated with having ever had sex. CONCLUSIONS A significant proportion of HIV-infected youths are sexually active, whereas their preventive practices such as condom use are poor despite good attitudes towards safe sex. Alcohol use, substance use and not perceiving religion as important were associated with risky sexual behaviours.
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Affiliation(s)
- Onai Diura-Vere
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Mathildah M. Mokgatle
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa
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Small LA, Huynh AK, Parchment TM. The association between self-Esteem, stigma, and mental health among South African youth living with HIV: the need for integrated HIV care services. AIDS Care 2022; 34:86-94. [PMID: 34839770 PMCID: PMC8785656 DOI: 10.1080/09540121.2021.2002253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Treatment among pYLHIV focuses on their physical health. However, they also experience depression and anxiety, compounded by developmental challenges and the stress of managing a chronic illness. However, limited services are available to help pYLHIV manage the emotional stressors of living with a stigmatized condition. Data are from 37 caregiver-child dyads in the VUKA EKHAYA study, in Durban, South Africa. Outcomes were self-esteem and stigma. Predictors included symptoms of depression and anxiety, and HIV treatment and transmission knowledge. Outcomes and predictors were standardized (mean: 0, standard deviation: 1). Pearson correlation, bivariate and multivariate associations between predictors and outcomes were examined. Self-esteem was negatively correlated with symptoms of anxiety (r=-0.5675; p<0.001) and depression (r=-0.6836; p<0.001), suggesting higher self-concept was correlated with fewer symptoms. In multivariate analyses, increased depressive and anxiety symptoms were associated with lower self-esteem, B=0.68 and 0.57, respectively. Higher depressive and anxiety symptoms connected to more internalized stigma B=0.38 and 0.34, respectively. Conversely, HIV knowledge was not related to self-esteem or stigma. HIV treatment and transmission knowledge are not enough to reduce stigma and improve the self-esteem of pYLHIV. Integrated mental and physical health care is needed to help pYLHIV manage psychological stressors that can mitigate their emotional wellbeing.
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Affiliation(s)
- Latoya A. Small
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles
| | - Alexis K. Huynh
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), V.A. Greater Los Angeles Healthcare System
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Mugo C, Seeh D, Guthrie B, Moreno M, Kumar M, John-Stewart G, Inwani I, Ronen K. Association of experienced and internalized stigma with self-disclosure of HIV status by youth living with HIV. AIDS Behav 2021; 25:2084-2093. [PMID: 33389374 PMCID: PMC8768004 DOI: 10.1007/s10461-020-03137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 01/07/2023]
Abstract
We examined patterns of disclosure among youth living with HIV (YLHIV) in Kenya, and the association between self-disclosure and antiretroviral therapy adherence, stigma, depression, resilience, and social support. Of 96 YLHIV, 78% were female, 33% were ages 14-18, and 40% acquired HIV perinatally. Sixty-three (66%) YLHIV had self-disclosed their HIV status; 67% to family and 43% to non-family members. Older YLHIV were 75% more likely to have self-disclosed than those 14-18 years. Of the 68 either married or ever sexually active, 45 (66%) did not disclose to their partners. Those who had self-disclosed were more likely to report internalized stigma (50% vs. 21%, prevalence ratio [PR] 2.3, 1.1-4.6), experienced stigma (26% vs. 3%, PR 11.0, 1.4-86), and elevated depressive symptoms (57% vs. 30%, PR 1.8, 1.0-3.1). The association with stigma was stronger with self-disclosure to family than non-family. Support should be provided to YLHIV during self-disclosure to mitigate psychosocial harms.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya.
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA.
| | - David Seeh
- Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Brandon Guthrie
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
| | - Megan Moreno
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
- Department of Pediatrics, University of Washington, Seattle, WA, 98104, USA
- Department of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
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Low A, Teasdale C, Brown K, Barradas DT, Mugurungi O, Sachathep K, Nuwagaba-Biribonwoha H, Birhanu S, Banda A, Frederix K, Payne D, Radin E, Wiesner L, Ginindza C, Philip N, Musuka G, Sithole S, Patel H, Maile L, Abrams EJ, Arpadi S. Human Immunodeficiency Virus Infection in Adolescents and Mode of Transmission in Southern Africa: A Multinational Analysis of Population-Based Survey Data. Clin Infect Dis 2021; 73:594-604. [PMID: 33912973 PMCID: PMC8366830 DOI: 10.1093/cid/ciab031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 01/04/2023] Open
Abstract
Background Adolescents aged 10–19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015–2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. Methods Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. Results HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%–66.6%) had HIV previously diagnosed, and 47.1% (41.9%–52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. Conclusions These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.
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Affiliation(s)
- Andrea Low
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Chloe Teasdale
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Kristin Brown
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Owen Mugurungi
- Ministry of Health and Child Welfare, AIDS and TB Programme, Harare, Zimbabwe
| | - Karam Sachathep
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Sehin Birhanu
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Koen Frederix
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Danielle Payne
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Elizabeth Radin
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Neena Philip
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Godfrey Musuka
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Sakhile Sithole
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Hetal Patel
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Stephen Arpadi
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Boon-Yasidhi V, Torsakul S, Durier Y, Sittanomai N, Kuntasorn J, Chokephaibulkit K. Disclosure of HIV status to sexual partners among perinatally HIV-infected youth in Thailand. Int J STD AIDS 2021; 32:361-367. [PMID: 33571066 DOI: 10.1177/0956462420968405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Data regarding disclosure of HIV status to sexual partners among perinatally acquired HIV-infected (PHIV) youth are limited, particularly from Asian countries. This cross-sectional study assessed the patterns of, attitudes about, and factors associated with HIV disclosure to sexual partners among PHIV youth aged 15-24 years who attended a pediatric HIV clinic in Thailand. Participants were interviewed using a semi-structured questionnaire designed to elicit demographic and sexual behavior information. Those who had sexual partners were queried about their relationship and HIV status disclosure. Reasons to disclose or not to disclose were assessed accordingly. Among the 51 (44.4%) youth who had sexual partners, 55.8% had steady partners, 45.1% did not always use condoms, and 41.2% disclosed their HIV status. Reasons to disclose included trust and concern about the risk of infection to their partners. Reasons not to disclose included fear of rejection and stigmatization, and not knowing how to disclose. Most youth reported a need for disclosure-related guidance. Knowing their sexual partner's HIV status was the only independent factor associated with disclosure (aOR 14.6; 95% CI 2.8-75.4). This study demonstrates a high rate of unsafe sex and a low rate of partner disclosure in PHIV youth, and highlights the need for a comprehensive guideline for HIV disclosure to sexual partners.
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Affiliation(s)
- Vitharon Boon-Yasidhi
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 546354Mahidol University, Bangkok, Thailand
| | | | - Yuitiang Durier
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 546354Mahidol University, Bangkok, Thailand
| | - Napat Sittanomai
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 546354Mahidol University, Bangkok, Thailand
| | - Jeeranan Kuntasorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 546354Mahidol University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, 546354Mahidol University, Bangkok, Thailand.,Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
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Kidman R, Violari A. Growing up positive: adolescent HIV disclosure to sexual partners and others. AIDS Care 2020; 32:1565-1572. [PMID: 32122168 PMCID: PMC7483538 DOI: 10.1080/09540121.2020.1736260] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/03/2020] [Indexed: 01/08/2023]
Abstract
Over three million youth live with HIV worldwide. Very little is known about whether youth disclose their HIV status to family, friends or sexual partners, and what risks and benefits may accrue from doing so. This study characterizes HIV disclosure among 250 youth with perinatally-acquired HIV (PHIV; age 13-24 years) living in Soweto, South Africa. A third had self-disclosed their HIV status to at least one person; similarly, only a third of sexually-active PHIV had disclosed their HIV status to their most recent partner. It is not clear whether HIV disclosure alone leads to positive impact: we found perceived social support from the family was negatively associated with disclosure (aOR 0.81, 95% 0.70-0.94). PHIV who spoke to a provider about disclosure were more likely to share their HIV status with a sexual partner (aOR 2.48; 95% CI 1.28-4.81). However, those PHIV who disclosed their status were no more likely to use a condom. The World Health Organization recommends that health providers advise adolescent patients on safe disclosure, but we still lack evidence on the consequences for young people and effective tools to help them weigh benefits and risks.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Moscicki AB, Karalius B, Tassiopoulos K, Yao TJ, Jacobson DL, Patel K, Purswani M, Seage GR. Human Papillomavirus Antibody Levels and Quadrivalent Vaccine Clinical Effectiveness in Perinatally Human Immunodeficiency Virus-infected and Exposed, Uninfected Youth. Clin Infect Dis 2020; 69:1183-1191. [PMID: 30927547 DOI: 10.1093/cid/ciy1040] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Persons who are infected with human immunodeficiency virus (HIV) are at high risk of human papillomavirus (HPV)-associated cancers. The objectives are to compare antibody titers to HPV 6, 11, 16, and 18 and rate of abnormal cytology between perinatally HIV-infected (PHIV) and perinatally HIV-exposed, uninfected (PHEU) youth. METHODS This is a prospective observational cohort study of HPV4 vaccinated youth performed as part of the multicenter Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol. Seroconversion and geometric mean titer (GMT) against HPV types 6, 11, 16, and 18 were calculated. Vaccine effectiveness included rates of abnormal cervical cytology and genital warts. RESULTS Seroconversion to HPV 6, 11, 16, and 18 occurred in 83%, 84%, 90%, and 62% of 310 vaccinated PHIV youth compared to 94%, 96%, 99%, and 87% of 148 vaccinated PHEU youth, respectively (P < .05 for all comparisons). GMTs were lower in the PHIV vs PHEU within each category of HPV4 doses received. Higher GMTs were associated with younger age, lower HIV type 1 RNA viral load, and higher CD4% at first HPV4 vaccination, as well as shorter duration between last vaccine dose and antibody specimen. Abnormal cytology occurred in 33 of 56 PHIV and 1 of 7 PHEU sexually active vaccinated females, yielding incidence rates per 100 person-years of 15.0 (10.9 to 20.6) and 2.9 (0.4 to 22.3), respectively. CONCLUSION Antibody titers to HPV4 were lower for all serotypes in PHIV compared to PHEU youth. Protection against abnormal cytology was also diminished in sexually active PHIV females.
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Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent Medicine, University of California, Los Angeles
| | - Brad Karalius
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kunjal Patel
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Murli Purswani
- Division of Pediatric Infectious Disease, Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mount Sinai, New York
| | - George R Seage
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Abstract
Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.
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Affiliation(s)
- Laura K Grubb
- Departments of Pediatrics and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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Aepfelbacher JA, Chaudhury CS, Mee T, Purdy JB, Hawkins K, Curl KA, Dee N, Hadigan C. Reproductive and sexual health knowledge, experiences, and milestones in young adults with life-long HIV. AIDS Care 2019; 32:354-361. [PMID: 31640401 DOI: 10.1080/09540121.2019.1679711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reproductive and sexual health outcomes of adults with perinatal human immunodeficiency virus (PHIV) have not been well-characterized. This prospective cross-sectional study of 35 adult persons living with HIV (PLWH) from early life and 20 matched HIV-negative controls assessed quality of life, depressive symptoms, HIV transmission knowledge, and sexual/reproductive behaviors through self-report questionnaires. PLWH scored significantly worse than controls on depressive symptoms (p = 0.04) and two of six quality of life domains (p = 0.03, p = 0.0002). In contrast, PLWH scored significantly higher on transmission knowledge in the context of family planning (p = 0.002). PLWH were more likely to learn about sex from healthcare providers (p = 0.002) and were more confident in their sexual/reproductive health knowledge (p < 0.05). Both groups reported inconsistent condom use, but PLWH were more likely to have planned pregnancies (p = 0.005) and to share pregnancy planning with their partners (p < 0.05). Despite the challenges of living with a chronic stigmatized condition, adults with PHIV were knowledgeable about HIV transmission and family planning and demonstrated sexual practices and reproductive outcomes similar to age-matched controls. However, sub-optimal rates of viral suppression, inconsistent condom use, and the psychosocial impact of living with HIV continue to require the attention of healthcare provides for young adults with PHIV.
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Affiliation(s)
- Julia A Aepfelbacher
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Chloe S Chaudhury
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Thomas Mee
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Julia B Purdy
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Karyn Hawkins
- Nursing Department, NIH Clinical Center, Bethesda, MD, USA
| | - Kara-Anne Curl
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Nicola Dee
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - Colleen Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
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Sandy PT, Vhembo T, Molotsi TK. Sexual behaviour among adolescents living with the human immunodeficiency virus in Zimbabwe: educational implications. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:130-137. [PMID: 31282303 DOI: 10.2989/16085906.2019.1621910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The incidence of HIV infection is increasing among adolescents in Zimbabwe. This rise in incidence is partly due to risky sexual behaviours yet there are no published research studies on sexual behaviours of HIV-positive adolescents in Zimbabwe. Hence, this study, which examined the sexual behaviours of HIV-positive adolescents. This study utilised a cross-sectional design with a conveniently selected sample of 341 HIV-positive adolescents. Data were collected through a questionnaire. Data were analysed using descriptive and analytical statistics. The study revealed that approximately 37 (11%) of the adolescents had engaged in sexual intercourse, and approximately 14 (60%) of these did not use condoms. Approximately 11 (30%) of the sexually active adolescents had multiple sexual partners, and only 9 (24.3%) of them had disclosed their HIV serostatus to their partners before sexual intercourse. A bivariate analysis revealed factors that were associated with being sexually activity. Examples of these include age (OR = 1.56, p < 0.001) and being treated by a psychiatrist (OR = 47.9, p < 0.001). A multivariate logistic regression analysis was carried out, revealing factors that were independently associated with being sexually active. Examples of these include age (AOR = 1.91, p < 0.01) and exposure to erotic television programmes (AOR = 3.9, p < 0.04). The results of the study indicate that the sexual risk behaviours of HIV-positive adolescents contributes to the increase in incidence and prevalence of HIV/AIDS in Zimbabwe. The development and rolling out of a health education programme will help health care workers to address this concern.
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Affiliation(s)
- Peter T Sandy
- a Health Studies , University of South Africa , Pretoria , South Africa
| | - Tichaona Vhembo
- a Health Studies , University of South Africa , Pretoria , South Africa
| | - Tebogo K Molotsi
- a Health Studies , University of South Africa , Pretoria , South Africa
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Bucek A, Mellins CA, Leu CS, Dolezal C, Korich R, Wiznia A, Abrams EJ. Psychiatric disorders and young adult milestones in HIV-exposed, uninfected youth. AIDS Care 2019; 32:420-428. [PMID: 31537111 DOI: 10.1080/09540121.2019.1668535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The global population of perinatally HIV-exposed but uninfected (HEU) children is growing, with relatively little known about their psychosocial outcomes, particularly across adolescence and young adulthood. Using data from a longitudinal cohort study of HEU youth in New York City (N = 134), we examine rates of substance use disorders (SUD) and non-SUD psychiatric disorders (mood, anxiety, and behavioral) at five time-points during adolescence and young adulthood, as well as associated demographic and environmental factors and the association of ever having a disorder with young adult developmental milestones. HEU participants in this study experienced high rates of psychiatric disorders, particularly SUD in young adulthood. During the entire study period (2003-2018), over one third were diagnosed at least once with a SUD, and 69% were diagnosed with a non-SUD psychiatric disorder. Older age and female gender were associated with higher rates of non-SUD diagnoses. A history of meeting criteria for any disorder at any time point was associated with reduced odds in young adulthood of working or being in school and increased odds of reporting incarceration, homelessness, and recent condomless sex. There is an urgent need to develop systems to follow HEU youth and provide services to intervene and treat psychiatric disorders, including substance use.
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Affiliation(s)
- Amelia Bucek
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Rehema Korich
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY, USA.,College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Moscicki AB, Yao TJ, Russell JS, Farhat S, Scott M, Magpantay L, Halec G, Shiboski CH, Ryder MI. Biomarkers of oral inflammation in perinatally HIV-infected and perinatally HIV-exposed, uninfected youth. J Clin Periodontol 2019; 46:1072-1082. [PMID: 31385616 DOI: 10.1111/jcpe.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/25/2019] [Accepted: 07/22/2019] [Indexed: 12/24/2022]
Abstract
AIM To examine oral biomarkers that have been associated with periodontal disease progression in HIV-infected adults in perinatally HIV-infected and HIV-exposed but uninfected youth. MATERIAL AND METHODS This was a cross-sectional, multicentre substudy of youth participating in the Oral Health Pediatric HIV/AIDS Cohort study. Gingival crevicular fluid repository samples from participants with and without periodontal disease (using Gingival Index [GI] and Bleeding on Probing [BOP] parameters on dental examination) were tested for concentration levels of inflammatory biomarkers. Associations were assessed using Wilcoxon test and Spearman correlation. RESULTS For perinatal HIV youth (n = 129), the markers consistently elevated (p < .05) in sites with GI ≥2 and in sites with BOP were interleukin-1β, 6 and 13, macrophage inflammatory protein-1α and metalloproteinase-9. Serum tumour necrosis factor-α and soluble CD14 were positively correlated with a summary count of elevated cytokines. No associations were seen among HIV-uninfected subjects (n = 71). CONCLUSIONS The association of oral biomarkers of inflammation with clinical indicators of periodontal inflammation and systemic immune activation suggests that perinatal HIV-infected youth may be at higher risk for developing significant periodontal disease, associated with tooth loss and HIV progression. More frequent dental care of this group is needed to prevent potential periodontal progression.
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Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, CA, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jonathan S Russell
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sepideh Farhat
- Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, CA, USA
| | - Mark Scott
- Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, CA, USA
| | - Larry Magpantay
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gordana Halec
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Caroline H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
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15
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Salomon T, Gomes I, Ozahata MC, Valente Moreira CH, Lorenzo Oliveira CD, Gonçalez TT, Duarte ME, Miranda C, de Freitas Carneiro Proietti AB, Sabino E, de Almeida Neto C, Custer B. Social and behavioral characteristics of male blood donors and their sexual partners: an analysis to define risk subsets. Transfusion 2019; 59:2584-2592. [PMID: 31158312 PMCID: PMC6679786 DOI: 10.1111/trf.15388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Men who have sex with men in Brazil are deferred from donation for 1 year since their last sexual contact. Legal proceedings in front of the Brazilian Supreme Court could compel blood collection agencies to discontinue use of sexual orientation questions. METHODS Data from male participants in a completed HIV risk factor case-control study were used to evaluate whether it is possible to differentiate donors at lower and higher risk for HIV using two analytical approaches: latent class and random forest analyses. RESULTS Male blood donors were divided into three distinct risk profile classes. Class 1 includes donors who are heterosexual (96.4%), are HIV negative (88.7%), have a main partner (99.4%), and practice unprotected sex (77.8%). Class 2 includes donors who are men who have sex with men /bisexuals' (100.0%), are HIV positive (97.4%), and were not aware of their sexual partners' HIV status (80.3%). Class 3 includes donors who are heterosexual (84.1%), practice unprotected vaginal/anal heterosexual sex (66.8% vs. 40.9%), and were both HIV positive and HIV negative (49.5% vs. 50.5%). We also found that asking donors about their partner(s)' HIV serostatus could replace asking about donors' sexual orientation and types of partners with relatively minor shifts in sensitivity (0.76 vs. 0.58), specificity (0.89 vs. 0.94), and positive predictive value (0.85 vs. 0.88). CONCLUSION Sexual orientation questions on the donor questionnaire could be replaced without great loss in the sensitivity, specificity, and positive predictive value. Social and sexual behaviors of donors and their partners are proxies for HIV risk and can help to develop modified questions that will need controlled trials to be validated.
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Affiliation(s)
- Tassila Salomon
- Hemominas, Minas Gerais – Brazil,Institute of Tropical Medicine, University of São Paulo, Brazil
| | - Isabel Gomes
- Faculdade Ciências Médicas – Belo Horizonte – Minas Gerais – Brazil
| | | | | | | | | | | | | | | | - Ester Sabino
- Institute of Tropical Medicine, University of São Paulo, Brazil
| | - Cesar de Almeida Neto
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, Brazil,Disciplina de Ciências Médicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute and University of California San Francisco
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Nestadt DF, Saisaengjan C, McKay MM, Bunupuradah T, Pardo G, Lakhonpon S, Gopalan P, Leu CS, Petdachai W, Kosalaraksa P, Srirompotong U, Ananworanich J, Mellins CA. CHAMP+ Thailand: Pilot Randomized Control Trial of a Family-Based Psychosocial Intervention for Perinatally HIV-Infected Early Adolescents. AIDS Patient Care STDS 2019; 33:227-236. [PMID: 31067121 PMCID: PMC6531900 DOI: 10.1089/apc.2019.0021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Within Asia, HIV prevalence is highest in Thailand, including thousands of children and adolescents. Care for children born with HIV [perinatal transmission of HIV (PHIV)] will need to focus on adolescents for the foreseeable future. Thai PHIV adolescents experience significant mental health and psychosocial challenges, including treatment adherence. Yet, few, if any, comprehensive interventions for them exist. CHAMP+, an evidence-based intervention adapted for Thailand, was evaluated with a pilot randomized control trial at four HIV clinics. Eighty-eight dyads of 9- to 14-year-old PHIV young adolescents/caregivers were randomized to CHAMP+ or standard of care (SOC). Eleven cartoon-based sessions were delivered over 6 months. Participants completed baseline, 6-month (postintervention), and 9-month surveys, measuring youth outcomes (e.g., mental health and adherence), contextual factors (e.g., demographics and caregiver factors), and self- and social-regulation factors (e.g., HIV knowledge and youth-caregiver communication). Multi-level modeling to account for clustering within individuals was used to assess longitudinal changes within and between groups. All families randomized to CHAMP+ completed the intervention. Although the study was not statistically powered to detect differences in treatment effects, the CHAMP+ group significantly improved at 6 months in youth mental health and adherence, HIV knowledge, youth-caregiver communication, internalized stigma, and HIV-related social support, with most improvements sustained at 9 months and significantly better improvements than the SOC group on a number of outcomes. High levels of baseline viral suppression highlight the importance of reaching these young PHIV adolescents at a period of lower risk before adherence and other challenges emerge. Designed to be delivered with limited cost/resources, CHAMP+ Thailand holds scale-up potential.
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Affiliation(s)
- Danielle Friedman Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | | | - Mary McKernan McKay
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York, New York
| | | | - Gisselle Pardo
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York, New York
| | | | - Priya Gopalan
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, New York, New York
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | | | | | - Jintanat Ananworanich
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Khon Kaen Hospital, Khon Kaen, Thailand
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, The University of Maryland School of Medicine, Baltimore, Maryland
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
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Abstract
: The World Health Organization estimates that over four million children have been infected with HIV, most via perinatal transmission. The availability of safe and effective antiretroviral therapy (ART) has radically reduced mortality in this population and most that have access to ART are now thriving. However, long-term effects of HIV infection and its therapy have significant impact on aging adolescents and young adults with perinatal HIV infection. Many of the complications of long-term HIV infection seen in adults are also present, although the main impact of long-standing HIV infection and its treatment in children has been on growth and development, including neurodevelopment. A better understanding of the complexities of growing up with perinatal HIV will help prepare low and middle-income countries of the world where ART is now available to successfully manage their aging up populations of adolescents and young adults with perinatal HIV infection.
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Judd A, Foster C, Thompson LC, Sturgeon K, Le Prevost M, Jungmann E, Rowson K, Castro H, Gibb DM. Sexual health of young people with perinatal HIV and HIV negative young people in England. PLoS One 2018; 13:e0205597. [PMID: 30312343 PMCID: PMC6185844 DOI: 10.1371/journal.pone.0205597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/27/2018] [Indexed: 12/25/2022] Open
Abstract
As adolescents with perinatal HIV (PHIV) survive into adulthood, gaining insight into sexual behaviour and risk-taking is important. Between 2013–2015, 296 PHIV aged 13–21 years and 96 HIV negative affected adolescents (13–23 years) were recruited to the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort in England. Sexual health data were collected through computer-assisted self-interview questionnaires. Quality of life and household deprivation were also measured. T-tests compared means, and χ2 proportions; logistic regression examined predictors of ever having sex. 120(41%) PHIV and 31(32%) HIV- young people were male, 254(86%) and 70(73%) were black, median age 16 [IQR 15,18] and 16 [14,18] years respectively. 77(26%) PHIV had a previous AIDS diagnosis. 93(32%) PHIV and 38(40%) HIV- had ever had sex; median number of partners was 3 [1,6] and 4 [1,6] respectively. 54 (41%) of 131 young people who were sexually active reported not always using condoms, including 32% (30/93) of PHIV. In multivariable analysis, older age, male sex, worse deprivation score, worse quality of life, and alcohol and/or drugs were associated with ever having sex, but not HIV status. 12/30 PHIV reporting unprotected sex had at least one HIV viral load ≥200c/ml in the previous 12 months. Age at first sex and number of sexual partners were similar among PHIV and HIV-, and comparable to normative data. In conclusion, small numbers of PHIV reported condomless sex with a detectable viral load, which could result in HIV transmission, indicating the need for targeted sexual health and ART adherence interventions for young people with perinatal HIV.
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Affiliation(s)
- Ali Judd
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
- * E-mail:
| | - Caroline Foster
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Lindsay C. Thompson
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Kate Sturgeon
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Marthe Le Prevost
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Eva Jungmann
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Katie Rowson
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Hannah Castro
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Diana M. Gibb
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
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19
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Abrams EJ, Mellins CA, Bucek A, Dolezal C, Raymond J, Wiznia A, Jurgrau A, Bamji M, Leu CS, Ng YKW. Behavioral Health and Adult Milestones in Young Adults With Perinatal HIV Infection or Exposure. Pediatrics 2018; 142:e20180938. [PMID: 30097528 PMCID: PMC6317560 DOI: 10.1542/peds.2018-0938] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Young adults living with perinatally acquired HIV infection (PHIVYAs) are at risk for poor biomedical and behavioral health outcomes. Few studies offer a comprehensive overview of the functioning of this population in young adulthood and the role of HIV. METHODS Data come from the Child and Adolescent Self-Awareness and Health Study, a longitudinal behavioral health cohort study of PHIVYAs and perinatally HIV-exposed but uninfected young adults (PHEUYAs) who are compared on psychiatric and neurocognitive functioning, sexual and substance use behaviors, health and reproductive outcomes, and young adult milestones. RESULTS Overall, 27% of participants met criteria for a psychiatric disorder, including mood (11%), anxiety (22%), and substance use (28%), with no HIV status differences. PHIVYAs performed worse on 2 neurocognitive tests. There were no HIV status differences in condomless sex (41%) or pregnancies (41% women; 38% men). Both groups exhibited similar adult milestones: 67% graduated high school or an equivalent, 19% were in college, and 42% were employed. However, 38% were neither in school or working, 12% reported incarceration, and 16% were ever homeless. Among PHIVYAs, 36% were viremic (>200 copies per mL), and 15% were severely immunocompromised (CD4+ cell count <100 cells per mm3). CONCLUSIONS Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.
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Affiliation(s)
- Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health,
- Vagelos College of Physicians and Surgeons, and
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Amelia Bucek
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Jeannette Raymond
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Jurgrau
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
| | | | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Yiu Kee Warren Ng
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York; and
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Mengesha MM, Dessie Y, Roba AA. Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study. BMJ Open 2018; 8:e019554. [PMID: 30166287 PMCID: PMC6119410 DOI: 10.1136/bmjopen-2017-019554] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the level and factors associated with caregivers' disclosure of perinatally HIV-infected (PHIV+) children's seropositive status. DESIGN We conducted a cross-sectional study in five public health facilities providing HIV treatment and care in Dire Dawa and Harar, Eastern Ethiopia. The data were collected from 310 caregivers through face-to-face interviews and record reviews. Data analyses were done using STATA V.14.2 and statistical significance was declared at p value <0.05. RESULTS The study revealed that the level of PHIV+ diagnosis disclosure was 49.4% (95% CI 43.8 to 54.9). Mean age at disclosure was 11.2 years. Disclosure level was higher among children who frequently asked about their health status (aOR (adjusted OR) 2.04, 95% CI 1.04 to 4.03) and when caregivers knew other people who had a disclosure experience (aOR 2.49, 95% CI 1.17 to 5.32). Disclosure level was less among children of 12 years or below (aOR 0.04, 95% CI 0.02 to 0.09) and among caregivers practising deception about the children's HIV positive status (aOR 0.38, 95% CI 0.19 to 0.74). CONCLUSION Only half of the caregivers disclosed their child's PHIV+ diagnosis. To facilitate disclosure, caregivers should be counselled about the appropriate age of disclosure and related misconceptions that hinder it. It is also apparent that caregivers need to be guided as to how to address children's frequent questions about their health status. These interventions can be made in a one-on-one approach or through patient group counselling when they come to get healthcare services.
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Affiliation(s)
- Melkamu Merid Mengesha
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aklilu Abrham Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Benson S, Elkington KS, Leu CS, Bucek A, Dolezal C, Warne P, Mellins C. Association Between Psychiatric Disorders, Substance Use, and Sexual Risk Behaviors in Perinatally HIV-Exposed Youth. J Assoc Nurses AIDS Care 2018; 29:538-549. [PMID: 29526603 PMCID: PMC5999563 DOI: 10.1016/j.jana.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/12/2018] [Indexed: 01/07/2023]
Abstract
As youth with perinatally acquired HIV infection age, there is a need for studies that identify predictors and correlates of sexual risk behaviors. We examined the association between psychiatric disorders and substance use disorders (SUD) with sexual risk behaviors in youth with perinatally acquired HIV infection and perinatally HIV-exposed but uninfected youth. Participants were recruited from four medical centers in New York City. The Diagnostic Interview Schedule for Children and the Adolescent Sexual Behavior Assessment were administered to assess psychiatric disorders and sexual behaviors, respectively. SUD and behavior disorders were correlated with either ever having had penetrative sex or recent condomless sex for participants with perinatally acquired HIV infection only. Results suggest that clinicians should screen and treat patients for SUD and behavioral disorders to reduce sexual risk behaviors in youth with perinatally acquired HIV infection.
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Affiliation(s)
- Stephanie Benson
- Research Assistant, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Katherine S. Elkington
- Assistant Professor, College of Physicians and Surgeons, Columbia University, New York, New York, USA, and Training Director, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Cheng-Shiun Leu
- Assistant Professor, Mailman School of Public Health, Columbia University, New York, New York, USA, and Biostatistician and Research Scientist, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Amelia Bucek
- Project Director, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Curtis Dolezal
- Research Scientist, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Patricia Warne
- Associate Director, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Claude Mellins
- Professor, Medical Center, Columbia University, New York, New York, USA, and Research Scientist and Co-Director, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, USA
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Correction to: AIDS Patient Care and STDs 2016;30:221-228; DOI: 10.1089/apc.2015.0333. AIDS Patient Care STDS 2018; 32:214. [PMID: 29750552 DOI: 10.1089/apc.2015.0333.correx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Scott RK, Crochet S, Huang CC. Universal Rapid Human Immunodeficiency Virus Screening at Delivery: A Cost-Effectiveness Analysis. Infect Dis Obstet Gynecol 2018; 2018:6024698. [PMID: 29731602 PMCID: PMC5872626 DOI: 10.1155/2018/6024698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/19/2018] [Accepted: 02/04/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to decrease mother-to-child transmission (MTCT), by comparing the cost and quality-adjusted life years (QALYs) of universal rapid HIV screening at time of delivery to two current standards of care for prenatal HIV screening in the United States. Study Design We conducted a cost-effectiveness analysis to compare the cost and QALY of universal intrapartum rapid HIV screening with two current standards of care: (I) opt-out rapid HIV testing limited to patients without previous third-trimester screening and (II) opt-out rapid HIV testing limited to patients without any prenatal screening. We developed a decision-tree model and performed sensitivity analyses to estimate the impact of variances in QALY, estimated lifetime medical costs, HIV prevalence, and cumulative incidence. Results The incremental cost-effectiveness ratio for universal screening was $7,973.45/QALY. The results remained robust to sensitivity analysis, except for annual cumulative incidence. In areas with an annual cumulative incidence rate of <0.02% for reproductive-age women, the incremental cost-effectiveness ratio for the expanded program would exceed $89,926.94/QALY, approaching the commonly applied cost-effectiveness thresholds ($100,000/QALY). Conclusions Intrapartum universal rapid HIV screening to decrease MTCT appears cost-effective in populations with high HIV incidence in the United States.
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Affiliation(s)
- Rachel K. Scott
- MedStar Health Research Institute (MHRI), Washington, DC, USA
- MedStar Washington Hospital Center (MWHC), Division of Women's and Infants' Services, Washington, DC, USA
| | | | - Chun-Chih Huang
- MedStar Health Research Institute (MHRI), Washington, DC, USA
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
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Health Risk Behaviour among Adolescents Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7375831. [PMID: 29789804 PMCID: PMC5896333 DOI: 10.1155/2018/7375831] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/10/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022]
Abstract
The burden of health risk behaviour (HRB) among adolescents living with HIV (ALWHIV) in sub-Saharan Africa (SSA) is currently unknown. A systematic search for publications on HRB among ALWHIV in SSA was conducted in PubMed, Embase, PsycINFO, and Applied Social Sciences Index and Abstracts databases. Results were summarized following PRISMA guidelines for systematic reviews and meta-analyses. Heterogeneity was assessed by the DerSimonian and Laird method and the pooled estimates were computed. Prevalence of current condom nonuse behaviour was at 59.8% (95% CI: 47.9–71.3%), risky sexual partnerships at 32.9% (95% CI: 15.4–53.2%), transactional sex at 20.1% (95% CI: 9.2–33.8%), and the experience of sexual violence at 21.4% (95% CI: 16.3–27.0%) among ALWHIV. From this meta-analysis, we did not find statistically significant differences in pooled estimates of HRB prevalence between ALWHIV and HIV uninfected adolescents. However, there was mixed evidence on the occurrence of alcohol and drug use behaviour. Overall, we found that research on HRB among ALWHIV tends to focus on behaviour specific to sexual risk. With such a high burden of HRB for the individuals as well as society, these findings highlight an unmet need for age-appropriate interventions to address the behavioural needs of these adolescents.
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Evangeli M. The Adolescent HIV Disclosure Cognition and Affect Scale: Preliminary Reliability and Validity. J Pediatr Psychol 2018; 42:711-720. [PMID: 28339782 DOI: 10.1093/jpepsy/jsw107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/12/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives Globally, there are 2 million HIV-positive 10-19-year-olds. One challenge for this population is sharing their HIV status with others (onward HIV disclosure). There are no multi-item, multidimensional scales of HIV disclosure cognitions and affect for young people living with HIV. An 18-item measure of HIV disclosure cognition and affect was developed, administered to 65 adolescents living with HIV (aged 12-16 years). Data were explored using principal component analysis and preliminary construct and criterion validity assessed. Three factors were revealed: negative disclosure attitudes and feelings, self-efficacy, and positive disclosure attitudes and feelings. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV disclosure in the past 6 months, HIV disclosure intention and self-perception. Preliminary evidence of the measure's good psychometric properties suggests it may be helpful in future clinical and research work.
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The Happy Teen programme: a holistic outpatient clinic-based approach to prepare HIV-infected youth for the transition from paediatric to adult medical care services in Thailand. J Int AIDS Soc 2017; 20:21500. [PMID: 28530043 PMCID: PMC5704900 DOI: 10.7448/ias.20.4.21500] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: We developed an 18‐month Happy Teen 2 (HT2) programme comprised of a one‐day workshop, two half‐day sessions, and three individual sessions to prepare HIV‐infected youth for the transition from paediatric to adult HIV care services. We describe the programme and evaluate the change in youth's knowledge scores. Methods: We implemented the HT2 programme among HIV‐infected Thai youth aged 14–22 years who were aware of their HIV status and receiving care at two hospitals in Bangkok (Siriraj Hospital, Queen Sirikit National Institute of Child Health [QSNICH]). Staff interviewed youth using a standardized questionnaire to assess HIV and health‐related knowledge at baseline and at 12 and 18 months while they participated in the programme. We examined factors associated with a composite knowledge score ≥95% at month 18 using logistic regression. Results: During March 2014–July 2016, 192 of 245 (78%) eligible youth were interviewed at baseline. Of these, 161 (84%) returned for interviews at 12 and 18 months. Among the 161 youth, the median age was 17 years, 74 (46%) were female, and 99% were receiving antiretroviral treatment. The median composite score was 45% at baseline and increased to 82% at 12 months and 95% at 18 months (P < 0.001). The range of median knowledge scores for antiretroviral management, HIV monitoring, HIV services, and family planning significantly increased from baseline (range 0–75%) to (range 67–100%) at 12 months and to 100% at 18 months (P < 0.001). Almost all youth were able to describe education and career goals at 12 and 18 months compared to 75% at baseline. In multivariable analysis, a composite knowledge score at 18 months >95% was associated with education level >high school (aOR: 2.15, 95%CI, 1.03–4.48) and receipt care at QSNICH (aOR: 2.43, 95%CI, 1.18–4.98). Youth whose mother and father had died were less likely to have score ≥95% (aOR: 0.22, 95%CI, 0.07–0.67) than those with living parents. Conclusions: Knowledge useful for a successful transition from paediatric to adult HIV care increased among youth participating in the HT2 programme. Youth follow‐up will continue to assess the impact of improved knowledge on outcomes following the transition to adult care services.
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Camacho-Gonzalez AF, Chernoff MC, Williams PL, Chahroudi A, Oleske JM, Traite S, Chakraborty R, Purswani MU, Abzug MJ. Sexually Transmitted Infections in Youth With Controlled and Uncontrolled Human Immunodeficiency Virus Infection. J Pediatric Infect Dis Soc 2017; 6:e22-e29. [PMID: 27440505 PMCID: PMC5907850 DOI: 10.1093/jpids/piw039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/16/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), disproportionately affect adolescents and young adults (AYAs) ages 13-24 years. Sexually transmitted infections likewise are a risk factor for HIV acquisition and transmission; however, there is a lack of data on STI acquisition in HIV-infected AYAs. METHODS We determined the incidence of STIs in HIV-infected AYAs 12.5 <25 years of age in the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1074 observational cohort study. Univariate and multivariable logistic regression models were used to evaluate the association of HIV control (mean viral load <500 copies/mL and CD4+ T cells >500 cells/mm3 in the year preceding STI diagnosis) and other risk factors with STI occurrence. RESULTS Of 1201 enrolled subjects, 1042 participants met age criteria and were included (49% male, 61% black, 88% perinatally infected; mean age 18.3 years). One hundred twenty participants had at least 1 STI on study, of whom 93 had their first lifetime STI (incidence rate = 2.8/100 person-years). For individual STI categories, 155 incident category-specific events were reported; human papillomavirus (HPV) and chlamydial infections were the most common. In the multivariable model, having an STI was associated with older age (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 1.05-1.22), female sex (aOR = 2.65; 95% CI, 1.67-4.21), nonperinatal HIV acquisition (aOR = 2.33; 95% CI, 1.29-4.22), and uncontrolled HIV infection (aOR = 2.05; 95% CI, 1.29-3.25). CONCLUSIONS Sexually transmitted infection acquisition in HIV-infected AYAs is associated with older age, female sex, nonperinatal HIV acquisition, and poorly controlled HIV infection. Substantial rates of STIs among HIV-infected AYAs support enhanced preventive interventions, including safe-sex practices and HPV vaccination, and antiretroviral adherence strategies.
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Affiliation(s)
- Andres F Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Division of Pediatric Infectious Diseases
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia,
| | - Miriam C Chernoff
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paige L Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Division of Pediatric Infectious Diseases
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia,
| | - James M Oleske
- Department of Pediatrics, Division of Allergy, Immunology, Infectious Diseases and Pulmonology, Rutgers New Jersey Medical School, Newark;
| | - Shirley Traite
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rana Chakraborty
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Division of Pediatric Infectious Diseases
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia,
| | - Murli U Purswani
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, and
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Division of Pediatric Infectious Diseases, Aurora
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Fongkaew W, Udomkhamsuk W, Viseskul N, Guptaruk M. Developing a program for enhancing youth HIV treatment adherence and risk reduction. Nurs Health Sci 2017; 19:427-435. [PMID: 28799688 DOI: 10.1111/nhs.12360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Abstract
Youth living with HIV face difficult and challenging situations that decrease their adherence to antiretroviral medications. In this study, we developed a pilot program to enhance HIV treatment adherence and risk reduction among youth living with HIV based on collaboration with a community hospital involving a multi-disciplinary healthcare team. Participants were 25 youth living with HIV/AIDS, 18 caregivers, and 12 healthcare providers. The action research process comprised a preliminary stage and four phases of assessment, planning, implementation, and evaluation. This program used "edutainment", participatory learning, and multi-disciplinary collaboration to improve HIV treatment adherence and HIV risk behavior knowledge, motivation, and behavior. Education aimed to improve knowledge of antiretroviral drugs and HIV risk-taking behaviors. Motivation was directed at reframing beliefs and increasing positive attitudes of youth toward treatment adherence and raising awareness about safer sex behaviors. The behavioral skills focused on medication management in daily life activities, problem-solving, refusal and negotiation, and condom use. Findings provided preliminary evidence that the program was practical in a clinical context in a community hospital.
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Affiliation(s)
- Warunee Fongkaew
- Nursing Science Division, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nongkran Viseskul
- Nursing Science Division, Chiang Mai University, Chiang Mai, Thailand
| | - Marisa Guptaruk
- Nursing Science Division, Chiang Mai University, Chiang Mai, Thailand
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Harris LL, Chernoff MC, Nichols SL, Williams PL, Garvie PA, Yildirim C, McCauley SR, Woods SP. Prospective memory in youth with perinatally-acquired HIV infection. Child Neuropsychol 2017; 24:938-958. [PMID: 28782457 DOI: 10.1080/09297049.2017.1360854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Youth with perinatal HIV infection (PHIV) are at increased risk for neurocognitive impairment (NCI). Prospective memory (PM) is a complex neurocognitive function that has been shown to be impaired in adults with HIV disease and independently associated with poorer daily living skills, including medication nonadherence. The current study sought to determine the presence and extent of PM deficits in youth with PHIV. Participants included 173 youth with PHIV and 85 youth perinatally HIV-exposed but uninfected (PHEU), mean age 14.1 years, 75% black, 18% Hispanic. Among youth with PHIV, 26% had a past AIDS-defining condition (Centers for Disease Control and Prevention [CDC], Class C), 74% did not (non-C). Adjusted generalized estimating equation models were used to compare groups (PHIV/C, PHIV/non-C, and PHEU) on the Naturalistic Event-Based Prospective Memory Test (NEPT) and the Prospective Memory Assessment for Children & Youth (PROMACY). Secondarily, subgroups defined by HIV serostatus and global NCI were compared (PHIV/NCI, PHIV/non-NCI, PHEU). PHIV/C had significantly lower NEPT scores than PHEU, with decreases of 40% in mean scores, but did not differ from PHIV/non-C. PHIV/NCI had 11-32% lower PROMACY scores and 33% lower NEPT scores compared to PHIV/non-NCI (all p < .05); significantly, lower scores for PHIV/NCI versus PHEU also were observed for PROMACY and NEPT indices. Findings suggest a subset of youth with PHIV (those with a prior AIDS-defining diagnosis) is vulnerable to PM deficits. The extent to which PM deficits interfere with development and maintenance of independent living and health-related behaviors during transition to adulthood requires further study.
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Affiliation(s)
- Lynnette L Harris
- a Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
| | - Miriam C Chernoff
- b Center for Biostatistics in AIDS Research , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Sharon L Nichols
- c Department of Neurosciences , University of California , San Diego , CA , USA
| | - Paige L Williams
- d Center for Biostatistics in AIDS Research & Department of Biostatistics , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Patricia A Garvie
- e Research Department , Children's Diagnostic & Treatment Center , Fort Lauderdale , FL , USA
| | - Cenk Yildirim
- b Center for Biostatistics in AIDS Research , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Stephen R McCauley
- f Departments of Physical Medicine & Rehabilitation, Neurology, and Pediatrics, Baylor College of Medicine , Michael E. DeBakey VA Medical Center , Houston , TX , USA
| | - Steven Paul Woods
- c Department of Neurosciences , University of California , San Diego , CA , USA.,g Department of Psychology , University of Houston , Houston , TX , USA
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Pardo G, Saisaengjan C, Gopalan P, Ananworanich J, Lakhonpon S, Nestadt DF, Bunupuradah T, Mellins CA, McKay MM. Cultural Adaptation of an Evidence-Informed Psychosocial Intervention to Address the Needs of PHIV+ Youth in Thailand. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2017; 4:209-218. [PMID: 29104848 PMCID: PMC5660129 DOI: 10.1007/s40609-017-0100-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Globally, pediatric HIV has largely become an adolescent epidemic. Thailand has the highest HIV prevalence in Asia (1.2%), with more than 14,000 children living with HIV. There is growing demand for evidence-based psychosocial interventions for this population that include health and mental health support and sexual risk reduction, which can be integrated into HIV care systems. To address this need, a multidisciplinary team of Thai and US researchers adapted an existing evidence-informed, family-based intervention, The Collaborative HIV Prevention and Adolescent Mental Health Program + (CHAMP+), which has been tested in multiple global trials. Using community-based participatory research methods, changes to the intervention curriculum were made to address language, culture, and Thai family life. Involvement of families, youth, and stakeholders in the adaptation process allowed for identification of salient issues and of program delivery methods that would increase engagement. Participants endorsed using a cartoon-based curriculum format for fostering discussion (as in CHAMP+ South Africa) given stigma around discussing HIV in the Thai context. The Thai version of CHAMP+ retained much of the curriculum content incorporating culturally appropriate metaphors and story line. Sessions focus on family communication, coping, disclosure, stigma, social support, and HIV education. This paper explores lessons learned through the adaption process of CHAMP+ Thailand that are applicable to other interventions and settings. It discusses how culturally informed adaptations can be made to interventions while maintaining core program components.
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Affiliation(s)
- Gisselle Pardo
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003 USA
| | - Chutima Saisaengjan
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Priya Gopalan
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003 USA
| | - Jintanat Ananworanich
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Present Address: U.S. Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, USA
| | - Sudrak Lakhonpon
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Danielle Friedman Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Mary McKernan McKay
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003 USA
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Nestadt DF, Lakhonpon S, Pardo G, Saisaengjan C, Gopalan P, Bunupuradah T, McKay MM, Ananworanich J, Mellins CA. A Qualitative Exploration of Psychosocial Challenges of Perinatally HIV-Infected Adolescents and Families in Bangkok, Thailand. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 13:158-169. [PMID: 30344614 PMCID: PMC6190906 DOI: 10.1080/17450128.2017.1356947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Thailand has the highest HIV prevalence in Asia, with 9,600 HIV+ adolescents and thousands additional younger HIV+ children (World Bank, 2015; UNICEF, 2015). Studies from other settings suggest perinatally HIV-infected (PHIV+) adolescents are at high risk for mental health problems and engagement in risk behaviors that threaten individual and public health. Yet, few studies exist in Thailand, and few evidence-based psychosocial interventions have been developed for and studied in this population, despite great need. The current study qualitatively explored psychosocial issues among Thai PHIV+ adolescents to inform development or adaptation of interventions. Thai and US-based researchers and clinicians conducted two focus group discussions with PHIV+ adolescents aged 12-16 and their adult caregivers, and six in-depth key informant interviews with health/social work providers at a large clinic for PHIV+ youth in Bangkok, Thailand. Data were analyzed thematically using framework analysis. Multiple challenges for PHIV+ youth and caregivers were identified. Adherence to antiretroviral treatment was a significant challenge attributed to lack of adult support, side effects, feeling too well to take medicines, and avoiding acknowledging sickness. Poor child-caregiver communication and conflict was a key concern, explained in part by cultural expectation of obedience and generation gaps. Concerns about societal stigma and discrimination emerged strongly and influenced delay or avoidance of disclosing HIV status to children and others. Respondents identified positive approaches to addressing these issues and highlighted the need for interventions to improve child-caregiver communication and generate peer and community support for PHIV+ youth. Thai PHIV+ adolescents and families experience significant psychosocial challenges, similar to those seen in other contexts. Cultural adaptation of an existing evidence-based clinic-based family group intervention is recommended to rapidly address these needs.
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Affiliation(s)
- Danielle Friedman Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, United States
| | - Sudrak Lakhonpon
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Gisselle Pardo
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003, United States, +1-212-998-4300
| | - Chutima Saisaengjan
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Priya Gopalan
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003, United States, +1-212-998-4300
| | - Torsak Bunupuradah
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Mary McKernan McKay
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11th Street, 7th Floor, New York, NY 10003, United States, +1-212-998-4300
| | - Jintanat Ananworanich
- The Children and Youth Program, SEARCH, HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand, +66-2-252-2568-9
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, United States
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Kalichman SC, Kalichman MO, Cherry C, Grebler T. HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men. AIDS Patient Care STDS 2017; 30:221-8. [PMID: 27158850 DOI: 10.1089/apc.2015.0333] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. Results showed that 166 (30%) men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. Men who engaged in nondisclosed condomless sex were less adherent to their HIV treatment, more likely to have unsuppressed HIV, demonstrated poorer disclosure self-efficacy, enacted fewer risk reduction communication skills, and held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.
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Affiliation(s)
- Seth C. Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Moira O. Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, Connecticut
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Neilan AM, Karalius B, Patel K, Van Dyke RB, Abzug MJ, Agwu AL, Williams PL, Purswani M, Kacanek D, Oleske JM, Burchett SK, Wiznia A, Chernoff M, Seage GR, Ciaranello AL. Association of Risk of Viremia, Immunosuppression, Serious Clinical Events, and Mortality With Increasing Age in Perinatally Human Immunodeficiency Virus-Infected Youth. JAMA Pediatr 2017; 171:450-460. [PMID: 28346597 PMCID: PMC5411314 DOI: 10.1001/jamapediatrics.2017.0141] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE As perinatally human immunodeficiency virus-infected youth (PHIVY) in the United States grow older and more treatment experienced, clinicians need updated information about the association of age, CD4 cell count, viral load (VL), and antiretroviral (ARV) drug use with risk of opportunistic infections, key clinical events, and mortality to understand patient risks and improve care. OBJECTIVE To examine the incidence or first occurrence during follow-up of key clinical events (including Centers for Disease Control and Prevention stage B [CDC-B] and stage C [CDC-C] events) and mortality among PHIVY stratified by age, CD4 cell count, and VL and ARV status. DESIGN, SETTING, AND PARTICIPANTS Combining data from the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol and International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1074 multicenter cohort studies (March 2007 through April 2015), we estimated event rates during person-time spent in key strata of age (7-12, 13-17, and 18-30 years), CD4 cell count (<200, 200-499, and ≥500/μL), and a combined measure of VL and ARV status (VL <400 or ≥400 copies/mL; ARV therapy or no ARV therapy). A total of 1562 participants in the PHACS Adolescent Master Protocol and IMPAACT P1074 were eligible, and 1446 PHIVY from 41 ambulatory sites in the 12 US states, including Puerto Rico were enrolled. The dates of analysis were March 2015 through January 2017. MAIN OUTCOMES AND MEASURES Clinical event rates stratified by person-time in age, CD4 cell count, and VL and ARV categories. RESULTS A total of 1446 PHIVY participated in the study (mean [SD] age, 14.6 [4.6] years; 759 female [52.5%]; 953 black [65.9%]). During a mean (SD) follow-up of 4.9 (1.3) years, higher incidences of CDC-B events, CDC-C events, and mortality were observed as participants aged. Older PHIVY (aged 13-17 and 18-30 years) spent more time with a VL of 400 copies/mL or more and with a CD4 cell count of less than 200/µL compared with 7- to 12-year-old participants (30% and 44% vs 22% of person-time with a VL≥400 copies/mL; 5% and 18% vs 2% of person-time with CD4 cell count <200/µL; P < .001 for each comparison). We observed higher rates of CDC-B events, CDC-C events, bacterial infections, and mortality at lower CD4 cell counts, as expected. The mortality rate among older PHIVY was 6 to 12 times that among the general US population. Higher rates of sexually transmitted infections were also observed at lower CD4 cell counts after adjusting for age. CONCLUSIONS AND RELEVANCE Older PHIVY were at increased risk of viremia, immunosuppression, CDC-B events, CDC-C events, and mortality. Interventions to improve ARV therapy adherence and optimize models of care for PHIVY as they age are urgently needed to improve long-term outcomes among PHIVY.
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Affiliation(s)
- Anne M. Neilan
- Division of Infectious Diseases and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston2Department of Pediatrics, Massachusetts General Hospital, Boston3Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Brad Karalius
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kunjal Patel
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts5Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Russell B. Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mark J. Abzug
- Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine and Children’s Hospital, Aurora
| | - Allison L. Agwu
- Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paige L. Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts5Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Murli Purswani
- Bronx-Lebanon Hospital Center, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - James M. Oleske
- Division of Pediatric Allergy, Immunology and Infectious Diseases, New Jersey Medical School at Rutgers, Newark
| | - Sandra K. Burchett
- Harvard Medical School, Harvard University, Boston, Massachusetts11Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Miriam Chernoff
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - George R. Seage
- Harvard Medical School, Harvard University, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts5Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrea L. Ciaranello
- Division of Infectious Diseases and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston3Harvard Medical School, Harvard University, Boston, Massachusetts
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Arabi-Mianrood H, Hamzehgardeshi Z, Khoori E, Moosazadeh M, Shahhosseini Z. Influencing factors on high-risk sexual behaviors in young people: an ecological perspective. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2016-0162/ijamh-2016-0162.xml. [PMID: 28422704 DOI: 10.1515/ijamh-2016-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/28/2017] [Indexed: 11/15/2022]
Abstract
Background In recent years, high-risk sexual behaviors due to their negative consequences both for the individual and society have received more attention than other high-risk behaviors. Objective The aim of this study was to review the influencing factors of high-risk sexual behaviors among young people from an ecological point of view. Methods This review was conducted through searching databases including PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Library with keywords such as sexual risk-taking behavior, high-risk sex, unprotected sex and unsafe sex. The relevant papers published between 1995 and 2016 were extracted. After reviewing the abstract and full text of the articles, 45 papers were used to write this article. Results From an ecological theory approach, factors which influence high-risk sexual behaviors are divided into three categories - the microsystem, the mesosystem and the macrosystem. The microsystem includes factors such as age, gender, race, marital status, place of residence, religion, level of education, personality traits, psychological problems, childhood experiences, body image and coincidence of high-risk behaviors; the mesosystem includes factors such as family structure, peers and sex education; in the macrosystem, the impact of culture and traditions of the society, economic status and the media are presented. Conclusion Given that high-risk sexual behaviors often have multiple causes, it seems that health policymakers must consider multi-dimensional interventions to influence high-risk sexual behaviors based on the ecological approach.
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Affiliation(s)
- Hoda Arabi-Mianrood
- Department of Reproductive Health and Midwifery, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Khoori
- Department of Reproductive Health and Midwifery, Counselling and Reproductive Health Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahmood Moosazadeh
- Department of Epidemiology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Shahhosseini
- Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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van den Berg JJ, Isabel Fernández M, Fava JL, Operario D, Rudy BJ, Wilson PA. Using Syndemics Theory to Investigate Risk and Protective Factors Associated with Condomless Sex Among Youth Living with HIV in 17 U.S. Cities. AIDS Behav 2017; 21:833-844. [PMID: 27624727 DOI: 10.1007/s10461-016-1550-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Identifying risk and protective factors associated with condomless sex among youth living with HIV is imperative for developing effective HIV prevention strategies. A cross-sectional sample of 1728 participants, 12-26 years of age, recruited from adolescent medicine clinics in 17 U.S. cities completed an audio-computer assisted self-interview with questions about their substance use, psychosocial factors, and attitudinal and behavioral factors. Guided by syndemics theory, a path analysis was used to assess the interrelations of these factors. Analyses of model fit statistics indicated statistically significant direct pathways between substance use, psychosocial factors, self-efficacy for risk-reduction, alternative risk-reduction attitudes and behaviors and condomless sex. The total indirect effect of self-efficacy for risk-reduction on condomless sex through alternative risk-reduction attitudes and behaviors was also significant. Multi-faceted, tailored interventions that address individual risk and protective factors and their combined synergistic effects are urgently needed to prevent condomless sex among this population.
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Affiliation(s)
- Jacob J van den Berg
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA.
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - M Isabel Fernández
- Division of Health Professions, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Bret J Rudy
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Patterns and Correlates of Serostatus Disclosure to Sexual Partners by Perinatally-Infected Adolescents and Young Adults. AIDS Behav 2017; 21:129-140. [PMID: 26874846 DOI: 10.1007/s10461-016-1337-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Similar to same-age peers, perinatally HIV-infected (PHIV+) youth in the US are engaging in sex, including condomless sex. Understanding decisions about serostatus disclosure to sexual partners is important to domestic and global HIV prevention efforts, since large numbers of PHIV+ children are entering adolescence and becoming sexually active. Using Social Action Theory (SAT) to inform variable selection, we examined correlates of disclosure among 98 PHIV+ adolescents/young adults in New York City. Over half of these youth reported not disclosing to any casual partners (59 %) or to any partners when using condoms (55 %). In bivariate analyses, increased disclosure was associated with older age; being female; earlier age of learning one's serostatus; and increased STD knowledge, disclosure intentions, and parent-child communication. Multiple regression analyses revealed a strong fit with the SAT model. As with adults, disclosure to sexual partners is difficult for PHIV+ youth and challenges prevention efforts. Effective interventions that help youth with disclosure decisions are needed to curb the epidemic.
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Echenique M, Rodriguez VJ, LaCabe RP, Privette CK, Jones DL, Potter JE, Fischl MA. Behaviorally and perinatally HIV-infected young women: targets for preconception counseling. AIDS Care 2016; 29:372-377. [PMID: 27535165 DOI: 10.1080/09540121.2016.1220483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to describe demographic and psychological characteristics among HIV-infected young women, and to identify knowledge, attitudes, and behaviors associated with conception, with the goal of informing interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV. Behaviorally and perinatally HIV-infected young women (n = 34) were conveniently sampled in Miami, Florida. Participants were asked to complete measures of reproductive knowledge, attitudes toward conception, and risk behaviors, as well as measures of depression and cognitive functioning. Perinatally and behaviorally HIV-infected young women were very similar in important areas of health preconception practices such as conception-related health literacy and conception-related communication with providers. Behaviorally infected women, however, were somewhat more likely to have been pregnant in the past, and had greater knowledge of healthy contraception practices and family planning. Despite the difference among groups, both the perinatally and behaviorally acquired women demonstrated having adequate overall knowledge. Depression was higher and consistent with moderate depression among the behaviorally HIV-infected women in comparison to perinatally infected women. This study found that that despite adequate reproductive knowledge, most young HIV-infected women were not using contraception. Given the consequences of presentation of advanced HIV during pregnancy, the need for both treatment adherence and preconception counseling is essential. Results suggest that interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV are necessary and potentially transferrable between populations.
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Affiliation(s)
- Marisa Echenique
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Violeta J Rodriguez
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Richard P LaCabe
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - C Kyle Privette
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Deborah L Jones
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - JoNell Efantis Potter
- b Department of Obstetrics and Gynecology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Margaret A Fischl
- c Department of Infectious Diseases , University of Miami Miller School of Medicine , Miami , FL , USA
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Sexual Behavior and Knowledge among Adolescents with Perinatally Acquired Human Immunodeficiency Virus Infection Compared to HIV-Uninfected Adolescents at an Urban Tertiary Center in New Jersey. Int J Reprod Med 2016; 2016:7098027. [PMID: 27595131 PMCID: PMC4995341 DOI: 10.1155/2016/7098027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/23/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Sexual behaviors and knowledge among PHIV-infected (PHIV(+)) adolescents in comparison with HIV-uninfected youths are not well understood and continue to be studied actively. Objective. To compare sexual behavior and sexual knowledge of PHIV(+) and HIV-uninfected adolescents at an urban, tertiary-care center in New Jersey. Study Design. Modified Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance questionnaire was administered to PHIV(+) and HIV-uninfected adolescents to assess and compare sexual behavior and knowledge over a 1-year-period. Results. Twenty-seven PHIV(+) and 100 HIV-uninfected adolescents were studied; 59% PHIV(+) and 52% HIV-uninfected adolescents were sexually active. A significantly higher proportion of PHIV(+) adolescents compared to HIV-uninfected adolescents reported ≥1 occasion of unprotected penetrative sex (p < 0.0001) and reported multiple (>4) sexual partners (p = 0.037). Significantly more PHIV(+) males reported receptive anal intercourse (p < 0.001). About 1/3 of adolescents in both groups were unaware that sexual abstinence can prevent HIV transmission and >80% adolescents in both groups did not consider multiple sexual partners a risk factor for HIV transmission. Only 25% PHIV(+) adolescents reported disclosing their seropositive status to their first sexual partners. Conclusions. High risk sexual behaviors were significantly more prevalent among PHIV(+) youths; however both groups demonstrated considerable gaps in sexual knowledge. There is an urgent need for heightening awareness about risky behaviors, interventions for prevention, and reproductive health promotion among adolescents.
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Moscicki AB, Yao TJ, Ryder MI, Russell JS, Dominy SS, Patel K, McKenna M, Van Dyke RB, Seage GR, Hazra R. The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth. PLoS One 2016; 11:e0156459. [PMID: 27299992 PMCID: PMC4907464 DOI: 10.1371/journal.pone.0156459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/13/2016] [Indexed: 01/27/2023] Open
Abstract
Objective To compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU). Methods In a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models. Results Eleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment. Conclusions Oral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions.
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Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mark I. Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
| | - Jonathan S. Russell
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Stephen S. Dominy
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kunjal Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Matt McKenna
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Russell B. Van Dyke
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - George R. Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
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Tassiopoulos K, Patel K, Alperen J, Kacanek D, Ellis A, Berman C, Allison SM, Hazra R, Barr E, Cantos K, Siminski S, Massagli M, Bauermeister J, Siddiqui DQ, Puga A, Van Dyke R, Seage GR. Following young people with perinatal HIV infection from adolescence into adulthood: the protocol for PHACS AMP Up, a prospective cohort study. BMJ Open 2016; 6:e011396. [PMID: 27288383 PMCID: PMC4908871 DOI: 10.1136/bmjopen-2016-011396] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The first generation of adolescents born with HIV infection has reached young adulthood due to advances in treatment. It is important to continue follow-up of these individuals to assess their long-term medical, behavioural and mental health and ability to successfully transition to adulthood while coping with a chronic, potentially stigmatising condition. To accomplish this, and to maintain their interest in long-term research participation, we need to accommodate the changing lifestyles and interests of young adult study participants while ensuring valid data collection. We report the protocol for Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) Up, a prospective cohort study enrolling young adult participants for long-term follow-up. METHODS AND ANALYSIS AMP Up is recruiting 850 young men and women 18 years of age and older-600 perinatally HIV-infected and a comparison group of 250 perinatally HIV-exposed, uninfected-at 14 clinical research sites in the USA and Puerto Rico. Recruitment began in April 2014 and is ongoing, with 305 participants currently enrolled. Planned follow-up is ≥6 years. Data are collected with a flexible hybrid of online and in-person methods. Outcomes include: transition to adult clinical care and retention in care; end-organ diseases; malignancies; metabolic complications; sexually transmitted infections; reproductive health; mental health and neurocognitive functioning; adherence to antiretroviral treatment; sexual behaviour and substance use; hearing and language impairments; and employment and educational achievement. ETHICS AND DISSEMINATION The study received ethical approval from the Harvard T.H. Chan School of Public Health's institutional review board (IRB), and from the IRBs of each clinical research site. All participants provide written informed consent; for cognitively impaired individuals with legally authorised representatives, legal guardian permission and participant assent is obtained. Findings will be disseminated through peer-reviewed journals, conference presentations and participant summaries.
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Affiliation(s)
- Katherine Tassiopoulos
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kunjal Patel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Julie Alperen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Angela Ellis
- Frontier Science and Technology Research Foundation, Inc, Amherst, New York, USA
| | - Claire Berman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Susannah M Allison
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Barr
- Department of Pediatric Infectious Diseases, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Krystal Cantos
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Suzanne Siminski
- Frontier Science and Technology Research Foundation, Inc, Amherst, New York, USA
| | - Michael Massagli
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jose Bauermeister
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Danish Q Siddiqui
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ana Puga
- Children's Diagnostic & Treatment Center, Inc., Fort Lauderdale, Florida, USA
| | - Russell Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - George R Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Contraceptive challenges in adolescents living with or at risk of HIV. J Virus Erad 2016; 2:82-6. [PMID: 27482440 PMCID: PMC4965250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Many adolescents living with or without HIV are sexually active and in need of continuous free access to a variety of contraceptive methods. Dual contraception, condom use together with reversible effective contraception (hormonal contraception [HC] or intrauterine device), seems to be the most effective option for female adolescents for protection from unintended pregnancy and sexually transmitted infections. When counselling on specific contraceptive choice, healthcare providers should be aware about possible interactions of some types of HC with the immune system, with possible changes in infectivity, as well as about drug interactions between mainly efavirenz and some types of progestins. Adding HC to HIV-positive status and antiretroviral therapy could have additive effects on metabolism. At the same time, the possible disadvantages of using HC in women living with HIV should be balanced against the advantages of very reliable methods of preventing unintended pregnancies. To reach and deliver a contraceptive service to more young women, it has proven effective to organise adolescent-friendly clinics and/or integrate them with HIV services. Diverse approaches, including community-based contraceptive service provision and the use of modern technologies, can complement the effort of providing contraceptive services to this target group of female adolescents living with HIV or at risk of HIV.
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Kancheva Landolt N, Bunupuradah T, Chaithongwongwatthana S. Contraceptive challenges in adolescents living with or at risk of HIV. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30474-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bhana A, Mellins CA, Small L, Nestadt DF, Leu CS, Petersen I, Machanyangwa S, McKay M. Resilience in perinatal HIV+ adolescents in South Africa. AIDS Care 2016; 28 Suppl 2:49-59. [PMID: 27391999 PMCID: PMC4991226 DOI: 10.1080/09540121.2016.1176676] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/29/2016] [Indexed: 11/21/2022]
Abstract
Increasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p < .001), less caregiver-reported communication about difficult issues (β = 1.882, p = .009) and higher youth self-esteem (β = -0.119, p = .020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p = .020) and child use of wishful thinking for coping (β = 5.532, p = .009). Less youth depression was associated with higher caregiver education (β =-0.399, p = .010), greater caregiver supervision (β = -1.261, p = .012), more social support seeking (β = -0.453, p = .002), higher youth self-esteem (β = -0.067, p < .001), lower internalized stigma (β = 0.608, p = .040), and child use of resignation for coping (β = 1.152, p = .041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV+ youth.
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Affiliation(s)
- Arvin Bhana
- SA Medical Research Council, Health Systems Research Unit, Durban, South Africa
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Latoya Small
- School of Social Work, The University of North Carolina at Chapel Hill, NC, USA
| | - Danielle F. Nestadt
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Inge Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Mary McKay
- Silver School of Social Work, New York University, New York, NY, USA
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Implementation and Operational Research: Risk Factors of Loss to Follow-up Among HIV-Positive Pediatric Patients in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2016; 70:e73-83. [PMID: 26247894 DOI: 10.1097/qai.0000000000000782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify risk factors for loss to follow-up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania, between 2004 and 2011. DESIGN Longitudinal analysis of 6236 HIV-infected children. METHODS We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to the risk of LTFU was examined using a Cox proportional hazards model. RESULTS A total of 2130 children (34%) were LTFU over a median follow-up of 16.7 months (interquartile range, 3.4-36.9). Factors independently associated with a higher risk of LTFU were age ≤2 years (relative risk [RR] = 1.59, 95% CI: 1.40 to 1.80), diarrhea at enrollment (RR = 1.20, 95% CI: 1.03 to 1.41), a low mid-upper arm circumference for age (RR = 1.20, CI: 1.05 to 1.37), eating protein-rich foods ≤3 times a week (RR = 1.39, 95% CI: 1.05 to 1.90), taking cotrimoxazole (RR = 1.39, 95% CI: 1.06 to 1.81), initiating onto antiretrovirals (RR = 1.37, 95% CI: 1.17 to 1.61), receiving treatment at a hospital instead of a local facility (RR = 1.39, 95% CI: 1.06 to 1.41), and starting treatment in 2006 or later (RR = 1.10, 95% CI: 1.04 to 1.16). CONCLUSIONS Health workers should be aware of pediatric patients who are at a greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.
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Elkington KS, Cruz JE, Warne P, Santamaria EK, Dolezal C, Mellins CA. Marijuana Use and Psychiatric Disorders in Perinatally HIV-Exposed Youth: Does HIV Matter? J Pediatr Psychol 2015; 41:277-86. [PMID: 26698841 DOI: 10.1093/jpepsy/jsv117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/12/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine longitudinal reciprocal relationships between marijuana use and psychiatric disorders, and identify the role of HIV in a sample (N = 340) of youth perinatally infected with HIV (PHIV+) and youth perinatally exposed but uninfected with HIV (PHIV-) (60.6% PHIV+; 9-16 years at baseline; 51% female). METHODS Cross-lagged structural equation modeling was used to examine longitudinal associations between changes in marijuana use and changes in any behavioral, mood, and anxiety disorders at three time points across adolescence. RESULTS Marijuana use predicted behavioral and mood disorders in youth, regardless of HIV status. Behavioral and mood disorders predicted marijuana use for PHIV- youth; behavioral disorders predicted marijuana use for PHIV+ youth. Anxiety disorders and marijuana use were not associated for either group. CONCLUSIONS For PHIV+ and PHIV- youth, interventions that target early marijuana use may reduce later psychiatric disorders. Similarly, treatment for early behavioral disorders may prevent subsequent marijuana use.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute,
| | - Jennifer E Cruz
- Special Needs Clinic, New York Presbyterian Hospital and Columbia University Medical Center, and
| | - Patricia Warne
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute
| | | | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute
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Chokephaibulkit K, Tarugsa J, Lolekha R, Leowsrisook P, Manaboriboon B, Naiwatanakul T, Punpanich W, Nuchanard W, Pattanasin S, Boon-yasidhi V. Outcomes of a Comprehensive Youth Program for HIV-infected Adolescents in Thailand. J Assoc Nurses AIDS Care 2015; 26:758-69. [PMID: 26363957 PMCID: PMC4701692 DOI: 10.1016/j.jana.2015.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
We developed an intervention program for HIV-infected Thai adolescents with two group sessions and two individual sessions, focusing on four strategies: health knowledge, coping skills, sexual risk reduction, and life goals. An audio computer-assisted self-interview (ACASI) was administered to assess knowledge, attitudes, and practices (KAP) regarding antiretroviral therapy management, reproductive health, and HIV-associated risk behavior. The program was implemented in two HIV clinics; 165 (84%) adolescents (intervention group) participated in the program; 32 (16%) completed the ACASI without participating in the group or individual sessions (nonintervention group). The median age was 14 years, and 56% were female. Baseline KAP scores of the intervention and nonintervention groups were similar. Two months after the intervention, knowledge and attitude scores increased (p < .01) in the intervention group, and the increase was sustained at 6 months. KAP scores did not change from baseline in the nonintervention group at 6 or 12 months after enrollment.
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Affiliation(s)
- Kulkanya Chokephaibulkit
- Professor, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jariya Tarugsa
- Member of the Faculty of Medicine, Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rangsima Lolekha
- Medical Research Scientist, Thailand MOPH – U.S. CDC Collaboration (TUC), Global AIDS Program (GAP), Nonthaburi, Thailand
| | - Pimsiri Leowsrisook
- Head Nurse of the HIV Clinic, Queen Sirikit National Institute for Child Health (QSNICH), Ministry of Public Health, Bangkok, Thailand
| | - Boonying Manaboriboon
- Associate Professor, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thananda Naiwatanakul
- Senior Policy Advisor, Thailand MOPH – U.S. CDC Collaboration (TUC), Global AIDS Program (GAP), Nonthaburi, Thailand
| | - Warunee Punpanich
- Associate Professor, Queen Sirikit National Institute for Child Health (QSNICH), Ministry of Public Health, Bangkok, Thailand
| | - Wipada Nuchanard
- Research Nurse, Thailand MOPH – U.S. CDC Collaboration (TUC), Global AIDS Program (GAP), Nonthaburi, Thailand
| | - Sarika Pattanasin
- Statistician, Thailand MOPH – U.S. CDC Collaboration (TUC), Global AIDS Program (GAP), Nonthaburi, Thailand
| | - Vitharon Boon-yasidhi
- Associate Professor, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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47
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Mbalinda SN, Kiwanuka N, Eriksson LE, Wanyenze RK, Kaye DK. Correlates of ever had sex among perinatally HIV-infected adolescents in Uganda. Reprod Health 2015; 12:96. [PMID: 26475268 PMCID: PMC4609043 DOI: 10.1186/s12978-015-0082-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the correlates of ever had sex among perinatally HIV-infected (PHIV) adolescents. METHODS A cross-sectional survey of sexual behaviour was conducted with 624 PHIV adolescents living three regions (12 districts) of Uganda. Data was collected on socio demographic characteristics (age, sex, occupation, religion and education status), sexual practices and behaviours (Intimate relationships, sexual intercourse, age of sexual debut, condom use, multiple and concurrent sexual partners), consequences of sexual behaviours (pregnancy and STI's) and life style factors (use of alcohol, psychoactive substances and peer influence). Multivariable logistic-regression was used to ascertain the determinants of sexual activity. RESULTS The majority of PHIV were female (59.3 %) and the mean age of the sample was 16.2 (±2.1) years. The mean age of sexual debut was 15.8 years; 16.2 % (101/624) reported symptoms for sexually transmitted infections (STI) and more than a third (213/624) reported ever had sex.Of these 76.5 % (165/213) used condoms inconsistently; and 49.3 % (105/213) had been pregnant or made someone pregnant. Of those in relationships, 56.3 % (223/396) did not disclose and were not aware of their partners' HIV status. Adolescents aged 15-19 years were more likely to have ever been sexually active (Adjusted odds ratio (AOR) 6.28, 95 % Confidence interval (CI): 2.63-14.99) compared to those aged 10-14 years. Adolescents who were living alone were more likely to have ever been sexually active compared to those living with one or both parents (AOR 4.33, 95 % CI: 1.13-16.62). The odds of being sexually active were lower among adolescents in school compared to those out of school (AOR 0.2, 95 % CI: 0.13-0.30), who had never been treated for STI (compared to those who had never been treated for STI) (AOR 0.19, 95 % 0.11-0.32) and adolescents who never drank alcohol (AOR 0.49, 95 % CI 0.28-0.87). CONCLUSION PHIV adolescents have risky sexual behaviours characterized by being sexually active, inconsistent condom use, and having partners of unknown status. Risk reduction interventions are required to minimize unplanned pregnancies, STI, and HIV transmission by PHIV adolescents.
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Affiliation(s)
| | - Noah Kiwanuka
- School of Public Health, Makerere University, Kampala, Uganda.
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
- School of Health Sciences, City University London, London, UK.
| | | | - Dan Kabonge Kaye
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
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48
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Greenhalgh C, Evangeli M, Frize G, Foster C, Fidler S. Intimate relationships in young adults with perinatally acquired HIV: a qualitative study of strategies used to manage HIV disclosure. AIDS Care 2015; 28:283-8. [PMID: 26444656 DOI: 10.1080/09540121.2015.1093594] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An increasing number of children born with perinatally acquired HIV (PAH) are surviving into late adolescence and early adulthood. At this developmental stage, forming and sustaining intimate relationships is important. Young adults with PAH face both normative challenges and additional, HIV-related, relationship stressors. One key issue is the decision about whether and how to share their HIV status with others. Being able to disclose one's HIV status to sexual partners may reduce the risk of onward HIV transmission but is associated with the fear of rejection. There has been little research on how young people with PAH manage such disclosure-related stressors in intimate relationships. This study examined how disclosure challenges are managed by young adults with PAH in the UK within their intimate relationships. Seven participants (five females and two males) currently or previously in an intimate relationship, aged 18-23 years, were recruited from a UK hospital clinic. The majority of participants were of sub-Saharan African origins. They took part in in-depth interviews, with data analysed according to the principles of interpretative phenomenological analysis. Four themes were elicited: (1) decisions about starting, continuing or resuming relationships shaped by disclosure, (2) disclosing early to avoid the pain of future rejection, (3) using condoms to avoid disclosure and (4) testing likely partner reactions to disclosure. The study revealed the significant extent to which HIV disclosure affected the experience of relationships in this population. Interventions to support adolescents and young adults with PAH to disclose to their partners should be developed alongside guidance for professionals. Future research should include older samples of adults with PAH and studies in sub-Saharan African settings.
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Affiliation(s)
- Clare Greenhalgh
- a Department of Clinical Psychology, Royal Holloway , University of London , Surrey , UK
| | - Michael Evangeli
- a Department of Clinical Psychology, Royal Holloway , University of London , Surrey , UK
| | - Graham Frize
- b The 900 Clinic , Imperial College Healthcare NHS Trust, St. Mary's Hospital , London , UK
| | - Caroline Foster
- b The 900 Clinic , Imperial College Healthcare NHS Trust, St. Mary's Hospital , London , UK
| | - Sarah Fidler
- b The 900 Clinic , Imperial College Healthcare NHS Trust, St. Mary's Hospital , London , UK
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49
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Mirani G, Williams PL, Chernoff M, Abzug MJ, Levin MJ, Seage GR, Oleske JM, Purswani MU, Hazra R, Traite S, Zimmer B, Van Dyke RB. Changing Trends in Complications and Mortality Rates Among US Youth and Young Adults With HIV Infection in the Era of Combination Antiretroviral Therapy. Clin Infect Dis 2015; 61:1850-61. [PMID: 26270680 DOI: 10.1093/cid/civ687] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in human immunodeficiency virus (HIV)-related opportunistic infections and deaths in US youth, but both continue to occur. METHODS We estimated the incidence of complications and deaths in IMPAACT P1074, a long-term US-based prospective multicenter cohort study conducted from April 2008 to June 2014. Incidence rates of selected diagnoses and trends over time were compared with those from a previous observational cohort study, P219C (2004-2007). Causes of death and relevant demographic and clinical features were reviewed. RESULTS Among 1201 HIV-infected youth in P1074 (87% perinatally infected; mean [standard deviation] age at last chart review, 20.9 [5.4] years), psychiatric and neurodevelopmental disorders, asthma, pneumonia, and genital tract infections were among the most common comorbid conditions. Compared with findings in P219C, conditions with significantly increased incidence included substance or alcohol abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D deficiency or metabolic bone disorders, anxiety disorders, and fractures; the incidence of pneumonia decreased significantly. Twenty-eight deaths occurred, yielding a standardized mortality rate 31.5 times that of the US population. Those who died were older, less likely to be receiving cART, and had lower CD4 cell counts and higher viral loads. Most deaths (86%) were due to HIV-related medical conditions. CONCLUSIONS Opportunistic infections and deaths are less common among HIV-infected youth in the US in the cART era, but the mortality rate remains elevated. Deaths were associated with poor HIV control and older age. Emerging complications, such as psychiatric, inflammatory, metabolic, and genital tract diseases, need to be addressed.
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Affiliation(s)
- Gayatri Mirani
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Paige L Williams
- Center for Biostatistics in AIDS Research Departments of Biostatistics Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Mark J Abzug
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Myron J Levin
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - George R Seage
- Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Murli U Purswani
- Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center, Bronx
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | - Bonnie Zimmer
- Frontier Science Technology and Research Foundation, Amherst, New York
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50
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Cruz MLS, Cardoso CA. Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus). World J Virol 2015; 4:277-284. [PMID: 26279988 PMCID: PMC4534818 DOI: 10.5501/wjv.v4.i3.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/12/2015] [Accepted: 07/23/2015] [Indexed: 02/05/2023] Open
Abstract
The availability of highly potent antiretroviral treatment during the last decades has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Children that were diagnosed during the first months or years of life and received treatment, are living longer and better and are presently reaching adolescence and adulthood. Perinatally HIV-infected adolescents (PHIV) and young adults may present specific clinical, behavior and social characteristics and demands. We have performed a literature review about different aspects that have to be considered in the care and follow-up of PHIV. The search included papers in the MEDLINE database via PubMed, located using the keywords “perinatally HIV-infected” AND “adolescents”. Only articles published in English or Portuguese from 2003 to 2014 were selected. The types of articles included original research, systematic reviews, and quantitative or qualitative studies; case reports and case series were excluded. Results are presented in the following topics: “Puberal development and sexual maturation”, “Growth in weight and height”, “Bone metabolism during adolescence”, “Metabolic complications”, “Brain development, cognition and mental health”, “Reproductive health”, “Viral drug resistance” and “Transition to adult outpatient care”. We hope that this review will support the work of pediatricians, clinicians and infectious diseases specialists that are receiving these subjects to continue treatment.
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