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Stoner MCD, Smith L, Ming K, Mancuso N, Patani H, Sukhija-Cohen A, Granados Y, Wagner D, Johnson MO, Napierala S, Neilands TB, Saberi P. Results From a Pilot Study of an Automated Directly Observed Therapy Intervention Using Artificial Intelligence With Conditional Economic Incentives Among Young Adults With HIV. J Acquir Immune Defic Syndr 2024; 96:136-146. [PMID: 38363868 PMCID: PMC11108745 DOI: 10.1097/qai.0000000000003397] [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: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Despite improvements in antiretroviral therapy (ART) availability, suboptimal adherence is common among youth with HIV (YWH) and can increase drug resistance and poor clinical outcomes. Our study examined an innovative mobile app-based intervention that used automated directly observed therapy (aDOT) using artificial intelligence, along with conditional economic incentives (CEIs) to improve ART adherence and enhance viral suppression among YWH. SETTING We conducted a pilot study of the aDOT-CEI intervention, informed by the operant framework of Key Principles in Contingency Management Implementation, to improve ART adherence among YWH (18-29) in California and Florida who had an unsuppressed HIV viral load. METHODS We recruited 28 virally unsuppressed YWH from AIDS Healthcare Foundation clinics, who used the aDOT platform for 3 months. Study outcomes included feasibility and acceptability, self-reported ART adherence, and HIV viral load. RESULTS Participants reported high satisfaction with the app (91%), and 82% said that it helped them take their medication. Comfort with the security and privacy of the app was moderate (55%), and 59% indicated the incentives helped improve daily adherence. CONCLUSIONS Acceptability and feasibility of the aDOT-CEI intervention were high with potential to improve viral suppression, although some a priori metrics were not met. Pilot results suggest refinements which may improve intervention outcomes, including increased incentive amounts, provision of additional information, and reassurance about app privacy and security. Additional research is recommended to test the efficacy of the aDOT-CEI intervention to improve viral suppression in a larger sample.
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Affiliation(s)
- Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Louis Smith
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristin Ming
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Noah Mancuso
- Women's Global Health Imperative, RTI International, Atlanta, GA
| | - Henna Patani
- AIDS Healthcare Foundation, Los Angeles, CA; and
| | | | | | - Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sue Napierala
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Parya Saberi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Namagga JK, Rukundo GZ, Batwala V, Niyonzima V, Nantongo H, Nambozi G. Healthcare Workers' Perspectives on the Utilization of the International HIV Dementia Scale for the Screening HIV-Associated Neurocognitive Disorders: A Qualitative Study at TASO Centres in Central and Southwestern Uganda. HIV AIDS (Auckl) 2024; 16:229-243. [PMID: 38827783 PMCID: PMC11144000 DOI: 10.2147/hiv.s444668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction HIV-associated neurocognitive disorders (HAND) are becoming a significant public health concern in the continuum of human immune virus (HIV) treatment. These disorders range from subtle cognitive impairments to severe dementia. Despite many early-stage HAND cases being asymptomatic, healthcare workers (HCWs) rarely perform routine neurocognitive assessments. This leads to a high number of unrecognized cases and increases the risk of HAND among people living with HIV (PLWH). Material and Methods We aimed to explore HCWs' perspectives on integrating the International HIV Dementia Scale (IHDS) into routine care for screening HAND at The AIDS Support Organization (TASO) centres in central and southwestern Uganda. Results We conducted five focus group discussions with 37 HCWs from five TASO centres. Thematic analysis revealed eight key theme: 1) Impaired brain function, 2) Changes in activities of daily living, 3) Promotion of quality care perspectives, 4) Tool applicable and user-friendly, 5) Client increased self-awareness and self-confidence, 6) Integration of IHDS into routine HIV care, 7) Uncertainty about IHDS use, and 8) Continuous training for HCWs. Conclusion As PLWH enjoy longer and healthier lives, their risk for HAND increases, potentially affecting their quality of life. The use of the IHDS has raised awareness among HCWs and improved decision-making through cognitive assessments, emphasizing it value in PLWH. We recommend a prospective study to assess the long-term outcomes and efficacy of increased HAND screening. Furthermore, integrating a HAND screening module into the consolidated HIV guidelines is recommended to enhance its relevance.
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Affiliation(s)
- Jane Kasozi Namagga
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vincent Batwala
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vallence Niyonzima
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Hanifah Nantongo
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Nambozi
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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O'Connor C, Leyritana K, Doyle AM, Lewis JJ, Salvaña EM. Changes in Adherence and Viral Load Suppression Among People with HIV in Manila: Outcomes of the Philippines Connect for Life Study. AIDS Behav 2024; 28:837-853. [PMID: 37794284 DOI: 10.1007/s10461-023-04190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
The Philippines HIV epidemic is among the fastest growing globally. Infections among men who have sex with men are rising at an alarming rate, necessitating targeted evidence-based interventions to retain people living with HIV in care, support adherence, and reach viral suppression. We conducted a 48-week prospective cohort study of 462 participants in which we provided a mobile health (mHealth) adherence support intervention using the Connect for Life platform. We observed an improvement in adherence, with the proportion of participants taking more than 95% of their antiretroviral therapy (ART) doses increasing from 78.6% at baseline to 90.3% at 48 weeks. Among treatment experienced participants, adherence improved significantly (McNemar's test = 21.88, P < 0.001). Viral load suppression did not change, with 92.6% suppression at baseline and 92.0% at 48 weeks. Illicit drug use was associated with reduced adherence (aOR = 0.56, 95%CI 0.31-1.00, P = 0.05) and being on second-line therapy was associated with poor viral load suppression (aOR = 0.33, 95%CI 0.14-0.78, P = 0.01). Quality of life improved following ART initiation, from a mean of 84.6 points (of a possible 120) at baseline to 91.01 at 48 weeks. Due to technical issues, fidelity to the intended intervention was low, with 22.1% (102/462) of participants receiving any voice calls and most others receiving a scaled-back SMS intervention. The mHealth intervention did not have any observed effect on adherence or on viral load suppression. While evidence of effectiveness of mHealth adherence interventions is mixed, these platforms should continue to be explored as part of differentiated treatment support services.
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Affiliation(s)
- Cara O'Connor
- Sustained Health Initiatives of the Philippines (SHIP), Mandaluyong, Philippines.
- The London School of Hygiene and Tropical Medicine, London, UK.
- Anova Health Institute, 12 Sherborne Ave. Parktown, Johannesburg, South Africa.
| | - Katerina Leyritana
- Sustained Health Initiatives of the Philippines (SHIP), Mandaluyong, Philippines
| | - Aoife M Doyle
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - James J Lewis
- Y Lab, the Public Services Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Edsel Maurice Salvaña
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila, Ermita, Manila, Philippines
- Section of Infectious Disease, Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
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Comfort AB, Asiimwe S, Amaniyre G, Orrell C, Moody J, Musinguzi N, Bwana MB, Bangsberg DR, Haberer JE, Tsai AC. Social networks and HIV treatment adherence among people with HIV initiating treatment in rural Uganda and peri-urban South Africa. SSM Popul Health 2024; 25:101593. [PMID: 38292051 PMCID: PMC10825562 DOI: 10.1016/j.ssmph.2023.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
Timely initiation of and adherence to antiretroviral therapy (ART) is critical for improving HIV outcomes and reducing HIV transmissibility. Social networks, or the social relationships individuals have with each other, have been linked with positive health outcomes, but less is known about the extent to which social network composition and structure are associated with improved ART adherence among people living with HIV (PLWH). We conducted an ego-centric network study among 828 previously ART-naïve PLWH presenting for ART initiation at 11 clinics in Mbarara, Uganda (rural population) and Gugulethu, South Africa (peri-urban population). We collected social network data using name generator and name interpreter questions. ART adherence was monitored over 12 months using wireless monitors (Wisepill). Our primary outcome of interest was ART adherence during the 12-month follow-up period. We used generalized linear models to estimate the associations between network measures and ART adherence. PLWH at the Uganda site (compared with the South Africa site) were less isolated, had larger social networks, and had more social ties providing sufficient social support; they were also more likely to bridge different social groups whereby not all social ties were connected to each other. In Uganda, social isolation was associated with a 5.5 percentage point reduction in ART adherence (95% confidence interval [CI] -9.95 to -1.13; p = 0.014), while having more same gender social ties was associated with higher ART adherence (b = 0.13, 95% CI 0.02-0.25, p = 0.025). In South Africa, there was no association between social isolation and ART adherence, and having more friendship ties (vs. family ties) was associated with lower ART adherence (b = -2.20, 95% CI -3.56 to -0.84; p = 0.002). Identifying and supporting PLWH who are isolated may facilitate optimal adherence, but understanding how networks differentially affect ART adherence by country context is important.
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Affiliation(s)
- Alison B. Comfort
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143-1224, USA
| | - Stephen Asiimwe
- Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Gideon Amaniyre
- Makerere University Joint AIDS Program, Plot 4B P.O.Box 7072 Kololo Hill Dr, Kampala, Uganda
| | - Catherine Orrell
- Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, 7915, Cape Town, South Africa
| | - James Moody
- Department of Sociology, 268 Soc/Psych Building, Duke University, Durham, NC, 27708-0088, USA
| | - Nicholas Musinguzi
- Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Mwebesa Bosco Bwana
- Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | | | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
| | - Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
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Robinson L, Arden MA, Dawson S, Walters SJ, Wildman MJ, Stevenson M. A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions. Health Psychol Rev 2024; 18:1-23. [PMID: 35086431 DOI: 10.1080/17437199.2022.2034516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 12/20/2022]
Abstract
Adherence to medication in long-term conditions is around 50%. The key components of successful interventions to improve medication adherence remain unclear, particularly when examined over prolonged follow-up periods. Behaviour change theories are increasingly interested in the utility of habit formation for the maintenance of health behaviour change, but there is no documentation on how habit has been conceptualised in the medication adherence intervention literature, or what effect the key technique identified in habit formation theory (context dependent repetition) has in these studies. To examine this, a machine-learning assisted review was conducted. Searches of MEDLINE, EMBASE and PSYCInfo and the reference list of a comprehensive systematic review of medication adherence interventions yielded 5973 articles. Machine learning-assisted title and abstract screening identified 15 independent RCTs published between 1976 and 2021, including 18 intervention comparisons of interest. Key findings indicate that conceptualisations of habit in the medication adherence literature are varied and behaviour change technique coding identified only six studies which explicitly described using habit formation. Future work should aim to develop this evidence base, drawing on contemporary habit theory and with explicit demonstration of what techniques have been used to promote habit formation.
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Affiliation(s)
- L Robinson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - S Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - S J Walters
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - M J Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - M Stevenson
- Department of Computer Science, The University of Sheffield, Sheffield, UK
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Nanyeenya N, Nakanjako D, Makumbi F, Nakigozi G, Nalugoda F, Kigozi G, Nasuuna E, Kibira SPS, Nabadda S, Kiyaga C, Huzaifah M, Kiwanuka N. Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low-level viraemia in Uganda. HIV Med 2024; 25:245-253. [PMID: 37853605 PMCID: PMC11047222 DOI: 10.1111/hiv.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Uganda was using a threshold of 1000 copies/mL to determine viral non-suppression for antiretroviral therapy monitoring among people living with HIV, prior to this study. It was not clear whether people living with HIV with low-level viraemia (LLV, ≥50 to <1000 copies/mL) would benefit from intensive adherence counselling (IAC). The purpose of this study was to determine the effectiveness of IAC among people living with HIV, receiving antiretroviral therapy, and with LLV in Uganda, to guide key policy decisions in HIV care, including the review of the viral load (VL) testing algorithm. METHODS This cluster-randomized clinical trial comprised adults from eight HIV clinics who were living with HIV, receiving ART, and had recent VL results indicating LLV (tested from July 2022 to October 2022). Participants in the intervention arm clinics received three once-monthly sessions of IAC, and those in the comparison non-intervention arm clinics received the standard of care. At the end of the study, all participants were re-tested for VL to determine the proportions of those who then had an undetectable VL (<50 copies/mL). We assessed the statistical association between cross-tabulated variables using Fisher's exact test and then modified Poisson regression. RESULTS A total of 136 participants were enrolled into the study at eight HIV clinics. All 68 participants in the intervention arm completed all IAC sessions. Only one participant in the non-intervention arm was lost to follow-up. The average follow-up time was 3.7 months (standard deviation [SD] 0.2) and 3.5 months (SD 0.1) in the intervention and non-intervention arms, respectively. In total, 59 (43.7%) of 135 people living with HIV achieved an undetectable VL during the study follow-up period. The effect of IAC on attaining an undetectable VL among people with LLV was nearly twice as high in the intervention arm (57.4%) than in the non-intervention arm (29.9%): adjusted risk ratio 1.9 (95% confidence interval 1.0-3.5), p = 0.037. CONCLUSION IAC doubled the likelihood of an undetectable VL among people living with HIV with LLV. Therefore, IAC has been instituted as an intervention to manage people living with HIV with LLV in Uganda, and this should also be adopted in other Sub-Saharan African countries with similar settings. CLINICALTRIALS GOV IDENTIFIER NCT05514418.
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Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Mutyaba Huzaifah
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Mbuagbaw L, Fernando S, Lee C, Owino M, Youssef C, Snow ME. Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study. BMC Health Serv Res 2024; 24:48. [PMID: 38200516 PMCID: PMC10782539 DOI: 10.1186/s12913-023-10481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada. METHODS We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences. RESULTS Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support. CONCLUSION Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada.
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Josep's Healthcare, Hamilton, ON, Canada.
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Saranee Fernando
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Chloe Lee
- McMaster University, Bachelors of Health Sciences Program, Hamilton, ON, Canada
| | - Maureen Owino
- The Canadian HIV Trials Network (CTN), Vancouver, BC, Canada
- Committee for Accessible AIDS Treatment, Toronto, ON, Canada
- York University, Toronto, ON, Canada
| | - Cynthia Youssef
- McMaster University, Bachelors of Health Sciences Program, Hamilton, ON, Canada
| | - M Elizabeth Snow
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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10
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Joska JA, Lee JS, Andersen LS, Stanton AM, O' Clereigh C, Safren S. "Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa". J Affect Disord 2023; 343:136-143. [PMID: 37797752 PMCID: PMC11195445 DOI: 10.1016/j.jad.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with HIV (PHW) are at greater risk of depression than the general population. Insight into the time-to-treatment-response and predictors of response to psychotherapy may improve implementation in primary care. METHODS We assessed depression treatment response among 80 participants in a trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal antiretroviral therapy (ART) adherence. Participants self-reported depressive symptoms (CESD) at each therapy session. Clinicians assessed participants' depression (HAMD), along with potential predictors of response, every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each phase. RESULTS During the active treatment phase (CESD) we identified an early response (at session 2 and with continued trajectory of improvement) and a non-response group. There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR = 0.74, 95%CI[0.56-0.90], p = .009), and social support was associated with increased likelihood of early response (aOR = 2.24, 95%CI[1.07-5.46], p = .045). LIMITATIONS Self-reported depression during the treatment phase may have resulted from social desirability bias. CONCLUSIONS Most participants responded to CBT-AD early during treatment (89 %) and had sustained improvements in depression by 4 months (80 %). Distress aversion was a risk factor for late response, and social support was protective. Future research is needed to assess the optimal dose of CBT-AD in resource limited settings.
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Affiliation(s)
- John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Conall O' Clereigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven Safren
- Department of Psychology, University of Miami, Miami, FL, USA
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Wang Y, Daar ES, Huang Y, Xiong D, Shen J, Zhou L, Siqueiros L, Guerrero M, Rosen MI, Liu H. Adherence to Antiretrovirals and HIV Viral Suppression Under COVID-19 Pandemic Interruption - Findings from a Randomized Clinical Trial Using Ingestible Sensors to Monitor Adherence. AIDS Behav 2023; 27:4041-4051. [PMID: 37401993 PMCID: PMC10598162 DOI: 10.1007/s10461-023-04118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
The COVID-19 pandemic had a significant impact on vulnerable populations, including people living with HIV. California implemented a coronavirus lockdown (stay-at-home order) in March 2020, which ended in January 2021. We evaluated the pandemic's impact on both clinical outcomes of HIV RNA viral load (VL) and retention rate in a randomized clinical trial conducted from May 2018 to October 2020. The intervention group took co-encapsulated antiretrovirals (ARVs) with ingestible sensor (IS) pills from baseline through week 16. The IS system has the capacity to monitor adherence in real-time using a sensor patch, a mobile device, and supporting software. Both the IS and usual care (UC) groups were followed monthly for 28 weeks. Longitudinal mixed-effects models with random intercept and slope (RIAS) were used to fit log VL and self-reported adherence. The sample size of the study was 112 (54 in IS). Overall, the retention rate at week 28 was 86%, with 90% before the lockdown and 83% after the lockdown. The lockdown strengthened the associations between adherence and VL. Before the lockdown, a 10% increase in adherence was associated with a 0.2 unit decrease in log VL (β = -1.88, p = 0.004), while during the lockdown, the association was a 0.41-unit decrease (β = -2.27, p = 0.03). The pandemic did not have a significant impact on our adherence-focused intervention. Our findings regarding the intervention effect remain valid. TRIAL REGISTRATION NUMBER: NCT02797262. Date registration: September 2015.
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Affiliation(s)
- Yan Wang
- Section of Public and Population Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | - Eric S Daar
- Department of Medicine, Division of HIV Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yilan Huang
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Di Xiong
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Jie Shen
- Section of Public and Population Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Linyu Zhou
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Lisa Siqueiros
- Department of Medicine, Division of HIV Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mario Guerrero
- Department of Medicine, Division of HIV Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Marc I Rosen
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Honghu Liu
- Section of Public and Population Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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12
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Palar K, Sheira LA, Frongillo EA, Kushel M, Wilson TE, Conroy AA, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Tien PC, Weiser SD. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV. AIDS Behav 2023; 27:3345-3355. [PMID: 37067613 PMCID: PMC10783960 DOI: 10.1007/s10461-023-04053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.
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Affiliation(s)
- Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Margot Kushel
- Division of General Internal Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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13
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Mate KKV, Engler K, Lessard D, Lebouché B. Barriers to adherence to antiretroviral therapy: identifying priority areas for people with HIV and healthcare professionals. Int J STD AIDS 2023; 34:677-686. [PMID: 37113058 PMCID: PMC10467008 DOI: 10.1177/09564624231169329] [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: 06/16/2022] [Revised: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Challenges to antiretroviral therapy adherence are well-known and continue to be a major hurdle in HIV care. The objective of this paper is to identify barriers to antiretroviral therapy (ART) adherence that are relevant to HIV care from the perspective of people living with HIV and healthcare and social service professionals. METHODS This study used an online survey design to collect information from the two groups. A total of 100 areas that covered six domains and 20 subdomains were administered to people living with HIV and care professionals in Canada and France. The survey asked participants to rate the importance of each area for HIV care on a four-point Likert scale. Any areas rated 3 or 4 were considered important and ranked. A Chi-square test was conducted for the difference between the groups, people living with HIV and professionals, and between women and men. RESULTS A response rate of 87% (58/66) in Canada and 65% (38/58) was achieved. 15 of 43 (35%) areas were endorsed as important barriers by both groups, across countries and sex-covering subdomains - drug cost coverage, challenging material circumstances, HIV stigma, and privacy concerns, affect, motivation, beliefs, acceptance of HIV, comorbidity, side effects, and demands and organisation of daily life. People living with HIV identified two, and care professionals identified nine, additional areas as important barriers to HIV care across different domains and subdomains. CONCLUSION The study identified some common and distinct barriers to ART from the perspective of the people living with HIV and care professionals.
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Affiliation(s)
- Kedar K. V. Mate
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
| | - Kim Engler
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - David Lessard
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
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14
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Odongo I, Arim B, Ayer P, Murungi T, Akullo S, Aceng D, Oboke H, Kumakech E, Obua C, Auma AG, Nyeko R. Utilization of antiretroviral therapy services and associated factors among adolescents living with HIV in northern Uganda: A cross-sectional study. PLoS One 2023; 18:e0288410. [PMID: 37440577 DOI: 10.1371/journal.pone.0288410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. METHODS We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 software. Descriptive analysis and logistic regressions were performed to determine the relationship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. RESULTS The level of utilization of ART services was suboptimal among 27.6% (81/293) of the participants, and only 63.1% (185/293) were virally suppressed. Of the participants who were optimally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10-14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. CONCLUSIONS AND RECOMMENDATIONS Not all ALHIV used ART services to their full potential. However, factors such as participants' age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.
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Affiliation(s)
| | - Barbara Arim
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Patrick Ayer
- Department of Public Health, Lira University, Lira, Uganda
| | - Tom Murungi
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Susan Akullo
- Department of Community Psychology, Lira University, Lira, Uganda
| | - Docus Aceng
- Department of Public Health, Lira University, Lira, Uganda
| | - Henry Oboke
- Department of Community Psychology, Lira University, Lira, Uganda
| | - Edward Kumakech
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anna Grace Auma
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Richard Nyeko
- Department of Paediatrics and Child Health, Lira University, Lira, Uganda
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15
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Moffatt K, Tekko IA, Vora L, Volpe-Zanutto F, Hutton ARJ, Mistilis J, Jarrahian C, Akhavein N, Weber AD, McCarthy HO, Donnelly RF. Development and Evaluation of Dissolving Microarray Patches for Co-administered and Repeated Intradermal Delivery of Long-acting Rilpivirine and Cabotegravir Nanosuspensions for Paediatric HIV Antiretroviral Therapy. Pharm Res 2023; 40:1673-1696. [PMID: 36224503 PMCID: PMC10421828 DOI: 10.1007/s11095-022-03408-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Whilst significant progress has been made to defeat HIV infection, the efficacy of antiretroviral (ARV) therapy in the paediatric population is often hindered by poor adherence. Currently, two long-acting (LA) intramuscular injectable nanosuspensions of rilpivirine (RPV) and cabotegravir (CAB) are in clinical development for paediatric populations. However, administration requires access to healthcare resources, is painful, and can result in needle-stick injuries to the end user. To overcome these barriers, this proof-of-concept study was developed to evaluate the intradermal delivery of RPV LA and CAB LA via self-disabling dissolving microarray patches (MAPs). METHODS Dissolving MAPs of two conformations, a conventional pyramidal and a bilayer design, were formulated, with various nanosuspensions of RPV and CAB incorporated within the respective MAP matrix. MAPs were mechanically robust and were capable of penetrating ex vivo skin with intradermal ARV deposition. RESULTS In a single-dose in vivo study in rats, all ARV MAPs demonstrated sustained release profiles, with therapeutically relevant plasma concentrations of RPV and CAB detected to at least 63 and 28 d, respectively. In a multi-dose in vivo study, repeated MAP applications at 14-d intervals maintained therapeutically relevant plasma concentrations throughout the duration of the study. CONCLUSIONS These results illustrate the potential of the platform to repeatedly maintain plasma concentrations for RPV and CAB. As such, these MAPs could represent a viable option to improve adherence in the paediatric population, one that is capable of being painlessly administered in the comfort of the patient's own home on a biweekly or less frequent basis.
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Affiliation(s)
- Kurtis Moffatt
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Ismaiel A Tekko
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Lalitkumar Vora
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Fabiana Volpe-Zanutto
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Aaron R J Hutton
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | | | | | - Nima Akhavein
- ViiV Healthcare, 1250 South Collegeville Rd, Collegeville, PA, 19426, USA
| | - Andrew D Weber
- ViiV Healthcare, 410 Blackwell Street, Durham, 27701, NC, UK
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Castelan A, Nellen JF, van der Valk M, Nieuwkerk PT. Intentional- but not Unintentional Medication Non-adherence was Related with Beliefs about Medicines Among a Multi-Ethnic Sample of People with HIV. AIDS Behav 2023; 27:1045-1054. [PMID: 36056998 PMCID: PMC9440648 DOI: 10.1007/s10461-022-03842-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/24/2022]
Abstract
Medication non-adherence can be intentional or unintentional. We investigated the prevalence of unintentional and intentional non-adherence to antiretroviral therapy (ART) and the relationship with beliefs about medicines, sociodemographic- and HIV-related variables among people with HIV (PWH) attending the HIV clinic of the Amsterdam University Medical Centers. Participants completed the Medication Adherence Rating Scale (MARS) and the Beliefs about Medicines (BMQ) questionnaire. About half of 80 participants reported unintentional non-adherence and 20% reported intentional non-adherence. Both unintentional and intentional non-adherence were associated with younger age. Additionally, intentional non-adherence was associated with being a migrant from Suriname /Netherlands Antilles, having more concerns about negative effects of ART and stronger beliefs that medicines in general are overused/ overprescribed. In conclusion, intentional but not unintentional non-adherence was associated with beliefs about medicines. Eliciting and discussing beliefs about medicines may be a promising avenue to address patients' concerns and perceptions thereby potentially enhancing medication adherence.
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Affiliation(s)
- Anjuly Castelan
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, J3-219-1), Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Jeannine F Nellen
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, J3-219-1), Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Nabunya P, Samuel K, Ssewamala FM. The effect of family support on self-reported adherence to ART among adolescents perinatally infected with HIV in Uganda: A mediation analysis. J Adolesc 2023. [PMID: 36810778 PMCID: PMC10257769 DOI: 10.1002/jad.12157] [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: 09/23/2022] [Revised: 12/13/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION This study examined the mechanisms through which family support affects self-reported adherence to antiretroviral therapy among adolescents perinatally infected with HIV in Uganda. METHODS Longitudinal data from 702 adolescent boys and girls (10-16 years) were analyzed. Structural equation models were conducted to assess the direct, indirect, and total effects of family support on adherence. RESULTS Results showed a significant indirect effect of family support on adherence (β = .112, 95% confidence interval [CI]: 0.052-0.173, p < .001). Specific indirect effects of family support through saving attitudes (β = .058, 95% CI: 0.008-0.108, p = .024), and communication with the guardian (β = .056, 95% CI: 0.012-0.100), p = .013), as well as the total effect of family support on adherence (β = .146 (95% CI: 0.032-0.259, p = .012), were statistically significant. Mediation contributed 76.7% of the total effects. CONCLUSION Findings support strategies to help promote family support and strengthen open communication between adolescents living with HIV and their caregivers.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School Washington University, St. Louis, Missouri, USA
| | - Kizito Samuel
- International Center for Child Health and Development (ICHAD), Brown School Washington University, St. Louis, Missouri, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School Washington University, St. Louis, Missouri, USA
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18
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Burger RL, Cohen CR, Mocello AR, Dworkin SL, Frongillo EA, Weke E, Butler LM, Thirumurthy H, Bukusi EA, Weiser SD. Relationship Power, Antiretroviral Adherence, and Physical and Mental Health Among Women Living with HIV in Rural Kenya. AIDS Behav 2023; 27:416-423. [PMID: 36001201 PMCID: PMC9908627 DOI: 10.1007/s10461-022-03775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Little is known about the association of gender-based power imbalances and health and health behaviors among women with HIV (WWH). We examined cross-sectional baseline data among WWH in a cluster-randomized control trial (NCT02815579) in rural Kenya. We assessed associations between the Sexual Relationship Power Scale (SRPS) and ART adherence, physical and mental health, adjusting for sociodemographic and social factors. SRPS consists of two subscales: relationship control (RC) and decision-making dominance. Women in the highest and middle tertiles for RC had a 7.49 point and 8.88 point greater Medical Outcomes Study-HIV mental health score, and a 0.27 and 0.29 lower odds of depression, respectively, compared to women in the lowest tertile. We did not find associations between SPRS or its subscales and ART adherence. Low sexual relationship power, specifically low RC, may be associated with poor mental health among WWH. Intervention studies aimed to improve RC among WWH should be studied to determine their effect on improving mental health.
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Affiliation(s)
- Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
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Patel P, Teichner P, Elliot E, Boffito M, Murray M, Polli JW, Baker M, Ford SL, Han K, Russu A, Crauwels H, D’Amico RD, Spreen WR, van Wyk J. Practical dosing guidance for the management of clinician-administered injections of long-acting cabotegravir and rilpivirine. Ther Adv Infect Dis 2023; 10:20499361231214626. [PMID: 38107552 PMCID: PMC10722954 DOI: 10.1177/20499361231214626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Cabotegravir (CAB) and rilpivirine (RPV) is the first complete long-acting (LA) injectable regimen recommended by treatment guidelines for the maintenance of HIV-1 virologic suppression in people with HIV-1 who are virologically suppressed on a stable antiretroviral regimen that is administered monthly (Q1M) or every 2 months (Q2M). As an alternative regimen to lifelong daily oral antiretroviral therapy, Q1M or Q2M dosing schedules are associated with increased patient satisfaction and treatment preference. In addition, it may address challenges associated with daily oral dosing, including fear of treatment disclosure or stigma, anxiety related to oral dosing adherence, and the daily reminder of HIV disease status. Cabotegravir + RPV LA is administered by clinical staff as two intramuscular injections dosed Q1M or Q2M. In this review, we share practical dosing guidance for CAB+RPV LA injectable therapy, including how to initiate therapy, schedule injection visits, manage dosing interruptions due to missed or delayed injection visits, manage errors in dosing, and transition to alternative antiretroviral therapy after discontinuation. Practical guidance on the clinical management of CAB+RPV LA dosing, including a detailed discussion using case-based scenarios that may be encountered in clinical practice, is provided. The clinician-administered CAB+RPV LA regimen has dosing management considerations that are flexible and considerate of the patient and has the potential to provide a highly desirable and efficacious alternative to daily oral antiretroviral therapy for many people with HIV-1.
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Affiliation(s)
- Parul Patel
- ViiV Healthcare, 410 Blackwell Street, Durham, NC 27701, USA
| | | | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Milena Murray
- Merck & Co, Inc, Rahway, NJ, USA
- Midwestern University and Northwestern Medicine, Chicago, IL, USA
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20
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Manuzak JA, Granche J, Tassiopoulos K, Rower JE, Knox JR, Williams DW, Ellis RJ, Goodkin K, Sharma A, Erlandson KM. Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV. Open Forum Infect Dis 2023; 10:ofac699. [PMID: 36726540 PMCID: PMC9879711 DOI: 10.1093/ofid/ofac699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Background Conflicting evidence exists on the impact of cannabis use on antiretroviral therapy (ART) adherence among people with human immunodeficiency virus (PWH). We leveraged data collected among older PWH to characterize longitudinal associations between cannabis use and ART adherence. Methods AIDS Clinical Trials Group (ACTG) A5322 study participants were categorized as <100% (≥1 missed dose in past 7 days) or 100% (no missed doses) ART adherent. Participants self-reported current (past month), intermittent (past year but not past month), and no cannabis (in past year) use at each study visit. Generalized linear models using generalized estimating equations were fit and inverse probability weighting was used to adjust for time-varying confounders and loss to follow-up. Results Among 1011 participants (median age, 51 years), 18% reported current, 6% intermittent, and 76% no cannabis use at baseline; 88% reported 100% ART adherence. Current cannabis users were more likely to be <100% adherent than nonusers (adjusted risk ratio [aRR], 1.53 [95% CI, 1.11-2.10]). There was no association between ART adherence and current versus intermittent (aRR, 1.39 [95% CI, .85-2.28]) or intermittent versus no cannabis use (aRR, 1.04 [95% CI, .62-1.73]). Conclusions Among a cohort of older PWH, current cannabis users had a higher risk of <100% ART adherence compared to nonusers. These findings have important clinical implications as suboptimal ART adherence is associated with ART drug resistance, virologic failure, and elevated risk for mortality. Further research is needed to elucidate the mechanisms by which cannabis use decreases ART adherence in older PWH and to advance the development of more efficacious methods to mitigate nonadherence in this vulnerable population.
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Affiliation(s)
- Jennifer A Manuzak
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Janeway Granche
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph E Rower
- Center for Human Toxicology, Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, Utah, USA
| | - Justin R Knox
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, New York, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
- Department of Sociomedical Science, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Karl Goodkin
- Consultant, AIDS Clinical Trials Group, Los Angeles, California, USA
- Consultant, Chronic HIV Infection in Aging and NeuroAIDS Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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21
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Schoenberger SF, Idrisov B, Sereda Y, Kiriazova T, Makarenko O, Bendiks S, Ahuja N, Dutta A, Flanigan T, Gillani FS, Lunze K. Police abuse and care engagement of people with HIV who inject drugs in Ukraine. Glob Public Health 2022; 17:3638-3653. [PMID: 35343870 PMCID: PMC9515241 DOI: 10.1080/17441692.2022.2049341] [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: 07/17/2021] [Accepted: 02/17/2022] [Indexed: 02/06/2023]
Abstract
Police abuse affects people who inject drugs (PWID), including those with HIV, and negatively impacts care engagement. This cross-sectional study evaluated police abuse among PWID receiving MOUD (medication for opioid use disorder) living with HIV and associations with HIV treatment adherence and receipt of NGO services. We assessed lifetime and past six-month rates of police abuse among a cohort of Ukrainian PWID with HIV receiving MOUD (n = 190) from August to September 2017. Logistic regression models evaluated associations between past six-month police abuse and past 30-day antiretroviral therapy (ART) adherence, and past six-month NGO service receipt. Almost all (90%) participants reported lifetime police abuse: 77% reported physical violence and 75% reported paying the police to avoid arrest. One in four females (25%) reported police-perpetrated sexual violence. Recent police abuse was reported by 16% of males and 2% of females and was not associated with ART adherence (aOR: 1.1; 95% CI:0.3-5.0) or NGO service receipt (aOR: 3.4; 95% CI:0.6-18.3). While lifetime police abuse rates were high, few participants reported recent police abuse, which was not linked to care engagement. These trends should encourage the Ukrainian government for public health-public safety partnerships and legal interventions to eliminate human rights violations against PWID living with HIV.
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Affiliation(s)
- Samantha F Schoenberger
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Bulat Idrisov
- Institute for Leadership and Health Management, Sechenov First Moscow State Medical University, Moscow, Russia
- Bashkir State Medical University, Ufa, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | | | | | | | - Sally Bendiks
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Arunima Dutta
- Section of Internal Medicine, McLaren Flint/Michigan State University, Flint, MI, USA
| | - Timothy Flanigan
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam & Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Fizza S Gillani
- Division of Infectious Disease, Alpert Medical School of Brown University, The Miriam & Rhode Island Hospitals, Brown University, Providence, RI, USA
| | - Karsten Lunze
- Clinical Addiction and Research Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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22
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Senu E, Sakyi SA, Ayisi-Boateng NK, Enimil AK, Opoku S, Ansah RO, Aning BD, Ojuang DA, Wekesa DN, Ahmed FO, Okeke CB, Sarfo AD, Kwofie GS, Amoani B. Factors associated with anti-retroviral therapy (ART) adherence among adult people living with HIV (PLWH): A 5-year retrospective multi-centre study in Kumasi, Ghana. DIALOGUES IN HEALTH 2022; 1:100082. [PMID: 38515921 PMCID: PMC10954008 DOI: 10.1016/j.dialog.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 03/23/2024]
Abstract
Background Combined antiretroviral therapy (cART) is the recommended treatment regimen for people living with HIV (PLWH). Long-term HIV treatment of over 95% adherence inhibits increase in viral load and boosts immune system performance. On the contrary, non-adherence results in treatment failure, accelerated development of HIV drug-resistance and increased mortality. However, there is paucity of data on the prevalence of antiretroviral therapy (ART) adherence and its associated factors in Ghana. We assessed the prevalence, sociodemographic and clinical factors associated with ART adherence among registered PLWH. Methods In a multi-centre hospital-based retrospective study, we collected data on 720 registered PLWH 18 years and above, who attend the HIV clinic at the University Hospital (KNUST), Komfo Anokye Teaching Hospital (KATH), and the Bomso Clinic, on ART and with up-to-date medical records. They were enrolled using a multistage sampling technique. Adherence was assessed retrospectively using missed doses and prescriptions renewal. All analysis were done using SPSS Version 26.0 and GraphPad prism version 8.0. Results Of 720 registered PLWH, 51.8% had good ART adherence, 35.3% had fair ART adherence and 12.9% had poor ART adherence. Those diagnosed at WHO stage II (aOR = 0.45, 95% CI: (0.30-0.68); p < 0.0001) and stage III (aOR = 0.40, 95% CI: (0.27-0.59) < 0.0001) were independently associated with lower chances of good adherence to ART. Moreover, those treated with AZT/3TC/EFV (aOR = 0.33, 95% CI: (0.16-0.68); p = 0.0030), and AZT/3TC/NVP (aOR = 0.50, 95% CI: (0.26-0.98); p = 0.0410) were independently associated with lower likelihood of good ART adherence. On the contrary, PLWH who have been on treatment for 4 years (aOR = 3.56, 95% CI: (1.10-11.54); p = 0.0340) was an independent predictor of good ART adherence. Conclusion About half of PLWH on treatment have good adherence to ART. Being diagnosed at WHO stage II and stage III, being treated with AZT/3TC/EFV, and AZT/3TC/NVP ART combination are associated with lesser chances of good ART adherence. However, increased duration of ART among PLWH influence good ART adherence. PLWH on ART should be monitored to achieve over 95% ART adherence for effective management of HIV/AIDS.
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Affiliation(s)
- Ebenezer Senu
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Anthony Kwame Enimil
- Pediatric Infectious Disease Unit, Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Stephen Opoku
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Owusu Ansah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bismark Dankwah Aning
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Diana Atsieno Ojuang
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Doreen Nafula Wekesa
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fatima Osman Ahmed
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Chidinma B. Okeke
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ama Darkoaa Sarfo
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Benjamin Amoani
- Department of Biomedical Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
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23
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Olojede SO, Lawal SK, Dare A, Naidu ECS, Rennie CO, Azu OO. Evaluation of tenofovir disoproxil fumarate loaded silver nanoparticle on testicular morphology in experimental type-2 diabetic rats. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2022; 50:71-80. [PMID: 35343349 DOI: 10.1080/21691401.2022.2042009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
Reproductive derangement and metabolic disorders in human immunodeficiency virus (HIV) infected persons require a nanoparticle delivery system to convey antiretroviral drugs to the anatomical sanctuary such as testis. This study investigated the effects of tenofovir disoproxil fumarate (TDF) loaded silver nanoparticles (AgNPs) on the testicular oxidative stress, inflammatory cytokines and histology in male diabetic rats. Thirty-six Sprague-Dawley rats weighing 230 ± 20 g were randomly divided into diabetic and non-diabetic groups (n = 18). Diabetes was induced using the fructose-streptozotocin (Frt-STZ) rat model. Both groups were further divided into three (n = 6) and administered distilled water, TDF, or TDF-AgNP. Results obtained with the TDF-AgNP administration showed a significant increase (p < .05) in the reduced glutathione and catalase levels. Tumour necrosis factor-alpha and interleukin 6 were reduced in diabetic rats administered TDF-AgNP. More so, administration of TDF-AgNP to diabetic rats improved testicular histoarchitecture in diabetic rats. In addition, diabetic rats administered TDF-AgNP showed a significant reduction (p < .05) in blood glucose levels. TDF-AgNP to diabetic rats enhanced testicular antioxidant enzyme, reduced testicular inflammation, and alleviated structural derangements in the testis. Thus, the application of AgNP to deliver TDF may alleviate testicular toxicity and subsequently cater for neglected reproductive dysfunction during the management of HIV infection.
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Affiliation(s)
- Samuel Oluwaseun Olojede
- Discipline of Clinical Anatomy, School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sodiq Kolawole Lawal
- Discipline of Clinical Anatomy, School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ayobami Dare
- Discipline of Physiology, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Edwin C Stephen Naidu
- Discipline of Clinical Anatomy, School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carmen Olivia Rennie
- Discipline of Clinical Anatomy, School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Onyemaechi Okpara Azu
- Department of Human, Biological & Translational Medical Sciences, School of Medicine, University of Namibia, Hage Geingob Campus, Windhoek, Namibia
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24
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Hossain F, Hasan M, Begum N, Mohan D, Verghis S, Jahan NK. Exploring the barriers to the antiretroviral therapy adherence among people living with HIV in Bangladesh: A qualitative approach. PLoS One 2022; 17:e0276575. [PMID: 36269716 PMCID: PMC9586390 DOI: 10.1371/journal.pone.0276575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. METHODS We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. RESULTS The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. CONCLUSIONS We recommended strengthening Bangladesh's HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
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Affiliation(s)
- Fariha Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | | | | | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Sharuna Verghis
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Nowrozy Kamar Jahan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
- * E-mail:
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25
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Pugh LE, Roberts JS, Viswasam N, Hahn E, Ryan S, Turpin G, Lyons CE, Baral S, Hansoti B. Systematic review of interventions aimed at improving HIV adherence to care in low- and middle-income countries in Sub-Saharan Africa. J Infect Public Health 2022; 15:1053-1060. [PMID: 36063721 PMCID: PMC10117278 DOI: 10.1016/j.jiph.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
Long-term adherence to antiretroviral medication continues to present as a challenge along the continuum of the HIV care cascade. HIV interventions and support programs are significantly threatened in resource-limited settings by challenges in maintaining long-term follow-up for ART adherence. We sought to complete a systematic review to comprehensively examine ART adherence and retention in care interventions in Sub-Saharan Africa and to report on the implementation of interventions in real-world settings to inform future health investments in HIV care. Interventions were grouped according to their impact on individual, community, and health-systems levels. While a vast majority of studies evaluated a combination of interventions, those studies that incorporated the community as a resource were most successful. In addition, providing education and behavior reminders proved effective and should be accompanied by community and peer efforts for best results. Multi-level interventions, such as combining individual and community-level interventions showed promising results for long term ART adherence.
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Affiliation(s)
- Laura E Pugh
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jacob S Roberts
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nikita Viswasam
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hahn
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophia Ryan
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ghilane Turpin
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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26
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Carrico AW, Rubin LH, Paul RH. The Interaction of HIV With Mental Health in the Modern Antiretroviral Therapy Era. Psychosom Med 2022; 84:859-862. [PMID: 36214528 PMCID: PMC9553253 DOI: 10.1097/psy.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT People with HIV (PWH) receiving effective antiretroviral therapy (ART) continue to display residual immune dysregulation that amplifies the risk for neuropsychiatric comorbidities. At the same time, PWH commonly experience intersectional stigma and other psychosocial stressors that are linked to neuroendocrine stress responses, potentiate residual immune dysregulation, and alter other biobehavioral processes relevant to health outcomes. This special issue of Psychosomatic Medicine seeks to advance our understanding of the intersection of HIV with mental health in the modern ART era. Several articles cover topics related to the prevalence and treatment of psychiatric comorbidities among PWH such as depression, suicidality, and substance use disorders. Other articles delineate biobehavioral mechanisms relevant to mental health in PWH such as inflammation, immune activation, neuroendocrine signaling, cellular aging, the microbiome-gut-brain axis, and neurobehavioral processes. Collectively, the articles in this special issue highlight the continued importance of biobehavioral and neurobehavioral mental health research in the modern ART era.
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27
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Ransome Y, Kershaw T, Kawachi I, Nash D, Mayer KH. Racial disparity in ART adherence is closed in states with high social trust: Results from the Medical Monitoring Project (MMP), 2015. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3659-3680. [PMID: 35460588 PMCID: PMC10485770 DOI: 10.1002/jcop.22862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/23/2022] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
Racial/ethnic disparities persist in antiretroviral therapy (ART) adherence and viral suppression. We examined associations between state-level social trust and individual-level ART adherence and viral suppression and assessed whether these relationships varied by race/ethnicity. The Medical Monitoring Project (MMP) annually reports nationally representative estimates of the behavioral and clinical characteristics of HIV-positive adults in primary care. A total of 3298 adults diagnosed with HIV between 2015 and 2016 from 16 US states were included. We used weighted logistic regression to model the association between state-level social trust, race/ethnicity (Non-Hispanic Black, White, and Hispanic/Latino), and cross-product interactions with ART adherence (a binary measure derived from three self-reported questions), and viral suppression (a binary measure corresponding to plasma HIV RNA < 200 copies/ml). Social trust was the percentage of people in each state who agreed that most people in their neighborhood could be trusted. A high level of social trust was associated with a higher likelihood of ART adherence (PR [prevalence ratio] = 1.17; 95% confidence interval [CI]: 1.05-1.30). In covariate-adjusted analyses, the association between state-level social trust and individual-level ART adherence significantly varied by race/ethnicity (Wald χ2 F = 9.8 [df = 4], p = 0.044). Social trust was positively associated with ART, but the effect was smaller for Blacks than for Whites (PR = 0.66; 95% CI: 0.57-0.82) in states with the lowest social trust. Black-White differences were closed and no longer significant above mean social trust (PP [predicted probability] = 0.50 vs. 0.53, at two standard deviations). Racial/ethnic disparities in ART adherence were closed among individuals living in states with high social trust. Understanding the mechanisms that promote social trust among neighbors may have downstream impacts on reducing disparities in ART adherence among people with HIV (PWH).
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Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Trace Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ichiro Kawachi
- Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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28
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Weldesenbet AB, Tusa BS, Debele GR, Sisay MM, Ayele TA. Time to First Line Antiretroviral Therapy Adverse Drug Reaction and its Predictors Among Adult HIV/AIDS Patients on Treatment in Eastern Ethiopia. Front Pharmacol 2022; 13:922744. [PMID: 36046817 PMCID: PMC9421417 DOI: 10.3389/fphar.2022.922744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Even though determining the time to anti-retroviral therapy (ART) adverse drug reaction and its predictors is a crucial step to overcome the negative consequences of the adverse drug reaction, there is limited information regarding the time to ART adverse drug reaction and its predictors. Therefore, this study aimed to determine the time to first ART adverse drug reaction and its predictors among adult HIV/AIDS patients on first-line antiretroviral therapy in West Hararghe Zone, Eastern Ethiopia. Methods: An institution-based retrospective cohort study was conducted on 561 HIV/AIDS patients on first-line ART from September 2013–January 2019 at public hospitals in West Hararghe Zone, Eastern Ethiopia. Data were collected using checklists and document reviews, entered using Epi Info and analyzed in R software. A Cox proportional hazard model was fitted to identify predictors of the time to first ART adverse drug reaction. Model adequacy was checked using Cox Snell residuals. An adjusted hazard ratio with its confidence interval was used to show the presence and strength of association at a 95% confidence level. Result: Most (90.74%) ART adverse drug reactions occurred within 1 year of initiation of ART. Overall, 54 patients developed ART adverse drug reactions with an incidence density of 3.5/100 persons-years of observations (95% CI: 2.7–4.6). The initial ART regimen (TDF, 3TC, EFV) [AHR = 0.3, 95% CI 0.1–0.7], fair adherence [AHR = 8.8, 95% CI 3.3–23.2], poor adherence [AHR = 7.8, 95% CI 3.1–19.5], moderate body mass index (BMI) at the baseline [AHR = 4.4, 95% CI 1.8–11.0], severe body mass index [AHR = 2.8, 95% CI 1.1–6.8], World Health Organization (WHO) stage II [AHR = 3.7, 95% CI 1.2–11.3] and WHO stage IV [AHR = 6.3, 95% CI 2.0–19.8] were significant predictors of the time to ART adverse drug reactions. Conclusion: In conclusion, most of the ART adverse drug reactions occurred within 1 year of initiation of ART. The initial ART regimen (TDF, 3TC, EFV), adherence, HIV/AIDS stage, and BMI were risk factors for the time to ART adverse drug reaction. The incidence of the antiretroviral therapy adverse reaction was relatively low with early onset. Close monitoring of clients in clinical stage II and above is required and continuous assessment for improving the detection and management of adverse drug reactions is recommended. Patients with poor adherence need to get continuous counseling to improve their adherence status.
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Affiliation(s)
- Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- *Correspondence: Biruk Shalmeno Tusa,
| | - Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Treatment Adherence among HIV and TB Patients Using Single and Double Way Mobile Phone Text Messages: A Randomized Controlled Trial. J Trop Med 2022; 2022:2980141. [PMID: 35996467 PMCID: PMC9392638 DOI: 10.1155/2022/2980141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Research has shown that patients fail to adhere to ART and TB treatment due to the long duration of both therapies, side effects, and forgetfulness. Objective To assess the role of the double-way and single-way SMS on adherence to HIV and TB treatment. Materials and Methods A randomized controlled trial among adult HIV and TB patients on treatment at the Buea Regional and Kumba District Hospitals, South West Region, Cameroon, was conducted. Participants were randomly allocated to the control, single-way, and double-way SMS intervention groups. HIV and TB participants were followed independently for a period of 6 months and 3 months, respectively. Baseline and post-intervention data were collected and analyzed using the chi-square and Student's t-tests with statistical significance set at p < 0.05. Results A total of 210 HIV participants and 84 TB were recruited into the study with a mean age of 41.25 ± 10 years and 37.89 ± 13.27 years, respectively. Optimal adherence to ART and TB treatment at baseline was [65 (31%) CI: 0.247–0.372] and [35 (41.7%) CI: 0.311-0.522], respectively, and after the intervention, it increased to [72 (42.6%) CI: 0.347-0.495] and 41 (61.2%), respectively. There was an increase in adherence to ART among participants in the double-way SMS intervention group from 23 (32.9%) (RR: 1.04, CI: 0.8-1.31, p=0.716) to 29 (48.3%) (RR: 1.06, CI: 0.75-1.50, p=0.746). Combined single-way and double-way SMS significantly increased adherence to ART. Conclusions The level of adherence was low among HIV and TB participants. The single-way and double-way SMS did not significantly increase adherence. However, a combination of both the double-way and single-way SMS intervention significantly improved adherence to ART.
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Yousaf I, Haqqani S. HIV Treatment Adherence Self-efficacy Scale for Pakistani HIV/AIDS patients: Translation and psychometric evaluation. Appl Nurs Res 2022; 66:151606. [DOI: 10.1016/j.apnr.2022.151606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
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Ironson G, Hylton E, Verhagen R. A New Attitude Towards Treatment Measure Predicts Survival Over 17 Years. J Gen Intern Med 2022; 37:2351-2357. [PMID: 35296979 PMCID: PMC9360262 DOI: 10.1007/s11606-021-07245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients diagnosed with chronic illness, attitude towards treatment may play an important role in health and survival. For example, negative attitudes towards treatment have been related to poorer adherence to treatment recommendations and prescribed medication across a range of chronic illnesses. In addition, prior research has shown that attitude towards treatment assessed through a psychiatric interview predicted survival at 1 year after bone marrow transplantation with great accuracy (> 90%). OBJECTIVE The purpose of this study was to determine the relationship between a self-report attitude to a treatment measure that operationalized a psychiatric interview, and survival over 17 years in a sample of people living with HIV (PLWH). PARTICIPANTS AND DESIGN Participants (N = 177) who were in the mid-range of HIV illness at baseline (CD4s 150 to 500, no prior AIDS-defining clinical symptom) were administered the Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale and followed longitudinally to determine survival at 17 years. MEASURES The Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale is a 20-item self-report questionnaire designed to survey multiple factors that contribute to an overall psychological construct of the treatment process. RESULTS The MMAT-20/HIV predicted survival over 17 years controlling for biomedical (baseline CD4, viral load, antiretroviral medications, age) and psychosocial (race, education, antiretroviral medications) variables. Those in the top half on the MMAT-20/HIV were almost twice as likely to survive than those in the lower half. Scores on the MMAT-20/HIV were significantly but modestly correlated with adherence (r = .20, p < .05), but adherence was not a mediator of the relationship between the MMAT-20/HIV and survival. CONCLUSIONS An individual's attitude towards the treatment process predicted survival, raising the possibility that optimal clinical management would include ways to probe these attitudes and intervene where possible. The ease of administering the MMAT-20 and adaptability to other illnesses could facilitate this endeavor.
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Affiliation(s)
| | - Emily Hylton
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA
| | - Rachel Verhagen
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA
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Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs. AIDS 2022; 36:1233-1243. [PMID: 35833680 DOI: 10.1097/qad.0000000000003234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Owing to advances in antiretroviral therapy (ART), we re-examined minimum ART adherence levels necessary to achieve sustained HIV-1 viral load (VL) suppression among people with HIV who use drugs (PHIV-PWUD). DESIGN AND METHODS We used data from ACCESS, a community-recruited prospective cohort of PHIV-PWUD in Vancouver, Canada. We calculated adherence using the proportion of days of ART dispensed in the year before each VL measurement. We used generalized linear mixed-effects models to identify adherence- and ART regimen-related correlates of VL suppression (<200 copies/ml). We employed probit regression models and generated dose-response curves to estimate the minimum adherence level needed to produce VL suppression in 90% of measures, stratified by regimen and calendar-year. RESULTS Among 837 ART-exposed PHIV-PWUD recruited between 1996 and 2017, the overall estimated adherence level necessary to achieve 90% VL suppression was 93% (95% confidence interval [CI]: 90-96). This differed by regimen: 69% (95% CI: 45-92) for integrase inhibitor (INSTI)-, 96% (95% CI: 92-100) for boosted protease inhibitor (bPI)-, and 98% (95% CI: 91-100) for non-nucleoside reverse transcriptase inhibitor-based regimens. In multivariable analysis, INSTI-based regimens were positively associated with VL suppression (vs. bPIs), while un-boosted PIs and other regimens were negatively associated. We observed a decreasing temporal trend of estimated adherence necessary for 90% VL suppression, dropping to 64% (95% CI: 50-77) during 2016-2017. CONCLUSION Although high levels of ART adherence were necessary to achieve consistent VL suppression, the minimum necessary adherence levels decreased over time. Overall, INSTI-based regimens performed the best, suggesting that they should be preferentially prescribed to PHIV-PWUD.
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Wagner GJ, Wagner Z, Gizaw M, Saya U, MacCarthy S, Mukasa B, Wabukala P, Linnemayr S. Increased Depression during COVID-19 Lockdown Associated with Food Insecurity and Antiretroviral Non-Adherence among People Living with HIV in Uganda. AIDS Behav 2022; 26:2182-2190. [PMID: 34570315 PMCID: PMC8475428 DOI: 10.1007/s10461-021-03371-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
The health and economic threats posed by the COVID-19 pandemic can be sources of great distress among people living with HIV, which in turn can impact the management of their HIV disease. We examined change in depression from pre- to post-lockdown restrictions and correlates of elevated depressive symptoms, including antiretroviral therapy (ART) adherence. Participants enrolled in a randomized controlled trial of an ART adherence intervention in Uganda. The month-12 follow-up assessment was fully administered just prior to the start of the pandemic-related lockdown in March 2020; at the conclusion of the lockdown three months later, we administered a mixed-methods phone-based assessment. ART adherence was electronically monitored throughout the study period, including during and after the lockdown. Depression was assessed with the 8-item Patient health questionnaire (PHQ-8), on which scores > 9 signify a positive screen for elevated depressive symptoms. A sample of 280 participants completed both the month-12 and post-lockdown assessments. Rates of elevated depressive symptoms nearly tripled from month 12 (n = 17, 6.1%) to the post-lockdown assessment (n = 50, 17.9%; McNemar test < .001). Elevated depressive symptoms at post-lockdown were associated with being female, indicators of economic struggles at month 12 (unemployment, low income, high food insecurity), and lower ART adherence during the 3-month lockdown period [mean of 71.9% (SD = 27.9) vs. 80.8% (SD = 24.1) among those not depressed; p = .041] in bivariate analysis. In multiple regression analysis, higher food insecurity [adj. OR (95% CI) = 4.64 (2.16–9.96)] and perception that the pandemic negatively impacted ART adherence [adj. OR (95% CI) = 1.96 (1.22–3.16)] remained associated with a greater likelihood of elevated depressive symptoms, when other correlates were controlled for. Qualitative data suggested that economic stressors (lack of food, work, and money) were key contributors to elevated depressive symptoms, and these stressors led to missed ART doses because of lack of food and stress induced forgetfulness. Elevated depressive symptoms significantly increased during the COVID-19 lockdown and was associated with food insecurity and reduced ART adherence. Mechanisms for identifying and treating depression and food insecurity are needed to help PLHIV cope with and mitigate the harmful effects of unexpected crises that may impede disease management and access to food.
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Affiliation(s)
| | - Zachary Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main St., Santa Monica, CA 90407 USA
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Perceptions About Local ART Adherence Norms and Personal Adherence Behavior Among Adults Living with HIV in Rural Uganda. AIDS Behav 2022; 26:1892-1904. [PMID: 35034237 DOI: 10.1007/s10461-021-03540-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/08/2023]
Abstract
Although misperceived norms often drive personal health behaviors, we do not know about this phenomenon in the context of antiretroviral therapy (ART) adherence. We conducted a cross-sectional study including all persons living with HIV (PLWH) on ART across eight villages in one parish in a rural region of southwestern Uganda. We used surveys to measure personal reports of ART adherence (not missing any doses of ART in the past 7 days was considered optimal adherence whereas missing doses was considered suboptimal adherence) and perceived norms about the local ART adherence norm (whether or not each individual thought 'most other PLWH on ART in this parish' missed any doses in the past 7 days). Multivariable Poisson regression models were used to estimate the association between perceived norms and personal adherence. Among 159 PLWH on ART (95% response rate), 142 (89%) reported no missed doses. However, 119 (75%) thought most individuals in this population of PLWH on ART were sub-optimally adherent. This misperception about the local ART adherence norm was prevalent in every subgroup of PLWH. Misperceiving the local ART adherence norm to be sub-optimal adherence was associated with a reduced likelihood of optimal adherence among married PLWH (adjusted relative risk [aRR] = 0.83; 95% confidence interval [CI] 0.71-0.97). The association was similar but imprecisely estimated for all PLWH (aRR = 0.91; 95% CI 0.82-1.01). Interventions to correct misperceived ART adherence norms as a stand-alone intervention or as a complement to other adherence promotion programs may influence ART adherence behavior and perhaps reduce HIV-related stigma.
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Narváez M, Lins-Kusterer L, Valdelamar-Jiménez J, Brites C. Quality of Life and Antiretroviral Therapy Adherence: A Cross-Sectional Study in Colombia. AIDS Res Hum Retroviruses 2022; 38:660-669. [PMID: 35459414 DOI: 10.1089/aid.2021.0233] [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: 11/12/2022] Open
Abstract
The introduction of highly active combined antiretroviral therapy (cART) has changed the management of HIV/AIDS, which is recognized as a chronic disease with relevant aspects, such as adherence and quality of life. This study aimed to compare clinical and demographic characteristics and health-related quality of life in people with adherence and non-adherence to cART. A cross-sectional study was carried out with 200 participants. The instruments used were the Adherence Follow-up Questionnaire, the Beck Depression Inventory-II, the 36-Item Short Form Health Survey and the WHOQOL-HIV BREF. Poisson regression was applied to obtain estimates of adjusted prevalence ratios (PRadj). Individuals lacking therapeutic support were more likely to be non-adherent than those with proper support (PR: 1.79). The health-related quality of life of individuals with non-adherence was 4% lower (PR = 0.96) in the general health domain than individuals with adherence. Non-adherence to cART was associated with lower quality of life in the general health domain and no therapeutic support.
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Affiliation(s)
- Mónica Narváez
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Liliane Lins-Kusterer
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Juliet Valdelamar-Jiménez
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
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Kalungwe M, Mbalinda SN, Karonga T, Simwanza NR, Mumba Mtambo CM, Nyashanu M. Exploring barriers to antiretroviral therapy adherence among pregnant women: a scoping literature review. Int J Gynaecol Obstet 2022; 159:343-350. [PMID: 35122429 DOI: 10.1002/ijgo.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/01/2022] [Accepted: 02/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) is one of the most effective ways of preventing HIV-related maternal mortality. However, the rates of retention in care and long-term adherence remain extremely low. OBJECTIVE The aim of this study was to explore barriers to antiretroviral therapy adherence among pregnant women. SEARCH STRATEGY The search for articles was conducted using EBSCO Host, PubMed, Google scholar, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). SELECTION CRITERIA The studies included were conducted between 2000 and 2020 and covered barriers to antiretroviral therapy. DATA COLLECTION AND ANALYSIS Data was collected from 8 selected articles and analyzed using Arksey and O'Malley five stages framework. MAIN RESULTS Barriers to antiretroviral therapy adherence included side effects of the therapy and financial constraints limiting access to food, transport, and medication. Other barriers included cultural and religious factors, lack of spouse support, stigma, and discrimination. CONCLUSION There is need to support pregnant women undergoing antiretroviral therapy to mitigate barriers associated with the uptake of the therapy.
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Affiliation(s)
| | | | | | | | | | - Mathew Nyashanu
- School of Public Health, Nottingham Trent University, Nottingham, UK
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Schürmann D, Jackson Rudd D, Schaeffer A, De Lepeleire I, Friedman EJ, Robberechts M, Zhang S, Liu Y, Kandala B, Keicher C, Däumer M, Hofmann J, Grobler JA, Stoch SA, Iwamoto M, Ankrom W. Single Oral Doses of MK-8507, a Novel Non-Nucleoside Reverse Transcriptase Inhibitor, Suppress HIV-1 RNA for a Week. J Acquir Immune Defic Syndr 2022; 89:191-198. [PMID: 34654041 PMCID: PMC8740605 DOI: 10.1097/qai.0000000000002834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND MK-8507 is a novel HIV-1 non-nucleoside reverse transcriptase inhibitor being developed for treatment of HIV-1 infection. MK-8507 has high antiviral potency in vitro and pharmacokinetic (PK) properties that support once-weekly dosing. SETTING A phase 1, open-label, proof-of-concept study was conducted in treatment-naive adults with HIV-1 infection to assess monotherapy antiviral activity. METHODS In 3 sequential panels, participants aged 18-60 years with baseline plasma HIV-1 RNA ≥10,000 copies/mL and CD4+ T-cell count >200/mm3 received a single oral dose of 40, 80, or 600 mg MK-8507 in the fasted state. Participants were assessed for HIV-1 RNA for at least 7 days, PKs for 14 days, and safety and tolerability for 21 days postdose. RESULTS A total of 18 participants were enrolled (6 per panel). The mean 7-day postdose HIV-1 RNA reduction ranged from ∼1.2 to ∼1.5 log10 copies/mL across the doses assessed. One patient had a viral rebound associated with emergence of an F227C reverse transcriptase variant (per chain-termination method sequencing) 14 days postdose; this variant was found in a second participant by ultra-deep sequencing as an emerging minority variant. MK-8507 PKs were generally dose-proportional and similar to observations in participants without HIV-1 infection in prior studies; mean MK-8507 half life was 56-69 hours in this study. MK-8507 was generally well tolerated at all doses. CONCLUSIONS The robust antiviral activity, PK, and tolerability of MK-8507 support its continued development as part of a complete once weekly oral regimen for HIV-1 treatment; combination therapy could mitigate the emergence of resistance-associated variants.
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Affiliation(s)
- Dirk Schürmann
- Charité Research Organisation GmbH, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | - Yang Liu
- Merck & Co., Inc., Kenilworth, NJ
| | | | | | | | - Jörg Hofmann
- Institute of Virology, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Mills A, Richmond GJ, Newman C, Osiyemi O, Cade J, Brinson C, De Vente J, Margolis DA, Sutton KC, Wilches V, Hatch S, Roberts J, McCoig C, Garris C, Vandermeulen K, Spreen WR. Long-acting cabotegravir and rilpivirine for HIV-1 suppression: switch to 2-monthly dosing after 5 years of daily oral therapy. AIDS 2022; 36:195-203. [PMID: 34652287 PMCID: PMC8711606 DOI: 10.1097/qad.0000000000003085] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Long-acting formulations of cabotegravir (CAB) and rilpivirine (RPV) have demonstrated efficacy in Phase 3 studies. POLAR (NCT03639311) assessed antiviral activity and safety of CAB+RPV long-acting administered every 2 months (Q2M) in adults living with HIV-1 who previously received daily oral CAB+RPV in LATTE (NCT01641809). DESIGN A Phase 2b, multicenter, open-label, rollover study. METHODS LATTE participants with plasma HIV-1 RNA less than 50 copies/ml who completed at least 300 weeks on study were eligible. Participants elected to switch to either CAB+RPV long-acting Q2M or daily oral dolutegravir/RPV for maintenance of virologic suppression. The primary endpoint was the proportion of participants with HIV-1 RNA greater than or equal to 50 copies/ml at Month 12 (M12) per the Food and Drug Administration Snapshot algorithm. The incidence of confirmed virologic failure (CVF, two consecutive HIV-1 RNA measurements greater than or equal to 200 copies/ml), as well as safety, laboratory, and patient-reported outcomes (HIV Treatment Satisfaction and preference questionnaires) were also assessed. RESULTS Of 97 participants enrolled, 90 chose to receive CAB+RPV long-acting and seven chose dolutegravir/RPV. At M12, no participant had HIV-1 RNA greater than or equal to 50 copies/ml or met the CVF criterion in either treatment group. No new safety signals were identified. Total treatment satisfaction was high at Baseline and remained stable through M12 across both treatment groups. Overall, 88% (n = 77/88) of long-acting arm participants preferred CAB+RPV long-acting to oral CAB+RPV. CONCLUSION CAB+RPV long-acting maintained virologic suppression in participants who had previously received daily oral CAB+RPV for at least 5 years in LATTE, with a favorable safety profile. Most participants preferred CAB+RPV long-acting to their prior oral CAB+RPV regimen at M12.
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Affiliation(s)
| | | | | | | | - Jerry Cade
- Wellness Center UMC of Southern Nevada, Las Vegas, Nevada
| | | | - Jerome De Vente
- Long Beach Education and Research Consultants, Long Beach, California
| | - David A. Margolis
- Brii Biosciences, Durham
- ViiV Healthcare, Research Triangle Park, North Carolina
| | | | | | - Sarah Hatch
- GlaxoSmithKline, Upper Providence, Pennsylvania, USA
| | | | | | - Cindy Garris
- ViiV Healthcare, Research Triangle Park, North Carolina
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GLICK JL, RUSSO RG, HUANG AKH, JIVAPONG B, RAMASAMY V, ROSMAN LM, PELAEZ DL, SHERMAN SG. ART uptake and adherence among female sex workers (FSW) globally: A scoping review. Glob Public Health 2022; 17:254-284. [PMID: 33301704 PMCID: PMC8190161 DOI: 10.1080/17441692.2020.1858137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted the first scoping literature review on ART uptake and adherence among Female Sex Workers (FSW), following PRISMA-ScR guidelines. Searches were conducted in PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting an ART uptake or adherence result among FSW aged 18 or older; peer-reviewed; published in English between 1996 and 2018. Our search identified 6,735 studies; 30 met eligibility requirements. ART uptake ranges from 0 to 100% and adherence ranges from 50-90%, depending on measurement methods. Uptake and adherence influencing factors are mapped onto a social ecological model (SEM). Knowledge and beliefs, substance use, food insecurity and sex-work engagement were negatively associated, while older age, relationships and social support were positively associated with ART uptake and adherence. Standardised methods to measure uptake and adherence prevalence must be established for data comparison. Evidence regarding ART uptake and adherence barriers and facilitators span multiple SEM levels, although more research is needed regarding structural and occupational level influencers. Results suggest that the multi-level ART uptake and adherence barriers faced by FSW require complex multi-level evidence-based interventions. Study findings can inform ART interventions, future research, and offer guidance to other support services with FSW, such as PrEP interventions.
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Affiliation(s)
- Jennifer L. GLICK
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Rienna G. RUSSO
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Aimee Kao-Hsuan HUANG
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Belinda JIVAPONG
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Lori M. ROSMAN
- Welch Medical Library, Johns Hopkins University, Baltimore MD, USA
| | - Danielle L PELAEZ
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Susan G. SHERMAN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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Glasner S, Patrick K, Ybarra M, Reback CJ, Ang A, Kalichman S, Bachrach K, Garneau HC, Venegas A, Rawson RA. Promising outcomes from a cognitive behavioral therapy text-messaging intervention targeting drug use, antiretroviral therapy adherence, and HIV risk behaviors among adults living with HIV and substance use disorders. Drug Alcohol Depend 2022; 231:109229. [PMID: 34979421 DOI: 10.1016/j.drugalcdep.2021.109229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To date, no studies have reported the use of text messaging to deliver cognitive behavioral therapy (CBT) to people living with HIV and substance use disorders. OBJECTIVE We developed and evaluated a 12-week, CBT-based text-messaging intervention (TXT-CBT) targeting drug use and adherence to antiretroviral therapy (ART) for adults with HIV and comorbid opioid and stimulant use disorders. MATERIALS AND METHODS Participants were randomly assigned to receive either TXT-CBT (n = 25) or an informational pamphlet (INFO) discussing substance use and medication adherence (n = 25). ART adherence, drug use, and HIV-risk behaviors were assessed at baseline, monthly during treatment, and treatment-end, and were compared between groups using a mixed-model repeated-measures analysis. Injection drug use was examined as a moderator of outcomes. RESULTS Relative to the INFO group, TXT-CBT participants evidenced increased ART adherence, measured by phone-based unannounced pill counts and biochemically by viral load and CD4 count. TXT-CBT participation was also associated with reductions in opioid use and HIV risk behaviors. While reductions in cocaine use were observed in the TXT-CBT group, relative to the INFO group, other stimulant use did not change. Among people who inject drugs, TXT-CBT produced increases in ART adherence and corresponding changes in viral load, relative to injection drug users in the control condition. CONCLUSIONS Findings demonstrated promising preliminary evidence for the efficacy of TXT-CBT in improving ART adherence and reducing drug use and HIV-risk behaviors among people with HIV infection and comorbid opioid and stimulant use disorders.
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Affiliation(s)
- Suzette Glasner
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; UCLA School of Nursing, Los Angeles, USA.
| | - Kevin Patrick
- University of California at San Diego, San Diego, USA
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, USA
| | - Cathy J Reback
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; Friends Research Institute, West Hollywood, USA
| | - Alfonso Ang
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; UCLA School of Nursing, Los Angeles, USA
| | - Seth Kalichman
- University of Connecticut, Department of Psychology, Storrs, USA
| | | | - Hélène Chokron Garneau
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA
| | - Alexandra Venegas
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA
| | - Richard A Rawson
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; University of Vermont, Department of Psychiatry, Burlington, USA
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Wu Y, Liu S, Chu L, Zhang Q, Yang J, Qiao S, Li X, Zhou Y, Deng H, Shen Z. Hair Zidovudine Concentrations Predict Virologic Outcomes Among People Living with HIV/AIDS in China. Patient Prefer Adherence 2022; 16:1885-1896. [PMID: 35945983 PMCID: PMC9357394 DOI: 10.2147/ppa.s371623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hair antiretroviral concentrations are an objective and non-invasive measure of adherence to long-term antiretroviral therapy (ART) and can further predict virologic outcomes among people living with HIV/AIDS (PLWH). Zidovudine, one of the mainstream antiretrovirals in China, has been verified to have high reliability in adherence assessment, especially for its hair concentrations. However, data are limited in its predicting virologic outcomes. Therefore, this study aimed to characterize whether hair zidovudine concentrations can predict virologic suppression among Chinese PLWH compared with hair lamivudine concentrations and two self-reported measures, the overall frequency of adherence behaviors and percentage adherence. METHODS This cross-sectional study randomly recruited 564 PLWH currently treated with zidovudine, lamivudine, and other ART agents (efavirenz, nevirapine, or lopinavir/ritonavir) in Guangxi, China. Hair antiretroviral concentrations were determined using the LC-ESI+-MS/MS method. Receiver operating characteristic (ROC) curves were used to estimate the optimal classification thresholds of hair concentrations of zidovudine and lamivudine, and the two self-reported measures. Based on those optimal classification thresholds, logistic regression was used to examine whether those four adherence measures can predict virologic suppression (HIV-1 RNA <200 copies/mL). RESULTS ROC curves demonstrated good classification performance for association with virologic suppression of zidovudine with the optimal threshold at 58 pg/mg and lamivudine at 255 pg/mg but no self-reported measures. PLWH with hair zidovudine concentrations >58 pg/mg had an adjusted odds ratio (aOR) of 43.191 (95% confidence interval (CI) = 10.171‒183.418, p < 0.001) for virologic suppression. Hair lamivudine concentrations were also associated with virologic suppression (aOR = 10.656, 95% CI = 3.670‒30.943, p < 0.001). However, two self-reported measures did not predict virologic suppression (aORs = 1.157 and 2.488, ps >0.149). CONCLUSION Hair zidovudine concentrations can be served as an alternative tool for clinically predicting virologic suppression among PLWH in China.
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Affiliation(s)
- Yan Wu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People’s Republic of China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People’s Republic of China
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
| | - Shuaifeng Liu
- Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, People’s Republic of China
| | - Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People’s Republic of China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People’s Republic of China
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
| | - Quan Zhang
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jin Yang
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
- Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing, People’s Republic of China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Yuejiao Zhou
- Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, People’s Republic of China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing, People’s Republic of China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, People’s Republic of China
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, People’s Republic of China
- Correspondence: Huihua Deng, Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096, People’s Republic of China, Tel +86 25 8379 5664, Fax +86 25 8379 3779, Email
| | - Zhiyong Shen
- Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, People’s Republic of China
- Zhiyong Shen, Unit of AIDS Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, No. 18 Jinzhou Road, Nanning, 530028, People’s Republic of China, Tel +86 771 251 8838, Email
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Rock A, Comins C, Mulumba N, Young K, Mcingana M, Guddera V, Hausler H, Phetlhu R, Baral S, Schwartz S. Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success. J Int Assoc Provid AIDS Care 2022; 21:23259582221110820. [PMID: 35786210 PMCID: PMC9263844 DOI: 10.1177/23259582221110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In South Africa, 62% of female sex workers (FSW) are estimated to be living with HIV. Qualitative research indicates that FSW share antiretroviral therapy (ART) with peers to surmount treatment barriers. We quantitatively described ART sharing, its correlates, and its relationship with viral suppression (VS) among FSW living with HIV in eThekwini, South Africa. Among FSW on ART (n = 890), 30% ever shared (gave and/or received) ART. Sharing ART was more likely among those with higher levels of alcohol use, illicit drug use, depression severity, and physical/sexual violence in the adjusted model. There was a positive, dose-response relationship between number of pills given to peers in the last 30 days and VS likelihood (aPR: 1.05, 95% CI: 1.02, 1.08; p < 0.01). Giving pills may strengthen peer relationships, which may facilitate ART adherence. ART distribution through peer networks holds promise as a context-appropriate intervention for improving ART adherence among FSW in this setting.
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Affiliation(s)
- Amelia Rock
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carly Comins
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | | | | | | | | | - Rene Phetlhu
- TB HIV Care, Cape Town, South Africa.,School of Nursing, 108325University of the Western Cape, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Maggiolo F, Valenti D, Teocchi R, Comi L, Filippo ED, Rizzi M. Adherence to and Forgiveness of 3TC/DTG in a Real-World Cohort. J Int Assoc Provid AIDS Care 2022; 21:23259582221101815. [PMID: 35695220 PMCID: PMC9203954 DOI: 10.1177/23259582221101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: adherence and forgiveness are key factors for virologic success. We evaluated them for 3TC/DTG. Methods: pharmacy refills were used to calculate the proportion of days covered (PDC). Forgiveness was calculated as the achieved rate of HIV-RNA threshold by a given level of imperfect adherence. Results: 240 PLWH were included. The median follow-up was 819 days (IQR 450-1459) for a total of 681 person/years of follow-up. Adherence was very high with a median of 99% (IQR 95%-100%). Consequently, the virologic response was sustained with 83.8% of PLWH never exceeding a HIV RNA of 50 copies/ml and 95.8% of subjects with a steadily HIV-RNA < 200 copies/ml. A PDC lower than 80% was associated with a negative outcome irrespective of the HIV-RNA threshold considered. Conclusions: The extensive virologic efficacy of 3TC/DTG demonstrated both in clinical trials and real-world experiences seems to rely more on its friendliness than on its forgiveness.
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Affiliation(s)
- Franco Maggiolo
- UOC Infectious Diseases, 9333ASST Papa Giovanni XXII, Bergamo Italy
| | - Daniela Valenti
- UOC Infectious Diseases, 9333ASST Papa Giovanni XXII, Bergamo Italy.,FROM foundation, ASST Papa Giovanni XXII, Bergamo Italy
| | - Rodolfo Teocchi
- Informatics department, ASST Papa Giovanni XXII, Bergamo Italy
| | - Laura Comi
- UOC Infectious Diseases, 9333ASST Papa Giovanni XXII, Bergamo Italy
| | - Elisa Di Filippo
- UOC Infectious Diseases, 9333ASST Papa Giovanni XXII, Bergamo Italy
| | - Marco Rizzi
- UOC Infectious Diseases, 9333ASST Papa Giovanni XXII, Bergamo Italy
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A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya. AIDS Behav 2022; 26:232-242. [PMID: 34292429 PMCID: PMC8295454 DOI: 10.1007/s10461-021-03376-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/13/2022]
Abstract
Mobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.
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Maggiolo F, Valenti D, Teocchi R, Comi L, Di Filippo E, Rizzi M. Real World Data on Forgiveness to Uncomplete Adherence to Bictegravir/ Emtricitabine/Tenofovir Alafenamide. J Int Assoc Provid AIDS Care 2022; 21:23259582221140208. [PMID: 36423244 PMCID: PMC9703486 DOI: 10.1177/23259582221140208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background: forgiveness is the ability of a given regimen to maintain complete viral suppression despite a documented imperfect adherence. We explored forgiveness of bictegravir/emtricitabine/tenofovir alafenamide. Methods: drug refills were used to calculate the percent day covered (PDC) as a proxy of adherence. Forgiveness was calculated as the achieved rate of a selected HIV-RNA threshold by a given level of imperfect adherence. Results: 281 adult PLWH were followed for 343 patient/years. Adherence was very high with a median of 98% (IQR 95-100%). A PDC as low as 70% was sufficient to obtain 100% and maintain virologic suppression. According to probit analysis adherence was not related to the possibility to maintain an HIV-RNA TND or < 50 copies/ml. Conclusions: Long-term success of ART needs effective regimens that are the least intrusive of the patient's lifestyle, an elevated forgiveness may be considered as an additional feature that can further improve long-term outcomes.
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Affiliation(s)
- Franco Maggiolo
- UOC Infectious Diseases, ASST Papa Giovanni XXII, Bergamo, Italy
| | - Daniela Valenti
- UOC Infectious Diseases, ASST Papa Giovanni XXII, Bergamo, Italy
- FROM foundation, ASST Papa Giovanni XXII, Bergamo, Italy
| | - Rodolfo Teocchi
- Informatics department, ASST Papa Giovanni XXII, Bergamo, Italy
| | - Laura Comi
- UOC Infectious Diseases, ASST Papa Giovanni XXII, Bergamo, Italy
| | - Elisa Di Filippo
- UOC Infectious Diseases, ASST Papa Giovanni XXII, Bergamo, Italy
| | - Marco Rizzi
- UOC Infectious Diseases, ASST Papa Giovanni XXII, Bergamo, Italy
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Beloor J, Kudalkar SN, Buzzelli G, Yang F, Mandl HK, Rajashekar JK, Spasov KA, Jorgensen WL, Saltzman WM, Anderson KS, Kumar P. Long-acting and extended-release implant and nanoformulations with a synergistic antiretroviral two-drug combination controls HIV-1 infection in a humanized mouse model. Bioeng Transl Med 2022; 7:e10237. [PMID: 35079625 PMCID: PMC8780078 DOI: 10.1002/btm2.10237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/23/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
The HIV pandemic has affected over 38 million people worldwide with close to 26 million currently accessing antiretroviral therapy (ART). A major challenge in the long-term treatment of HIV-1 infection is nonadherence to ART. Long-acting antiretroviral (LA-ARV) formulations, that reduce dosing frequency to less than once a day, are an urgent need that could tackle the adherence issue. Here, we have developed two LA-ART interventions, one an injectable nanoformulation, and the other, a removable implant, for the delivery of a synergistic two-drug ARV combination comprising a pre-clinical nonnucleoside reverse transcriptase inhibitor (NNRTI), Compound I, and the nucleoside reverse transcriptase inhibitor (NRTI), 4'-ethynyl-2-fluoro-2'-deoxyadenosine. The nanoformulation is poly(lactide-co-glycolide)-based and the implant is a copolymer of ω-pentadecalactone and p-dioxanone, poly(PDL-co-DO), a novel class of biocompatible, biodegradable materials. Both the interventions, packaged independently with each ARV, released sustained levels of the drugs, maintaining plasma therapeutic indices for over a month, and suppressed viremia in HIV-1-infected humanized mice for up to 42 days with maintenance of CD4+ T cells. These data suggest promise in the use of these new drugs as LA-ART formulations in subdermal implant and injectable mode.
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Affiliation(s)
- Jagadish Beloor
- Department of Internal Medicine, Section of Infectious DiseasesYale University School of MedicineNew HavenConnecticutUSA
| | - Shalley N. Kudalkar
- Department of PharmacologyYale University School of MedicineNew HavenConnecticutUSA
- Department of Molecular Biophysics and BiochemistryYale University School of MedicineNew HavenConnecticutUSA
| | - Gina Buzzelli
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Fan Yang
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Hanna K. Mandl
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Jyothi K. Rajashekar
- Department of Internal Medicine, Section of Infectious DiseasesYale University School of MedicineNew HavenConnecticutUSA
| | - Krasimir A. Spasov
- Department of PharmacologyYale University School of MedicineNew HavenConnecticutUSA
- Department of Molecular Biophysics and BiochemistryYale University School of MedicineNew HavenConnecticutUSA
| | | | - W. Mark Saltzman
- Department of Biomedical EngineeringYale UniversityNew HavenConnecticutUSA
| | - Karen S. Anderson
- Department of PharmacologyYale University School of MedicineNew HavenConnecticutUSA
- Department of Molecular Biophysics and BiochemistryYale University School of MedicineNew HavenConnecticutUSA
| | - Priti Kumar
- Department of Internal Medicine, Section of Infectious DiseasesYale University School of MedicineNew HavenConnecticutUSA
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Peng Z, Chen H, Wei W, Yu Y, Liu Y, Wang R, Yu X, Xu C, Long R, Hou Y, Sun Z, Wang Y, Lin Z, Ying Z, Zhang K, Zou H, Cai Y. The information-motivation-behavioral skills (IMB) model of antiretroviral therapy (ART) adherence among people living with HIV in Shanghai. AIDS Care 2021; 35:1001-1006. [PMID: 34963399 DOI: 10.1080/09540121.2021.2019667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Information-Motivation-Behavioral skills (IMB) model of antiretroviral therapy (ART) adherence was applied in people living with HIV/AIDS in Shanghai, China to understand how adherence-related information, motivation and behavioral skills would affect ART adherence. The LifeWindows Information-Motivation-Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ) was translated into Chinese and used. The IMB model was then implemented by testing standardized path estimates with standard model fitness indices in the participants. 426 participants from 11 community centres in Putuo district of Shanghai were recruited, of which 95.3% reported a high level of adherence (>95% adherence). The fitness indices of the final adjusted model were χ2 = 6.110, df = 7, p = 0.527(>0.05), CFI = 1.000(>0.9) and RMSEA = 0.000 (<0.08). In the model, information, which was separated into two sections (the perceived effect of ART on health and knowledge about ART medication), had an indirect effect on the ART adherence through behavioral skills, while motivation did not have such an effect. Neither information nor motivation had a direct effect on ART adherence. In addition, motivation was related to the two sections of information. The feasibility of the IMB model of ART adherence is verified by its application to predictive of adherence-related behaviors among HIV+ patients in this study.
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Affiliation(s)
- Zihe Peng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wei Wei
- Putuo District Center For Disease Control and Prevention, Shanghai, People's Republic of China
| | - Yuelin Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rusi Long
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yongchun Hou
- Putuo District Center For Disease Control and Prevention, Shanghai, People's Republic of China
| | - Zhenyu Sun
- Taopu Town Community Health Service Center, Shanghai, People's Republic of China
| | - Ying Wang
- Yichuan Street Community Health Service Center, Shanghai, People's Republic of China
| | - Zhang Lin
- Shanghai Public Health Clinical Center, Shanghai, People's Republic of China
| | - Zhou Ying
- Shanghai Public Health Clinical Center, Shanghai, People's Republic of China
| | - Kechun Zhang
- Shenzhen Longhua District Center for Disease Control and Prevention, Shenzhen, People's Republic of China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Wu Y, Chu L, Yang H, Wang W, Zhang Q, Yang J, Qiao S, Li X, Shen Z, Zhou Y, Liu S, Deng H. Simultaneous Determination of 6 Antiretroviral Drugs in Human Hair Using an LC-ESI+-MS/MS Method: Application to Adherence Assessment. Ther Drug Monit 2021; 43:756-765. [PMID: 33587427 PMCID: PMC8355263 DOI: 10.1097/ftd.0000000000000878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The determination of antiretroviral drugs in hair is receiving considerable research interest to assess long-term adherence to antiretroviral therapy (ART). Currently in China, lamivudine, zidovudine, nevirapine, efavirenz, ritonavir, and lopinavir are combined as first-line and second-line free therapy regimens and are recommended for people living with HIV (PLWH). Simultaneous determination of the 6 antiretroviral drugs in human hair is important for accurately and widely assessing long-term adherence in Chinese PLWH receiving different ART regimens. METHODS Six drugs were extracted from 10-mg hair samples incubated in methanol for 16 hours at 37°C and then analyzed by liquid chromatography with tandem mass spectrometry using a mobile phase of 95% methanol, with an electrospray ionization source in multiple reaction monitoring and positive mode. RESULTS The LC-ESI+-MS/MS method exhibited a linear range (R2 > 0.99) within 6-5000, 10-5000, 6-50,000, 12-50,000, 8-5000, and 8-12,500 pg/mg for lamivudine, zidovudine, nevirapine, efavirenz, ritonavir, and lopinavir. For all 6 drugs, the limits of quantification ranged between 6 and 12 pg/mg. The intraday and interday coefficients of variation were within 15%, and the recoveries ranged from 91.1% to 113.7%. Furthermore, the other validation parameters (ie, selectivity, matrix effect, stability, and carryover) met the acceptance criteria stipulated by guidelines of the US Food and Drug Administration and European Medicines Agency. Significant intergroup differences were observed between high-adherence and low-adherence groups, with high intercorrelations in the hair content of the 6 drugs. CONCLUSIONS The developed method demonstrated good reliability, to comprehensively and accurately assess adherence in PLWH receiving different ART regimens.
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Affiliation(s)
- Yan Wu
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Haoran Yang
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Wei Wang
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Quan Zhang
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Institute of Applied Psychology and School of Public Administration, Hohai University
| | - Jin Yang
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
- Department of Preventive Medicine, School of Public Health, Southeast University, Nanjing; and
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Zhiyong Shen
- Unit of AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Unit of AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Shuaifeng Liu
- Unit of AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science and Medical Engineering, Southeast University
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing, China
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Castro-Granell V, Garin N, Jaén Á, Casado JL, Leal L, Cenoz S, Fuster-RuizdeApodaca MJ. Recreational Drug Use in People Living with HIV in Spain: Factors Associated with Drug Use and the Impact on Clinical Outcomes. AIDS Behav 2021; 25:3883-3897. [PMID: 33932187 PMCID: PMC8602223 DOI: 10.1007/s10461-021-03271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 01/28/2023]
Abstract
We analysed the impact of recreational drug use (RDU) on different outcomes in people living with HIV (PLHIV). A multicentre retrospective cohort study was performed with two cohorts of PLHIV included: people using recreational drugs (PURD) vs. people not using recreational drugs (PNURD). Overall, 275 PLHIV were included. RDU was associated with men having sex with men (OR 4.14, 95% CI [1.14, 5.19]), previous sexually transmitted infections (OR 4.00, 95% CI [1.97, 8.13]), and current smoking (OR 2.74, 95% CI [1.44, 5.19]). While the CD4/CD8 ratio increased amongst PNURD during the follow-up year, it decreased amongst PURD (p = 0.050). PURD presented lower scores of self-reported and multi-interval antiretroviral adherence (p = 0.017, and p = 0.006, respectively), emotional well-being (p < 0.0001), and regular follow-up (p = 0.059), but paid more visits to the emergency unit (p = 0.046). RDU worsens clinical, immunological, and mental health outcomes amongst PLHIV.
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Affiliation(s)
- Vanessa Castro-Granell
- Doctoral Programme in Pharmacy, Granada University, Granada, Spain
- Department of Pharmacy, Hospital Marina Baixa, Av. Alcalde En Jaume Botella Mayor, 7, 03570 Villajoyosa, Alicante Spain
| | - Noé Garin
- Department of Pharmacy, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ángeles Jaén
- Research Unit, Fundació Docència i Recerca mutua Terrassa. Universidad de Barcelona, Terrassa, Barcelona Spain
| | - José Luis Casado
- Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain
| | - Lorna Leal
- Infectious Diseases-HIV Unit, Hospital Clínic Barcelona- IDIBAPS, Barcelona, Spain
| | - Santiago Cenoz
- Medical Department, ViiV Healthcare, Tres Cantos, Madrid Spain
| | - María José Fuster-RuizdeApodaca
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Patel R, Pandya A, Patel KK, Malhotra S, Patel AK. Assessment of self-reported adherence to ART and patient's virological/CD4 response in a tertiary care clinic and government free ART clinic. Indian J Sex Transm Dis AIDS 2021; 42:62-68. [PMID: 34765940 PMCID: PMC8579589 DOI: 10.4103/ijstd.ijstd_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/20/2020] [Accepted: 06/19/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Treatment adherence to antiretroviral treatment (ART) is critical in reducing morbidity, mortality, and improving the survival in HIV patients. ART is a life-long commitment, and the variety of factors can influence treatment adherence. We studied the factors affecting treatment adherence in the private sector and public sector outdoor clinic in Ahmedabad, India. The primary objective of this study is to compare the level of adherence and factors that influence adherence to ART in patients attending government run free ART program and private setup. Methods We conducted a cross-sectional study of 8 weeks among HIV-infected patients who were receiving ART from private clinic and free ART center from July 2019 to September 2019. We enrolled all consecutive patients >18 years of age attending both clinics. Statistical analysis was carried out using the SPSS software version 25.0. Multiple logistic regression was used to identify the factors that were independently associated with adherence to ART. Results The study enrolled 306 patients, 151 (49.34%) from the outpatient department of private hospital, and 155 (50.65%) from the free ART center. Patients attending private clinics were more likely to have been diagnosed with HIV since ≥10 years compared to free ART center. Higher opportunistic infection rates were found in free ART center (64.51%). Treatment adherence was significantly lower in the patients attending free ART center (P = 0.004). Patients taking concomitant medications for other comorbid conditions (≥4 pills/day) were more likely to exhibit inadequate adherence ([odds ratio] 1.216, 95% confidence interval 1.0171-1.454). Univariate analysis showed that age, education, habits of alcohol, tobacco, number of pills, and duration of disease played a significant role in predicting adherence to ART (P < 0.05). Conclusions Patients attending private clinic are surviving longer with HIV diagnosis, have fewer opportunistic infections, and have better treatment adherence compared to free ART clinic.
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Affiliation(s)
- Rushin Patel
- Infectious Diseases Clinic, "VEDANTA" Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Amee Pandya
- Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Ketan K Patel
- Infectious Diseases Clinic, "VEDANTA" Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | - Supriya Malhotra
- Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India, India
| | - Atul K Patel
- Infectious Diseases Clinic, "VEDANTA" Institute of Medical Sciences, Ahmedabad, Gujarat, India
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