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Malika N, Bogart LM, Mutchler MG, Goggin K, Klein DJ, Lawrence SJ, Wagner GJ. Loneliness Among Black/African American Adults Living with HIV: Sociodemographic and Psychosocial Correlates and Implications for Adherence. J Racial Ethn Health Disparities 2024; 11:2467-2474. [PMID: 37436685 PMCID: PMC11236909 DOI: 10.1007/s40615-023-01712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
Loneliness, an emerging public health problem, is higher among people living with HIV and is associated with negative health outcomes. Black/African Americans have a high burden of HIV, and little is known about the characteristics of loneliness among Black adults living with HIV; therefore, this study sought to understand the sociodemographic and psychosocial correlates of Black adults living with HIV who are lonely and the implications of loneliness for their health outcomes. A sample of 304 Black adults living with HIV (73.8% sexual minority men) in Los Angeles County, CA, USA, completed the survey items assessing sociodemographic and psychosocial characteristics, social determinants of health, health outcomes, and loneliness. Antiretroviral therapy (ART) adherence was assessed electronically with the medication event monitoring system. Bivariate linear regressions analysis showed higher loneliness scores among those with higher levels of internalized HIV stigma, depression, unmet needs, and discrimination related to HIV serostatus, race, and sexual orientation. In addition, participants who were married or living with a partner, had stable housing, and reported receiving more social support had lower levels of loneliness. In multivariable regression models controlling for correlates of loneliness, loneliness was found to be a significant independent predictor of worse general physical health, worse general mental health, and greater depression. Loneliness was marginally associated with lower ART adherence. Findings suggest that Black adults living with HIV, who experience multiple intersectional stigmas, require targeted interventions and resources.
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Affiliation(s)
- Nipher Malika
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
| | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri-Kansas City, School of Medicine and Pharmacy, Kansas City, MO, USA
| | - David J Klein
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | | | - Glenn J Wagner
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
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Endalamaw A, Gilks CF, Ambaw F, Shiferaw WS, Assefa Y. Explaining inequity in knowledge, attitude, and services related to HIV/AIDS: a systematic review. BMC Public Health 2024; 24:1815. [PMID: 38978024 PMCID: PMC11229290 DOI: 10.1186/s12889-024-19329-5] [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: 12/30/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Equitable service provision and coverage are important responses to end the threat of the HIV/AIDS pandemic. Understanding inequity supports policies and programmes to deliver tailored interventions. There is continuous evidence generation on inequity in HIV/AIDS services. However, there was a lack of evidence on the global picture of inequity in behavioural and biomedical services related to HIV/AIDS. This systematic review assessed inequities in knowledge, attitude, HIV testing, and ART coverage across individual-level social groups and multiple (dis)advantage categories. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, with a PROSPERO registration number CRD42024521247. The risk of bias was assessed by using Hoy et al's and Joanna Brigg's quality appraisal checklists for cross-sectional quantitative and qualitative studies, respectively. The search date was from inception to the final database search date (May 29, 2023). The included articles were either quantitative or qualitative studies. We used mixed-methods approach to analyse the data from the review articles. Quantitative descriptive analysis was conducted to estimate frequency of articles published from different countries around the world. Qualitative content analysis of the findings from the original studies was conducted using the PROGRESS plus framework which stands for: place of residence, occupation or employment status, gender, religion, education status, socioeconomic status, and social capital. RESULTS Out of 6,029 articles that were accessed and screened, only 72 articles met the inclusion criteria. More articles on HIV-related equity in knowledge, attitude, testing, and ART were published in developed countries than in developing countries. Individuals from higher-income households had better knowledge about HIV/AIDS. Unfavourable attitudes towards people living with HIV and HIV/AIDS-associated stigma were common among women. HIV/AIDS service coverage (HIV testing or ART coverage) was higher among richer and urban residents. HIV/AIDS-associated stigma and lower levels of knowledge about HIV/AIDS were observed among multiple disadvantageous groups due to the intersection of two or more identities. CONCLUSIONS The current review revealed that there have been disparities in HIV/AIDS services between social classes. Ending service disparity towards the global threat of HIV/AIDS demands tailored interventions based on socially disadvantaged groups (e.g., poor, rural dwellers, and women) and intersectional determinants. There is a need to understand the deep-rooted causes of inequity and the challenges that an equity-oriented system faces over time. More studies on inequity are needed, including intersectional inequity, which has been rarely studied in developing countries.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- School of Public Health, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Feelemyer J, Jarlais DD, Nagot N, Huong DT, Oanh KTH, Khue PM, Giang HT, Thanh NTT, Cleland C, Arasteh K, Caniglia E, Chen Y, Bart G, Moles JP, Vinh VH, Vallo R, Quillet C, Rapoud D, Le SM, Michel L, Laureillard D, Khan MR. Utility of self-report antiretroviral adherence for predicting HIV viral load among persons who inject drugs in Hai Phong Vietnam: assessing differences by methamphetamine use. AIDS Care 2024; 36:553-560. [PMID: 37909053 PMCID: PMC10932855 DOI: 10.1080/09540121.2023.2275041] [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: 03/10/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
ABSTRACTIn resource-limited settings, alternatives to HIV viral load testing may be necessary to monitor the health of people living with HIV. We assessed the utility of self-report antiretroviral therapy (ART) to screen for HIV viral load among persons who inject drugs in Hai Phong Vietnam, and consider differences by recent methamphetamine use. From 2016 to 2018 we recruited PWID through cross sectional surveys and collected self-report ART adherence and HIV viral load to estimate sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios (LR+, LR-) for self-reported ART adherence as a screening test for HIV viral load. We used three HIV viral load thresholds: < 1000, 500 and 250 copies/mL; laboratory-confirmed HIV viral load was the gold standard. Among 792 PWID recruited, PPV remained above 90% regardless of recent methamphetamine use with slightly higher PPV among those not reporting recent methamphetamine use. The results remained consistent across all three HIV viral load thresholds. Our findings suggest that when HIV viral load testing is not possible, self-reported ART adherence may inform decisions about how to prioritize HIV viral load testing among PWID. The high PPV values suggest self-reported high ART adherence indicates likely HIV viral suppression, irrespective of methamphetamine use.
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Affiliation(s)
- Jonathan Feelemyer
- Department of Population Health, New York University School of Medicine, New York NY
| | - Don Des Jarlais
- New York University College of Global Public Health, New York, NY, USA
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, Antilles University, Montpellier, France
| | - Duong Thi Huong
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | | | - Pham Minh Khue
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Hoang Thi Giang
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | | | - Charles Cleland
- Department of Population Health, New York University School of Medicine, New York NY
| | - Kamyar Arasteh
- New York University College of Global Public Health, New York, NY, USA
| | - Ellen Caniglia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Yu Chen
- Department of Population Health, New York University School of Medicine, New York NY
| | - Gavin Bart
- Department of Medicine, University of Minnesota
| | - Jean Pierre Moles
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, Antilles University, Montpellier, France
| | - Vu Hai Vinh
- Dept of Infectious and tropical diseases, Viet Tiep Hospital, Haiphong, Vietnam
| | - Roselyne Vallo
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, Antilles University, Montpellier, France
| | - Catherine Quillet
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, Antilles University, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, Antilles University, Montpellier, France
| | - Sao M Le
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Laurent Michel
- Pierre Nicole Center, French Red Cross, CESP/Inserrm 1018, Paris, France
| | - Didier Laureillard
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, Antilles University, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Maria R Khan
- Department of Population Health, New York University School of Medicine, New York NY
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Development and Application of a Comprehensive Measure of Access to Health Services to Examine COVID-19 Health Disparities. Healthcare (Basel) 2023; 11:healthcare11030354. [PMID: 36766929 PMCID: PMC9914001 DOI: 10.3390/healthcare11030354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Research on access to health services during the COVID-19 pandemic is limited, and the conceptualization of access has not typically included access to community resources. We developed and tested an access-to-health-services measure and examined disparities in access among individuals in the U.S. during the pandemic. Data are from a U.S. sample of 1491 respondents who completed an online survey in August 2021. Linear regression models assessed the relationships between the access-to-health-services-measure components, including impact on access to medicine and medical equipment, impact on access to healthcare visits, and confidence in accessing community resources, and predictor variables, including sociodemographic- and health-related factors. Disparities in access to healthcare during the pandemic were associated with sociodemographic characteristics (i.e., race, gender, and age) and health-related characteristics (i.e., chronic illness, mental health condition, and disability). Factors such as race, gender, income, and age were associated with individuals' degree of confidence in accessing community services. Our study presents a new access-to-health-services measure, sheds light on which populations may be most vulnerable to experiencing reduced access to health services, and informs the development of programmatic interventions to address the salient needs of these populations.
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Zalla LC, Cole SR, Eron JJ, Adimora AA, Vines AI, Althoff KN, Silverberg MJ, Horberg MA, Marconi VC, Coburn SB, Lang R, Williams EC, Gill MJ, Gebo KA, Klein M, Sterling TR, Rebeiro PF, Mayor AM, Moore RD, Edwards JK. Association of Race and Ethnicity With Initial Prescription of Antiretroviral Therapy Among People With HIV in the US. JAMA 2023; 329:52-62. [PMID: 36594946 PMCID: PMC9856806 DOI: 10.1001/jama.2022.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Importance Integrase strand transfer inhibitor (INSTI)-containing antiretroviral therapy (ART) is currently the guideline-recommended first-line treatment for HIV. Delayed prescription of INSTI-containing ART may amplify differences and inequities in health outcomes. Objectives To estimate racial and ethnic differences in the prescription of INSTI-containing ART among adults newly entering HIV care in the US and to examine variation in these differences over time in relation to changes in treatment guidelines. Design, Setting, and Participants Retrospective observational study of 42 841 adults entering HIV care from October 12, 2007, when the first INSTI was approved by the US Food and Drug Administration, to April 30, 2019, at more than 200 clinical sites contributing to the North American AIDS Cohort Collaboration on Research and Design. Exposures Combined race and ethnicity as reported in patient medical records. Main Outcomes and Measures Probability of initial prescription of ART within 1 month of care entry and probability of being prescribed INSTI-containing ART. Differences among non-Hispanic Black and Hispanic patients compared with non-Hispanic White patients were estimated by calendar year and time period in relation to changes in national guidelines on the timing of treatment initiation and recommended initial treatment regimens. Results Of 41 263 patients with information on race and ethnicity, 19 378 (47%) as non-Hispanic Black, 6798 (16%) identified as Hispanic, and 13 539 (33%) as non-Hispanic White; 36 394 patients (85%) were male, and the median age was 42 years (IQR, 30 to 51). From 2007-2015, when guidelines recommended treatment initiation based on CD4+ cell count, the probability of ART initiation within 1 month of care entry was 45% among White patients, 45% among Black patients (difference, 0% [95% CI, -1% to 1%]), and 51% among Hispanic patients (difference, 5% [95% CI, 4% to 7%]). From 2016-2019, when guidelines strongly recommended treating all patients regardless of CD4+ cell count, this probability increased to 66% among White patients, 68% among Black patients (difference, 2% [95% CI, -1% to 5%]), and 71% among Hispanic patients (difference, 5% [95% CI, 1% to 9%]). INSTIs were prescribed to 22% of White patients and only 17% of Black patients (difference, -5% [95% CI, -7% to -4%]) and 17% of Hispanic patients (difference, -5% [95% CI, -7% to -3%]) from 2009-2014, when INSTIs were approved as initial therapy but were not yet guideline recommended. Significant differences persisted for Black patients (difference, -6% [95% CI, -8% to -4%]) but not for Hispanic patients (difference, -1% [95% CI, -4% to 2%]) compared with White patients from 2014-2017, when INSTI-containing ART was a guideline-recommended option for initial therapy; differences by race and ethnicity were not statistically significant from 2017-2019, when INSTI-containing ART was the single recommended initial therapy for most people with HIV. Conclusions and Relevance Among adults entering HIV care within a large US research consortium from 2007-2019, the 1-month probability of ART prescription was not significantly different across most races and ethnicities, although Black and Hispanic patients were significantly less likely than White patients to receive INSTI-containing ART in earlier time periods but not after INSTIs became guideline-recommended initial therapy for most people with HIV. Additional research is needed to understand the underlying racial and ethnic differences and whether the differences in prescribing were associated with clinical outcomes.
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Affiliation(s)
- Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Now with Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joseph J Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Keri N Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Vincent C Marconi
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sally B Coburn
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Raynell Lang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, Washington
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly A Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marina Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Timothy R Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter F Rebeiro
- Division of Epidemiology, School of Medicine, Vanderbilt University, Nashville, Tennessee
- Division of Infectious Diseases, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Angel M Mayor
- Clinical Research Center, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Farhadian N, Karami Matin B, Farnia V, Zamanian MH, Najafi F, Farhadian M. The prevalence of people who inject drugs among those with HIV late presentation: a meta-analysis. Subst Abuse Treat Prev Policy 2022; 17:11. [PMID: 35144631 PMCID: PMC8832672 DOI: 10.1186/s13011-022-00439-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background One of the most important routes of HIV transmission is through injections of drugs, and this group, due to unawareness of their infection, causes the spread of HIV. The coexistence of other opportunistic infections and diseases with HIV among people who inject drugs (PWID) imposes healthcare costs and is associated with high morbidity/mortality rates. Early detection of HIV among PWID is essential to prevent and control the spread of the disease. Objectives This study aimed to determine the prevalence of PWID among those with late presentation (LP). Methods Three electronic databases of PubMed, Scopus, and Web of science were searched using appropriate keywords. Besides the prevalence data reported for PWID among LP, the other outcomes of interest were LP defined as having CD4 count < 350 cells/μL or HIV or advanced disease defined with CD4 count < 200 cells/μL or HIV at the time of diagnosis. Results Of the 160 studies found, only eight met the inclusion criteria. Among those presented late, 36.5% were PWID (95% CI = 24.88–48.17). Compared with men who have sex with men (MSM), HIV-infected PWID had a higher risk of LP [OR = 1.51; 95% CI = 0.96–2.06]. Conclusion The results of this study show that HIV is diagnosed late in the majority of PWID when CD4 is less than 350 cells/μL. Targeted interventions/strategies are highly required to reduce LP among HIV-infected PWID.
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Shah SV, Reist BM, Sawyer JL, Chiao AB, Hodge SE, Jones CD, Rein DB. Evaluating Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes: Quantitative Findings from the Ryan White HIV/AIDS Program Special Projects of National Significance Black Men Who Have Sex with Men Initiative. AIDS Patient Care STDS 2022; 36:S3-S20. [PMID: 36178388 DOI: 10.1089/apc.2022.0095] [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: 01/29/2023] Open
Abstract
The Black Men who have Sex with Men (MSM) Initiative was implemented at eight sites to engage and retain Black MSM in HIV medical care and supportive services (SS) by addressing their behavioral health (BH) care needs. Using a pre-post design and generalized logistic mixed-effects models adjusting for patient-level random effects, site, baseline age, and baseline mental health status, we evaluated whether participants experienced increased postintervention attainment of (1) Awareness of HIV medical care, BH care, and SS; (2) Screening, referral, linkage, receipt, and engagement in HIV care, BH care, and SS; and (3) Retention, antiretroviral therapy prescription, and suppressed viral load. Among 758 evaluated participants, the proportion of participants who were aware of, screened for, screened positive for, and referred to BH and SS, retention in care (72% to 79%), and viral load suppression (68% to 75%) increased between baseline and postintervention. Among participants who screened positive and received BH services were statistically more likely to be linked to [OR, 1.34 (95% CI: 1.08-1.66)] and retained in [OR, 1.36 (95% CI: 1.00-1.83)] care. Among those who screened positive and received SS were statistically more likely to be retained in care [OR, 1.54 (95% CI: 1.07-2.22)]. Measures of linkage to care declined significantly during the study period, perhaps because of COVID-19 that delayed in-person care. This study suggests that interventions designed to increase utilization of BH services and SS can be effective at improving retention in care and viral load suppression among Black MSM, at least among those currently using HIV services.
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Affiliation(s)
- Savyasachi V Shah
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
| | - Benjamin M Reist
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
| | - Jared L Sawyer
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
| | - Andrew B Chiao
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
| | - Sarah E Hodge
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
| | - Chandria D Jones
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
| | - David B Rein
- Department of Health Care Evaluation, NORC at the University of Chicago, Bethesda, Maryland, USA
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Jemal A, Caliste S. Work-in-progress: Focus groups evaluate and inform revisions of a socio-behavioral health intervention. EVALUATION AND PROGRAM PLANNING 2022; 93:102079. [PMID: 35751913 PMCID: PMC10148963 DOI: 10.1016/j.evalprogplan.2022.102079] [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: 06/08/2021] [Revised: 11/24/2021] [Accepted: 03/13/2022] [Indexed: 05/03/2023]
Abstract
African American men and women are disproportionately impacted by HIV/STI risk. Particularly, African American women are more likely to be infected with HIV from heterosexual sex. Yet, much of the intervention research has focused on men who have sex with men. This article describes the development and feasibility study of a six-session socio-behavioral health intervention that utilized sociodrama to reduce substance use and HIV/STI risk among heterosexual, African American men and women who have multiple sex partners. The intervention was developed based on theories and models of critical consciousness, social scripts, and group work practice. Content and delivery were informed by qualitative data collection with a range of stakeholders including service providers and members of the target population. The resulting intervention was six group sessions, delivered by two licensed social workers, with one of the facilitators trained in sociodrama. The results of the qualitative study explored the feasibility of conducting this six-week intervention and evaluated a trial run of the intervention. The data was obtained through focus group interviews and observations. Findings revealed that the intervention could be delivered with fidelity and was acceptable to participants and indicated that the intervention's innovative components of sociodrama and critical consciousness resonated with the participants and has potential to reduce HIV/STI risk and substance use. Reported barriers and suggested revisions need to be examined further and addressed to develop and implement a sustainable program that can be delivered in community-based settings. A future randomized control trial of the revised intervention will evaluate the intervention's efficacy.
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HIV Antiretroviral Medication Neuropenetrance and Neurocognitive Outcomes in HIV+ Adults: A Review of the Literature Examining the Central Nervous System Penetration Effectiveness Score. Viruses 2022; 14:v14061151. [PMID: 35746623 PMCID: PMC9227894 DOI: 10.3390/v14061151] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
This literature review summarizes the existing research examining the CNS penetration effectiveness (CPE) score and neurocognitive outcomes (i.e., neuropsychological assessment and neurocognitive screening) in HIV+ individuals. Despite the effectiveness of Combined Antiretroviral Therapy (CART) in reducing mortality and morbidity in HIV and controlling viral replication, HIV often persists in the Central Nervous System (CNS), and rates of neurocognitive impairment remain higher than predicted in the post-CART era. The CPE score was developed to rank antiretroviral regimens on their ability to penetrate the CNS and potency in inhibiting the virus, and it has been examined in relation to neurocognitive functioning for over a decade. Based on the results of 23 studies, we conclude that CPE is not as strongly associated with neurocognitive outcomes as initially hypothesized, although higher CPE ARV regimens may be associated with modest, improved outcomes in global neurocognitive functioning, and to a lesser extent attention/working memory and learning/memory. Conclusions, however, are limited by the heterogeneity in study design and methods, and the lack of a more recent CPE metric update. It is recommended that future research in this area employ comprehensive, standardized neuropsychological test batteries and examine domain-level performance, and use the newer 2010 CPE metric, although an updated CPE ranking is urgently needed.
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Wise A, Kianian B, Chang HH, Linton S, Wolfe ME, Smith J, Tempalski B, Jarlais DD, Ross Z, Semaan S, Wejnert C, Broz D, Cooper HLF. Is the severity of the Great Recession's aftershocks correlated with changes in access to the combined prevention environment among people who inject drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103264. [PMID: 33990058 PMCID: PMC11091490 DOI: 10.1016/j.drugpo.2021.103264] [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: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. METHODS The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. RESULTS 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. CONCLUSION Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
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Affiliation(s)
- Akilah Wise
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Behzad Kianian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sabriya Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E Wolfe
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Justin Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, Inc. (NDRI), New York, NY, USA
| | - Don Des Jarlais
- College of Global Public Health, New York University, New York, NY, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, New York, NY, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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11
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Lyu T, Qiao S, Hair N, Liang C, Li X. Federal funding allocation on HIV/AIDS research in the United States (2008-2018): an exploratory study using Big Data. AIDS Care 2021:1-7. [PMID: 33682543 DOI: 10.1080/09540121.2021.1896664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Literature suggests that federal funding allocation for HIV-related research in the US may not align with HIV disease burden but is influenced by structural disparities. This study sought to examine how federal funding allocation is associated with HIV disease burden and research capacity of states by applying Big Data integration, text mining, and statistics. Using text mining, we identified 20,678 HIV-related federal projects from 2008 to 2018 in NIH ExPORTER, which were then integrated with data from AtlasPlus and US Census Bureau. We developed Gini coefficients to assess the inequality of funding and the Generalized Estimating Equations model to examine the associations between funding allocation and (1) state HIV disease burden, (2) state research capacity, and (3) geographic regions, respectively. The Gini coefficients (0.60 to 0.80) suggest a highly skewed funding distribution. Funding allocation was not associated with state HIV disease burden (p = 0.269) but HIV research capacity (p = 0.000). The South (with the heaviest HIV disease burden) did not receive significantly more federal funding. Our findings for the first time identified disparities of federal funding allocation, suggesting that federal agencies favor states of high research capacity over heavy disease burden, which may reinforce the HIV-related health disparities.
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Affiliation(s)
- Tianchu Lyu
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Nicole Hair
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Chen Liang
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
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12
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Berchuck JE, Meyer CS, Zhang N, Berchuck CM, Trivedi NN, Cohen B, Wang S. Association of Mental Health Treatment With Outcomes for US Veterans Diagnosed With Non-Small Cell Lung Cancer. JAMA Oncol 2021; 6:1055-1062. [PMID: 32496507 DOI: 10.1001/jamaoncol.2020.1466] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Preexisting mental health disorders (MHDs) are associated with increased mortality in people diagnosed with cancer, yet few data exist on the efficacy of interventions to mitigate this disparity. Objective To evaluate the association of participation in mental health treatment programs (MHTPs), housing support programs, or employment support programs with stage at cancer diagnosis, receipt of stage-appropriate treatment, and mortality among patients with a preexisting MHD. Design, Setting, and Participants This retrospective, population-based cohort study included 55 315 veterans in the Veterans Affairs Central Cancer Registry (VACCR) who had newly diagnosed non-small cell lung cancer (NSCLC) from September 30, 2000, to December 31, 2011. Data were analyzed from January 15, 2017, to March 17, 2020. Exposures Mental health disorders, including schizophrenia, bipolar disorder, depressive disorder, posttraumatic stress disorder, and substance use disorder. Main Outcomes and Measures Stage at cancer diagnosis, receipt of stage-appropriate cancer treatment, all-cause mortality, and lung cancer-specific mortality. Results Of 55 315 veterans with a new diagnosis of NSCLC included in the analysis (98.1% men; mean [SD] age, 68.1 [9.8] years), 18 229 had a preexisting MHD, among whom participation in MHTPs was associated with a lower likelihood of being diagnosed in a late stage (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), a higher likelihood of receiving stage-appropriate treatment (OR, 1.55; 95% CI, 1.26-1.89; P < .001), lower all-cause mortality (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.72-0.77; P < .001), and lower lung cancer-specific mortality (AHR, 0.77; 95% CI, 0.74-0.80; P < .001). Likewise, participation in housing and employment support programs was associated with similar improvements in all outcomes described above. Conclusions and Relevance In veterans with preexisting MHDs diagnosed with NSCLC, participation in MHTPs and housing and employment support programs was associated with improved lung cancer-related outcomes. This study might be the first to demonstrate significant improvement in cancer mortality for patients with MHDs who participate in MHTPs, housing support programs, or employment support programs. This work supports substantial literature that investment in mental health and social needs can improve health outcomes and highlights the importance of further research to identify, evaluate, and implement interventions to improve outcomes for patients with MHDs who are diagnosed with cancer.
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Affiliation(s)
- Jacob E Berchuck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Craig S Meyer
- Department of Medicine, School of Medicine, University of California, San Francisco
| | - Ning Zhang
- Department of Medicine, School of Medicine, University of California, San Francisco
| | | | - Neil N Trivedi
- Division of Pulmonary/Critical Care Medicine, San Francisco Veterans Affairs Medical Center and University of California, San Francisco
| | - Beth Cohen
- Department of Medicine, School of Medicine, University of California, San Francisco.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sunny Wang
- Department of Medicine, School of Medicine, University of California, San Francisco.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Division of Hematology/Oncology, San Francisco Veterans Affairs Medical Center, San Francisco, California
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13
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Scharer J, Arnold R, Wald R, Nichols J, Medoff D, Himelhoch S, Bennett ME. Personal Approach to Treatment Choices for HIV (PATCH): Randomized Controlled Trial of a Brief Motivational Enhancement Intervention to Improve Medication Adherence in Persons with HIV. AIDS Behav 2020; 24:1893-1902. [PMID: 31838589 DOI: 10.1007/s10461-019-02759-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This pilot randomized controlled trial evaluated the feasibility and efficacy of a brief motivational enhancement intervention to improve adherence to antiretroviral therapy in persons with HIV called Personal Approach to Treatment Choices for HIV (PATCH). We compared PATCH to an active control condition on self-reported adherence, clinical outcomes, and psychosocial outcomes. Participants were 34 individuals (61.8% male, Mage = 47.1) receiving HIV-related services who were suboptimally engaged in care. Participants completed baseline measures, participated in either PATCH or a stress reduction skills control intervention, and completed post-treatment and 3-month follow-up assessments. Results revealed no differences between conditions on adherence or clinical outcomes. At post-treatment, PATCH participants reported greater improvements in alcohol use, psychiatric symptoms, subjective mental functioning, and emotion-focused coping; improvements in subjective mental functioning were maintained at 3-months. Results suggest that motivational enhancement interventions can improve psychosocial outcomes for people with HIV. That some improvements were not maintained at follow-up suggests that effects wane over time and longer treatment may be indicated for lasting effects.
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14
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Ward T, Sugrue D, Hayward O, McEwan P, Anderson SJ, Lopes S, Punekar Y, Oglesby A. Estimating HIV Management and Comorbidity Costs Among Aging HIV Patients in the United States: A Systematic Review. J Manag Care Spec Pharm 2020; 26:104-116. [PMID: 32011956 PMCID: PMC10391104 DOI: 10.18553/jmcp.2020.26.2.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND As life expectancy of patients infected with human immunodeficiency virus (HIV) approaches that of the general population, the composition of HIV management costs is likely to change. OBJECTIVES To (a) review treatment and disease management costs in HIV, including costs of adverse events (AEs) related to antiretroviral therapy (ART) and long-term toxicities, and (b) explore the evolving cost drivers. METHODS A targeted literature review between January 2012 and November 2017 was conducted using PubMed and major conferences. Articles reporting U.S. costs of HIV management, acquired immunodeficiency syndrome (AIDS)-defining events, end of life care, and ART-associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and osteoporosis were included. All costs were inflated to 2017 U.S. dollars. A Markov model-based analysis was conducted to estimate the effect of increased life expectancy on costs associated with HIV treatment and management. RESULTS 22 studies describing HIV costs in the United States were identified, comprising 16 cost-effectiveness analysis studies, 5 retrospective analyses of health care utilization, and 1 cost analysis in a resource-limited setting. Management costs per patient per month, including routine care costs (on/off ART), non-HIV medication, opportunistic infection prophylaxis, inpatient utilization, outpatient utilization, and emergency department utilization were reported as CD4+ cell-based health state costs ranging from $1,192 for patients with CD4 > 500 cells/mm3 to $2,873 for patients with CD4 < 50 cells/mm3. Event costs for AEs ranged from $0 for headache, pain, vomiting, and lipodystrophy to $31,545 for myocardial infarction. The mean monthly per-patient costs for CVD management, CKD management, and osteoporosis were $5,898, $6,108, and $4,365, respectively. Improvements in life expectancy, approaching that of the general population in 2018, are projected to increase ART-related and AE costs by 35.4% and comorbidity costs by 175.8% compared with estimated costs with HIV life expectancy observed in 1996. CONCLUSIONS This study identified and summarized holistic cost estimates appropriate for use within U.S. HIV cost-effectiveness analyses and demonstrates an increasing contribution of comorbidity outcomes, primarily associated with aging in addition to long-term treatment with ART, not typically evaluated in contemporary HIV cost-effectiveness analyses. DISCLOSURES This analysis was sponsored by ViiV Healthcare, which had no role in the analyses and interpretation of study results. Ward, Sugrue, Hayward, and McEwan are employees of HEOR Ltd, which received funding from ViiV Healthcare to conduct this study. Anderson is an employee of GlaxoSmithKline and holds shares in the company. Punekar and Oglesby are employees of ViiV Healthcare and hold shares in GlaxoSmithKline. Lopes was employed by ViiV Healthcare at the time of the study and holds shares in GlaxoSmithKline.
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Affiliation(s)
| | | | | | | | | | - Sara Lopes
- ViiV Healthcare, Brentford, United Kingdom
| | | | - Alan Oglesby
- ViiV Healthcare, Research Triangle, North Carolina
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15
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Hessol NA, Eng M, Vu A, Pipkin S, Hsu LC, Scheer S. A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco. BMC Public Health 2019; 19:1440. [PMID: 31675932 PMCID: PMC6825332 DOI: 10.1186/s12889-019-7817-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/21/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. METHODS Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. RESULTS A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (aPR = 1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR = 0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. CONCLUSIONS Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.
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Affiliation(s)
- Nancy A Hessol
- Department of Clinical Pharmacy, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94118, USA.
| | - Monica Eng
- Department of Clinical Pharmacy, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94118, USA
| | - Annie Vu
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Sharon Pipkin
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Ling C Hsu
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Susan Scheer
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
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16
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Cohn ER, Korte JE, Lazenby GB. Disparities and Delay in the Use of Guideline-Based Antiretroviral Therapy for Treatment of Pregnant Women with HIV in the Southeast United States. AIDS Patient Care STDS 2019; 33:381-383. [PMID: 31393173 PMCID: PMC6745527 DOI: 10.1089/apc.2019.0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ellery R Cohn
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Gweneth B Lazenby
- Division of Infectious Diseases, Departments of Obstetrics and Gynecology and Medicine, Medical University of South Carolina, Charleston, South Carolina
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17
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Jemal A, Gardiner M, Bloeser K. Perceived Race as Variable: Moderating Relationship Between Perceived Discrimination in the Workplace and Mentally Unhealthy Days. J Racial Ethn Health Disparities 2019; 6:265-272. [PMID: 30141003 DOI: 10.1007/s40615-018-0521-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/13/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022]
Abstract
Since race is a social construct, the experience of racial discrimination occurs based on perceived race. This study explores the moderating effects of self-identified race and perceived racial identity on the relationship between perceived discrimination in the workplace and mentally unhealthy days using data derived from the four states (Arizona, Minnesota, Mississippi, and New Mexico) that responded to the 2014 Reactions to Race module of the Behavioral Risk Factor Surveillance System. The study hypothesized that self-identified White people, also perceived as White (WW), would have less perceived workplace discrimination and less mentally unhealthy days than self-identified non-White people perceived as White (NWW); NWW would have less perceived discrimination associated with mentally unhealthy days than self-identified White perceived as non-White (WNW); and, WNW would have less perceived discrimination associated with mentally unhealthy days than self-identified non-White perceived as non-White (NWNW). The study was conducted under the regulating body of the City University of New York in 2017. Findings suggest that being perceived as White is a protective factor as analysis determined that NWW experienced less discrimination in the workplace associated with mentally unhealthy days than NWNW.
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Affiliation(s)
- Alexis Jemal
- Silberman School of Social Work at Hunter College, 2180 3rd Ave, New York, NY, 10035, USA.
| | - Myrtho Gardiner
- The Graduate Center, CUNY, 365 5th Ave, New York, NY, 10016, USA
| | - Katharine Bloeser
- Silberman School of Social Work at Hunter College, 2180 3rd Ave, New York, NY, 10035, USA
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18
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Gamarel KE, Chakravarty D, Neilands TB, Hoff CC, Lykens J, Darbes LA. Composite Risk for HIV: A New Approach Towards Integrating Biomedical and Behavioral Strategies in Couples-Based HIV Prevention Research. AIDS Behav 2019; 23:283-288. [PMID: 30003506 PMCID: PMC6368473 DOI: 10.1007/s10461-018-2229-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A substantial number of new HIV infections among gay, bisexual, and other men who have sex with men and transgender women occurs in the context of primary partnerships. Given the diversity of risk reduction needs and various approaches available for reducing risk within couples, condomless sex is no longer the gold standard HIV outcome. We present a novel, comprehensive, and flexible Composite Risk for HIV (CR-HIV) approach for integrating evolving biomedical and behavioral HIV prevention strategies into couples-based HIV prevention intervention and survey research. We provide illustrative examples of the utility of the CR-HIV approach based on couples' HIV status.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - James Lykens
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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19
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Jemal A. Transformative Consciousness of Health Inequities: Oppression is a Virus and Critical Consciousness is the Antidote. JOURNAL OF HUMAN RIGHTS AND SOCIAL WORK 2018; 3:202-215. [PMID: 30687777 PMCID: PMC6345409 DOI: 10.1007/s41134-018-0061-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Oppression has been identified as a fundamental cause of disease. Like a self-replicating virus, it infects systems from the biological to the political, contributing to personal (e.g., substance use, low self-esteem) and social (e.g., community violence, mass incarceration) dysfunction. Paulo Freire's critical consciousness (CC) is a philosophical, theoretical and practice-based framework that has been identified as an antidote to oppression. Critical consciousness constitutes an awareness of, and action against, institutional, historical, and systemic forces that limit or promote opportunities for certain groups. Although CC theory has been used to address inequity, very few scholars have attempted to conceptualize, operationalize and describe the development process of CC. In response to the conceptual inconsistencies widely noted in the CC literature, this paper presents a new construct, Transformative Consciousness (TC), composed of three domains: Awareness, Behavioral-Response, and Consequence, for each level of the socio-ecosystem. The staged process of TC development is also described. The theoretical framework of TC can be applied to various social issues, such as violence, mass incarceration, homelessness, HIV/STI infection, and substance use - all of which have tremendous implications for health and well-being as a human right. With further research, Transformative Consciousness may prove necessary to move persons in the direction of anti-oppressive, individual and collective action to overcome and dismantle oppression, creating a healthier and more just and liberated society.
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Affiliation(s)
- Alexis Jemal
- Silberman School of Social Work at Hunter College, 2180 3 Ave New York, NY 10035
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20
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Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care. Soc Sci Med 2018; 211:78-86. [PMID: 29913303 DOI: 10.1016/j.socscimed.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 01/06/2023]
Abstract
RATIONALE Both the HIV epidemic and incarceration disproportionately affect Black men in the United States. A critical period for incarcerated Black men living with HIV/AIDS is re-entry into the community, which is often associated with adverse health outcomes. Additionally, Black men living with HIV/AIDS involved in the criminal justice system are burdened by multiple, intersecting disadvantaged identities and social positions. OBJECTIVE This study aimed to examine community re-entry experiences among Black men living with HIV/AIDS from an intersectional perspective. METHOD In-depth, semi-structured interviews were conducted with 16 incarcerated Black men in Wisconsin, at pre-release from prison and six months after re-entry. Thematic analysis guided by intersectionality theory was used to analyze interview transcripts. RESULTS Seven emerged themes included Intersectional Identities and Social Positions, Family Support, Neighborhood Violence, Relationship with Law Enforcement, Employment, Mental Health Concerns, and Medical Care and Medication Management. Intersecting identities and social positions interact with factors at multiple levels to inform health and HIV care. A conceptual framework was developed to illustrate relationships among themes. CONCLUSIONS Findings demonstrate the relevance of intersectionality theory in HIV care with Black men involved in criminal justice system. Incorporating a social-ecological perspective into intersectionality framework could be useful in theoretical and empirical research. Disenfranchised communities may particularly benefit from interventions that address community- and systemic-level issues.
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21
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Quinn KG, Kelly JA, DiFranceisco WJ, Tarima SS, Petroll AE, Sanders C, Lawrence JSS, Amirkhanian YA. The Health and Sociocultural Correlates of AIDS Genocidal Beliefs and Medical Mistrust Among African American MSM. AIDS Behav 2018; 22:1814-1825. [PMID: 28013400 DOI: 10.1007/s10461-016-1657-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined social and health-related correlates of AIDS conspiracy theories among 464 African American men who have sex with men (MSM). Exploratory factor analysis revealed two subscales within the AIDS conspiracy beliefs scale: medical mistrust and AIDS genocidal beliefs. Multiple regression analyses revealed medical mistrust and AIDS genocidal beliefs were both associated negative condom use attitudes and higher levels of internalized homonegativity. Medical mistrust was also associated with lower knowledge of HIV risk reduction strategies. Finally, we conducted bivariate regressions to examine the subsample of participants who reported being HIV-positive and currently taking HIV antiretroviral therapy (ART) to test associations between sexual behavior and HIV treatment and AIDS conspiracy theories. Among this subsample, medical mistrust was associated with having a detectable viral load and not disclosing HIV-status to all partners in the previous 3 months. Collectively, these findings have implications for HIV prevention and treatment for African American MSM.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Jeffrey A Kelly
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
| | - Wayne J DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
| | - Sergey S Tarima
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chris Sanders
- Department of Sociology, Lakehead University, Thunder Bay, ON, Canada
| | | | - Yuri A Amirkhanian
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA
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22
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Calkins KL, Canan CE, Moore RD, Lesko CR, Lau B. An application of restricted mean survival time in a competing risks setting: comparing time to ART initiation by injection drug use. BMC Med Res Methodol 2018. [PMID: 29523081 PMCID: PMC5845164 DOI: 10.1186/s12874-018-0484-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Restricted mean survival time (RMST) is an underutilized estimand in time-to-event analyses. Herein, we highlight its strengths by comparing time to (1) all-cause mortality and (2) initiation of antiretroviral therapy (ART) for HIV-infected persons who inject drugs (PWID) and persons who do not inject drugs. Methods RMST to death was determined by integrating the Kaplan-Meier survival curve to 5 years of follow-up. To account for the competing risks of death and loss-to-clinic when estimating time to ART, we calculated RMST to ART initiation by estimating the area between the survival curve for ART initiation and the cumulative incidence curve for death or loss-to-clinic. We standardized all curves using inverse probability of exposure weights. Results We followed 3044 HIV-positive, ART-naive persons from enrollment into the Johns Hopkins HIV Clinical Cohort from 1996 to 2014. PWID had a − 0.19 year (95% confidence interval (CI): − 0.29, − 0.10) difference in survival over 5 years of follow-up compared to persons who did not inject drugs. There was no difference between the two groups in time not on ART while alive and in clinic (RMST difference = 0.08, 95% CI: -0.10, 0.36). Conclusions PWID have similar expected time to ART initiation after properly accounting for their greater risk of death and loss-to-clinic. Electronic supplementary material The online version of this article (10.1186/s12874-018-0484-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keri L Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Chelsea E Canan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Vaughan Sarrazin MS, Ohl ME, Richardson KK, Asch SM, Gifford AL, Bokhour BG. Patient and Facility Correlates of Racial Differences in Viral Control for Black and White Veterans with HIV Infection in the Veterans Administration. AIDS Patient Care STDS 2018; 32:84-91. [PMID: 29620926 DOI: 10.1089/apc.2017.0213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Black persons with HIV are less likely than white persons to experience viral control even while in treatment. We sought to understand whether patient characteristics and site of care explain these differences using a cross-sectional analysis of medical records. Our cohort included 8779 black and 7836 white patients in the Veterans Administration (VA) health system with HIV who received antiretroviral medication during 2013. Our primary outcome, viral control, was defined as HIV serum RNA <200 copies/mL. We examined the degree to which racial differences in viral control are related to site of care, patient characteristics (demographics, HIV treatment history, comorbid conditions, time in care, and medication adherence), retention in care, and combination antiretroviral therapy (cART) adherence, using multi-variable logistic regression models. Compared to whites, blacks were younger and had lower CD4 counts, more comorbidities, lower retention in care, and poorer medication adherence. The odds of uncontrolled viral load were 2.02 (p < 0.001) for black relative to white patients without risk adjustment (15% vs. 8% uncontrolled viral load, respectively). The odds decreased to 1.83 (p < 0.001), 1.65 (p < 0.001), 1.62 (p < 0.001), and 1.24 (p = 0.01) in models that sequentially controlled for site of care, age and clinical characteristics, care retention, and cART adherence, respectively. Overall, 51% of the viral control difference between blacks and whites was accounted for by adherence; 26% by site of care. We conclude that differences in the site of HIV care and cART adherence account for most of the difference in viral control between black and white persons receiving HIV care, although the exact pathway by which this relationship occurs is unknown. Targeting poorer performing sites for quality improvement and focusing on improving antiretroviral adherence in black patients may help alleviate disparities in viral control.
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Affiliation(s)
- Mary S. Vaughan Sarrazin
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Michael E. Ohl
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Kelly K. Richardson
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
| | - Steven M. Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
| | - Allen L. Gifford
- VA Center for Healthcare Organization and Implementation Research (CHOIR) at ENRM Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Barbara G. Bokhour
- VA Center for Healthcare Organization and Implementation Research (CHOIR) at ENRM Veterans Affairs Medical Center, Bedford, Massachusetts
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
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Landovitz RJ, Desmond KA, Leibowitz AA. Antiretroviral Therapy: Racial Disparities among Publicly Insured Californians with HIV. J Health Care Poor Underserved 2018; 28:406-429. [PMID: 28239010 DOI: 10.1353/hpu.2017.0031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Only 43% of Americans with HIV are virally suppressed; the rate is lower for African Americans, even among insured populations. This study uses 2010 Medicare and Medicaid data for HIV-positive Californians to examine how antiretroviral treatment (ART) relates to patient and provider characteristics. Logistic regressions isolated the effect of race/ethnicity on receipt of ART. Over 90% of the full sample received any ART. Nearly 80% of ART users received a recommended combination for at least half the year; half had a recommended combination for 90% of the year. Lacking evaluation and management visits, or seeing only providers with low HIV patient volume lowered the odds of receiving ART. Controlling for other factors, African Americans remained less likely to receive ART at all, or to be covered for 90% of the year with a recommended regimen. The observed racial treatment differentials may lead to important health disparities.
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Howe CJ, Dulin-Keita A, Cole SR, Hogan JW, Lau B, Moore RD, Mathews WC, Crane HM, Drozd DR, Geng E, Boswell SL, Napravnik S, Eron JJ, Mugavero MJ. Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework. Am J Epidemiol 2018; 187:316-325. [PMID: 28992096 DOI: 10.1093/aje/kwx247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 06/08/2017] [Indexed: 01/10/2023] Open
Abstract
Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data.
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Affiliation(s)
- Chanelle J Howe
- Centers for Epidemiology and Environmental Health, Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Akilah Dulin-Keita
- Center for Health Equity Research, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph W Hogan
- Center for Statistical Sciences, Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Richard D Moore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Daniel R Drozd
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Elvin Geng
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | | | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph J Eron
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Trends in Racial/Ethnic Disparities Among Patients Living with HIV in Texas, 1996 to 2013. J Racial Ethn Health Disparities 2017; 5:1023-1032. [PMID: 29270841 DOI: 10.1007/s40615-017-0450-1] [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: 09/05/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996-1997 (T1), 1998-2006 (T2), 2007-2010 (T3), and 2011-2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1, Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74-0.87, p < 0.001; HR = 0.82, 95% CI = 0.78-0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66-0.79, p < 0.001; HR = 0.77, 95% CI = 0.74-0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00-1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30-2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34-2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.
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de Moraes RP, Casseb J. Depression and adherence to antiretroviral treatment in HIV-positive men in São Paulo, the largest city in South America: Social and psychological implications. Clinics (Sao Paulo) 2017; 72:743-749. [PMID: 29319720 PMCID: PMC5738567 DOI: 10.6061/clinics/2017(12)05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/28/2017] [Accepted: 10/11/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The aim of the present study was to investigate the prevalence of depression and adherence to antiretroviral treatment in two groups of individuals: men who have sex with men (MSM) and men who have sex with women (MSW). METHODS Two hundred and sixteen participants (MSM=116; MSW=100) who visited the Clinics Hospital of the School of the Medicine of the University of São Paulo completed two independent surveys (the BECK Depression Inventory and an adherence self-declared questionnaire) to evaluate their depression status and adherence to antiretroviral treatment, respectively. RESULTS The study highlighted a positive relationship between depression and low adherence to Highly Active Antiretroviral Therapy in these patients regardless of age and sexual orientation. In addition, MSM subjects were two times more prone than MSW subjects to develop depression symptoms. White or mixed race men showed 7.6 times greater adherence to treatment than black men. The probability of complete adherence to treatment was 3.8 times higher in non-depressed subjects than in depressed subjects regardless of their ethnicity. The chance of developing depression was 4.17 times higher for an individual with non-adherent behavior than for an adherent individual. CONCLUSIONS Individuals with low adherence rates have proportionally higher depression rates. Depressed men tend to show less adherence to treatment. Black but not mixed race or white men show less adherence to Highly Active Antiretroviral Therapy and have a greater chance of developing depression, which directly interferes with adherence. The chances of developing depression are four times greater for a patient with non-adherent behavior than for a patient with adherent behavior.
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Affiliation(s)
- Ricardo Pereira de Moraes
- Ambulatorio de Imunodeficiencias Secundarias, Departamento de Dermatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jorge Casseb
- Ambulatorio de Imunodeficiencias Secundarias, Departamento de Dermatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Medicina Tropical de Sao Paulo, Sao Paulo, SP, BR
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Wohl AR, Benbow N, Tejero J, Johnson C, Scheer S, Brady K, Gagner A, Hughes A, Eberhart M, Mattson C, Skarbinski J. Antiretroviral Prescription and Viral Suppression in a Representative Sample of HIV-Infected Persons in Care in 4 Large Metropolitan Areas of the United States, Medical Monitoring Project, 2011-2013. J Acquir Immune Defic Syndr 2017; 76:158-170. [PMID: 28628527 DOI: 10.1097/qai.0000000000001482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comparisons of antiretroviral therapy (ART) prescription and viral suppression among people in HIV care across US metropolitan areas are limited. Medical Monitoring Project, 2011-2013, data were used to describe and compare associations between sociodemographics and ART prescription and viral suppression for persons receiving HIV care. SETTING Chicago, Los Angeles County (LAC), Philadelphia, and San Francisco in the United States. METHODS Bivariate and multivariable methods were used. RESULTS The proportion of patients prescribed ART (91%-93%) and virally suppressed (79%-88%) was consistent although more persons were virally suppressed in San Francisco compared with the other areas, and a smaller proportion was virally suppressed in Philadelphia compared with Chicago. In the combined cohort, persons aged 30-49 years were less likely than persons 50+ (adjusted prevalence ratio (aPR) -0.97, confidence interval (CI): 0.94 to 0.99); persons reporting non-injection drug use were less likely than non-users (aPR = 0.94, CI: 0.90 to 0.98); and Hispanics were more likely than whites (aPR - 1.04, CI: 1.01 to 1.08) to be prescribed ART. Blacks (aPR = 0.93; CI: 0.87 to 0.99) and homeless persons (aPR = 0.87; CI: 0.80 to 0.95) were less likely to be virally suppressed in the combined cohort. In LAC, persons aged 30-49 years were less likely than those 50+ to be prescribed ART (aPR = 0.94, CI: 0.90 to 0.98). Younger persons (18-29) (aPR = 0.77; CI: 0.60 to 0.99) and persons with less than a high school education (aPR = 0.80; CI: 0.67 to 0.95) in Philadelphia, blacks (aPR = 0.90; CI: 0.83 to 0.99) and men who have sex with women only (aPR = 0.89; CI: 0.80 to 0.99) in Chicago, and homeless individuals in LAC (aPR = 0.80; CI: 0.67 to 0.94) were less likely to be virally suppressed. CONCLUSION Data highlight the need to increase ART prescription to achieve viral suppression among younger persons, noninjection drug users, blacks, and homeless persons in US metropolitan areas and underscores the importance of region-specific strategies for affected subgroups.
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Affiliation(s)
- Amy Rock Wohl
- *Division of HIV and STD Programs, Los Angeles County Department of Public Health; †HIV/STI Services Division, Chicago Department of Public Health; ‡Clinical Outcomes Team, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention; §Applied Research, Community Health, Epidemiology and Surveillance Branch, San Francisco Department of Public Health; and ‖AIDS Activities Coordinating Unit, Philadelphia Department of Public Health
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Markell M, Brar A, Stefanov DG, Salifu MO. Gender disparity in fistula use at initiation of hemodialysis varies markedly across ESRD networks-Analysis of USRDS data. Hemodial Int 2017; 22:168-175. [DOI: 10.1111/hdi.12579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mariana Markell
- Department of Medicine; SUNY Downstate School of Medicine; Brooklyn, New York, USA
| | - Amarpali Brar
- Department of Medicine; SUNY Downstate School of Medicine; Brooklyn, New York, USA
| | - Dimitre G. Stefanov
- Division of Research; SUNY Downstate School of Medicine; Brooklyn, New York, USA
| | - Moro O. Salifu
- Department of Medicine; SUNY Downstate School of Medicine; Brooklyn, New York, USA
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Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care. J Acquir Immune Defic Syndr 2017; 73:39-46. [PMID: 27028501 DOI: 10.1097/qai.0000000000001014] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care. METHODS We conducted a cohort study within Kaiser Permanente California during 1996-2011, using abridged life tables to estimate the expected years of life remaining ("life expectancy") at age 20. RESULTS Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996-1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9-14.8 years) in 2011. In 2008-2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008-2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1-10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors. CONCLUSIONS Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
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Liu P, Dillingham R, McManus KA. Hospital days attributable to immune reconstitution inflammatory syndrome in persons living with HIV before and after the 2012 DHHS HIV guidelines. AIDS Res Ther 2017; 14:25. [PMID: 28469696 PMCID: PMC5414162 DOI: 10.1186/s12981-017-0152-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/26/2017] [Indexed: 12/24/2022] Open
Abstract
Background Immune reconstitution inflammatory syndrome (IRIS) can manifest with initiation or reintroduction of antiretroviral therapy (ART) in persons living with HIV (PLWH). In 2012, updated United States treatment guidelines recommended initiation of ART for all PLWH regardless of CD4 count. The objectives of this study were to quantify hospital usage attributable to IRIS and assess the reasons for hospitalization in PLWH before and after the guideline update. Methods Subjects were PLWH between 18–89 years of age who were hospitalized between November 1, 2009 and July 31, 2014. Equivalent time periods before and after updated treatment guidelines were considered, and designated as Time Period 1 and Time Period 2, respectively. IRIS-attributable hospitalizations were identified by ICD9 codes and electronic medical record searches with subsequent review and confirmation. For hospitalizations that were not confirmed as being IRIS-attributable, primary discharge diagnoses were reviewed. Results A total of 278 PLWH were hospitalized 521 times throughout the study period. Time Period 1 had 9 PLWH with 12 IRIS-attributable hospitalizations while Time Period 2 had 6 PLWH with 9 IRIS-attributable hospitalizations. A larger proportion of IRIS-attributable hospital days was observed in Time Period 1 compared to Time Period 2 (7.5 vs 4.2%; p < 0.001). Median length of stay for IRIS-attributable hospitalizations was longer than for other diagnoses, particularly during Time Period 1 (12.0 vs 4.0; p = 0.05). The most common causes for hospitalizations in PLWH were non AIDS-defining infection, AIDS-defining malignancy, and gastrointestinal. PLWH who had HIV viral suppression (<200 copies/mL) accounted for 34 and 24% of hospitalizations in Time Periods 1 and 2 respectively. Conclusions Hospitalizations for PLWH continue at high rates and IRIS is a significant contributing factor. In our single-center study, there was a lower number of IRIS-attributable hospitalizations and IRIS-attributable hospital days in Time Period 2 compared with Time Period 1. The hospital burden of IRIS may decrease over time as more PLWH are started on ART earlier in the course of infection. This study highlights the continued importance of early diagnosis and linkage to care of those infected with HIV, so that morbidity and costs associated with IRIS continue to decline.
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Lesko CR, Tong W, Moore RD, Lau B. Retention, Antiretroviral Therapy Use and Viral Suppression by History of Injection Drug Use Among HIV-Infected Patients in an Urban HIV Clinical Cohort. AIDS Behav 2017; 21:1016-1024. [PMID: 27752872 DOI: 10.1007/s10461-016-1585-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Compared to HIV-infected persons who do not inject drugs (non-IDU), persons who inject drugs (PWID) experience disparities in linking to medical care, initiating antiretroviral therapy (ART) and achieving viral suppression. There has been little attention to changes in these disparities over time. We estimated the proportion of PWID and non-IDU retained in care, on ART, and virally suppressed each year from 2001-2012 in the Johns Hopkins HIV Clinical Cohort (JHHCC). We defined active clinic patients as those who had ≥1 clinical visit, CD4 cell count, or viral load between July 1 of the prior year, and June 30 of the analysis year. Within a calendar year, retention was defined as ≥2 clinical visits or HIV-related laboratory measurements >90 days; ART use was defined as ≥1 ART prescription active ≥30 days; and viral suppression was defined as ≥1 HIV viral load <400 copies/mL. While PWID were less likely to be retained in earlier years, the gaps in retention closed around 2010. After 2003-2004, PWID and non-IDU retained in care had similar probability of receiving a prescription for ART and PWID and non-IDU on ART had similar probability of viral suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA.
| | - Weiqun Tong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Predictors of willingness to use a smartphone for research in underserved persons living with HIV. Int J Med Inform 2017; 99:53-59. [PMID: 28118922 DOI: 10.1016/j.ijmedinf.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The burden of HIV/AIDS is borne disproportionally by a growing number of racial and ethnic minorities and socioeconomically disadvantaged individuals. Developing mHealth interventions for the everyday self-management needs of persons living with HIV (PLWH) can be challenging given the current constraints of the U.S. healthcare system, especially for those from underserved communities. In order to develop effective, evidence-based mHealth self-management interventions, we need a better understanding of the factors associated with mHealth research. The purpose of this study was to assess factors associated with PLWH's for participation in research using smartphones. METHODS We conducted a prospective cohort study (parent study) to examine the relationships among HIV self-management, age, gender and mental wellness. Relevant to this study, we analyzed the relationship between self-reported use of smartphones, willingness to use a smartphone for research, and other predictor variables including: HIV stigma, social isolation, social integration functions, and depression. We selected these variables because previous work indicated they may influence smartphone or mHealth use and because they also tend to be elevated in PLWH. RESULTS We found increased age, HIV stigma and social isolation were negatively associated with smartphone use, which supports the use of smartphones for conducting research with PLWH but also suggests that age, stigma, social integration functions and social isolation need to be considered in research involving PLWH. CONCLUSIONS Findings here support smartphone use in research involving PLWH. However, future mHealth interventions targeting PLWH should take into account the inverse relationship between smartphone use and age, HIV stigma, and social isolation, and other predictor variables.
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Musa BM, Garbati MA, Nashabaru IM, Yusuf SM, Nalado AM, Ibrahim DA, Simmons MN, Aliyu MH. Sex disparities in outcomes among adults on long-term antiretroviral treatment in northern Nigeria. Int Health 2016; 9:3-10. [PMID: 27940480 DOI: 10.1093/inthealth/ihw050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are conflicting reports of sex differences in HIV treatment outcomes in Africa. We investigated sex disparities in treatment outcomes for adults on first line antiretroviral treatment (ART) in Nigeria. METHODS We compared clinical and immunologic responses to ART between HIV-infected men (n=205) and women (n=140) enrolled in an ART program between June 2004 and December 2007, with follow-up through June 2014. We employed Kaplan-Meier estimates to examine differences in time to immunologic failure and loss to follow-up (LTFU), and generalized estimating equations to assess changes in CD4+ count by sex. RESULTS Men had lower baseline mean CD4+ count compared to women (327.6 cells/µL vs 413.4, respectively, p<0.01). Women had significantly higher rates of increase in CD4+ count than men, even after adjusting for confounders, p<0.0001. There was no significant difference in LTFU by sex: LTFU rate was 2.47/1000 person-months (95% CI 1.6-3.9) in the first five years for men vs 1.98/1000 person-months (95% CI (1.3-3.0) for women. There was no difference in time to LTFU by sex over the study period. CONCLUSIONS Women achieved better long-term immune response to ART at baseline and during treatment, but had similar rates of long-term retention in care to men. Targeted efforts are needed to improve immune outcomes in men in our setting.
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Affiliation(s)
- Baba M Musa
- Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Musa A Garbati
- Section of Infectious Diseases, King Fahad Medical City 11525 Riyadh, Saudi Arabia
| | - Ibrahim M Nashabaru
- Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Shehu M Yusuf
- Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aisha M Nalado
- Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Daiyabu A Ibrahim
- Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Melynda N Simmons
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
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Beer L, Bradley H, Mattson CL, Johnson CH, Hoots B, Shouse RL. Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009-2013. J Acquir Immune Defic Syndr 2016; 73:446-453. [PMID: 27391389 PMCID: PMC5085853 DOI: 10.1097/qai.0000000000001125] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine trends in racial/ethnic disparities in antiretroviral therapy (ART) prescription and viral suppression among HIV-infected persons in care, overall and among men who have sex with men (MSM), from 2009 to 2013. DESIGN The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. METHODS We used weighted interview and medical record data collected June 2009-May 2014 to estimate the prevalence of ART prescription and viral suppression among racial/ethnic groups overall and among MSM. RESULTS We found significant increases in ART prescription and viral suppression among all racial/ethnic groups from 2009 to 2013, both overall and among MSM. By 2013, overall and among MSM, the Hispanic-white disparity in ART prescription was nonexistent, and the black-white disparity was not significant after accounting for differences between blacks and whites in age and length of HIV diagnosis. Despite reductions in racial/ethnic disparities in viral suppression over the time period, significant disparities remained among the total population, even after adjusting for differences in racial/ethnic group characteristics. Encouragingly, however, there was no significant Hispanic-white disparity in viral suppression among MSM by 2013. CONCLUSIONS Despite significant improvements in ART prescription and viral suppression in recent years, racial and ethnic disparities persist, particularly for black persons. If the United States is to achieve the National HIV/AIDS Strategy goal of reducing HIV-related health disparities, continued efforts to accelerate the rate of improvement in ART prescription and viral suppression among Hispanic and black persons may need to be prioritized.
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Affiliation(s)
- Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather Bradley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine L. Mattson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher H. Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brooke Hoots
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R. Luke Shouse
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Haines CF, Fleishman JA, Yehia BR, Lau B, Berry SA, Agwu AL, Moore RD, Gebo KA. Closing the Gap in Antiretroviral Initiation and Viral Suppression: Time Trends and Racial Disparities. J Acquir Immune Defic Syndr 2016; 73:340-347. [PMID: 27763997 PMCID: PMC5119893 DOI: 10.1097/qai.0000000000001114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the current antiretroviral (ART) era, the evolution of HIV guidelines and emergence of new ART agents might be expected to impact the times to ART initiation and HIV virologic suppression. We sought to determine if times to AI and virologic suppression decreased and if disparities exist by age, race/ethnicity, and HIV risk. METHODS We performed a retrospective cohort study of data from 12 sites of the HIV Research Network, a consortium of US clinics caring for HIV-infected patients. HIV-infected adults (≥18 year old) newly presenting for care between 2003 and 2013 were included in this study. Times to AI and virologic suppression were defined as time from enrollment to AI and HIV RNA <400 copies per milliliter, respectively. We conducted time-to-event analyses using competing risk regression in the HIV Research Network cohort from 2003 to 2012 in 2-year intervals, with follow-up through 2013. RESULTS Among 15,272 participants, 76.9% were male, 48.4% black, and 10.9% were injection drug use with median age of 38 years (interquartile range: 29-46 years). The adjusted subdistribution hazards ratios (SHRs) for AI and virologic suppression each increased for years 2007-2008 [SHR 1.23 (1.16-1.30), and SHR 1.25 (1.17-1.34), respectively], 2009-2010 [1.55 (1.46-1.64), and 1.54 (1.43-1.65), respectively], and 2011-2012 [1.94 (1.83-2.07), and 1.73 (1.61-1.86), respectively] compared with 2003-2004. Blacks had a lower probability of AI than whites and Hispanics. CONCLUSIONS Since 2007, times from enrollment to AI and virologic suppression have decreased significantly compared with 2003-2004, but persisting disparities should be addressed.
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Affiliation(s)
- Charles F Haines
- *Department of Medicine, Division of Infectious Disease, The John Hopkins School of Medicine, Baltimore, MD;†Agency for Healthcare Research and Quality (AHRQ);‡University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA;§Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD; and‖The Johns Hopkins Department of Pediatrics, Division of Infectious Diseases, Baltimore, MD
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Richardson KK, Bokhour B, McInnes DK, Yakovchenko V, Okwara L, Midboe AM, Skolnik A, Vaughan-Sarrazin M, Asch SM, Gifford AL, Ohl ME. Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care. J Natl Med Assoc 2016; 108:201-210.e3. [PMID: 27979005 DOI: 10.1016/j.jnma.2016.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/13/2016] [Accepted: 08/08/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States. METHOD The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA < 200 copies/ml among those on cART), hypertension control (blood pressure < 140/90 mm Hg among those with hypertension), diabetes control (hemoglobin A1C < 9% among those with diabetes), lipid monitoring, guideline-concordant antidepressant prescribing, and initiation and engagement in substance use disorder (SUD) treatment. Black persons were less likely than their white counterparts to receive cART (90.2% vs. 93.2%, p<.001), and experience viral control (84.6% vs. 91.3%, p<.001), hypertension control (61.9% vs. 68.3%, p<.001), diabetes control (85.5% vs. 89.5%, p<.001), and lipid monitoring (81.5% vs. 85.2%, p<.001). Initiation and engagement in SUD treatment were similar among blacks and whites. Differences remained after adjusting for age, comorbidity, retention in HIV care, and a measure of neighborhood social disadvantage created from census data. SIGNIFICANCE Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities.
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Affiliation(s)
- Kelly K Richardson
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA.
| | - Barbara Bokhour
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA
| | - D Keith McInnes
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA
| | - Vera Yakovchenko
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA
| | - Leonore Okwara
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Amanda M Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Avy Skolnik
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA
| | - Mary Vaughan-Sarrazin
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Division of General Medical Science, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Dr, Palo Alto, CA 94304, USA
| | - Allen L Gifford
- Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA
| | - Michael E Ohl
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Arul K, Mesfin A. The Top 100 Cited Papers in Health Care Disparities: a Bibliometric Analysis. J Racial Ethn Health Disparities 2016; 4:854-865. [PMID: 27654024 DOI: 10.1007/s40615-016-0288-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/08/2016] [Indexed: 02/04/2023]
Abstract
Health care disparities research is an exponentially growing and multi-faceted field. Our objective was to identify and analyze the top 100 cited articles in health care disparities. The authors searched the Thomas Reuters Web of Science for citations of all research papers (articles) relevant to health care disparities. After analyzing search results, the number of citations, authorship, year, journal, country of publication, institution of publication, and relevant topic were recorded for each article. The most cited article was Martin's 2002 work identifying the demography of incidence and occurrence of sepsis with specific analysis of race, sex, and disposition of US patients. The second most cited article was Kamangar's 2006 paper outlining geographic patterns in cancer incidence, mortality, and prevalence. The third most cited article was Williams' 1996 study determining the differences in US health patterns in populations of different races and socioeconomic statuses through a review of similar studies. The majority of articles originated in the USA (91). The journal with the most published articles was JAMA-The Journal of the American Medical Association (14). The second most cited journal was The New England Journal of Medicine (7). Most articles were published in the 2000s (84). In descending order, the 3 most common topics were (1) disparities in cancer incidence, screening, treatment, and mortality, (2) disparities in mental health treatment, and (3) physician concordance, cultural competency, and relationships with minority patients. Overall, the highly cited articles contain current advancements in the body of knowledge used to resolve health care disparities in race, ethnicity, socioeconomic status, gender, age, wealth, education level, mental health, and geography throughout the world.
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Affiliation(s)
- Karan Arul
- Department of Orthopaedic Surgery, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA.
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Loutfy M, Johnson M, Walmsley S, Samarina A, Vasquez P, Hao-Lan H, Madihlaba T, Martinez-Tristani M, van Wyk J. The Association Between HIV Disclosure Status and Perceived Barriers to Care Faced by Women Living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada. AIDS Patient Care STDS 2016; 30:435-44. [PMID: 27551959 PMCID: PMC5035367 DOI: 10.1089/apc.2016.0049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Generally, women are less likely than men to disclose their HIV status. This analysis examined the relationship between HIV disclosure and (1) perceived barriers to care and (2) quality of life (QoL) for women with HIV. The ELLA (EpidemioLogical study to investigate the popuLation and disease characteristics, barriers to care, and quAlity of life for women living with HIV) study enrolled HIV-positive women aged ≥18 years. Women completed the 12-item Barriers to Care Scale (BACS) questionnaire. QoL was assessed using the Health Status Assessment. BACS and QoL were stratified by dichotomized HIV disclosure status (to anyone outside the healthcare system). Multilevel logistic regression analysis was used to identify factors associated with disclosure. Of 1945 patients enrolled from Latin America, China, Central/Eastern Europe, and Western Europe/Canada between July 2012 and September 2013, 1929 were included in the analysis (disclosed, n = 1724; nondisclosed, n = 205). Overall, 55% of patients lived with a husband/partner, 53% were employed, and 88% were receiving antiretroviral therapy. Patients who were with a serodiscordant partner were more likely to disclose (p = 0.0003). China had a disproportionately higher percentage of participants who did not disclose at all (nearly 30% vs. <15% for other regions). Mean BACS severity scores for medical/psychological service barriers and most personal resource barriers were significantly lower for the disclosed group compared with the nondisclosed group (p ≤ 0.02 for all). Compared with the disclosed group, the nondisclosed group reported statistically significantly higher (p ≤ 0.03) BACS item severity scores for 8 of the 12 potential barriers to care. The disclosed group reported better QoL. Overall, HIV nondisclosure was associated with more severe barriers to accessing healthcare by women with HIV.
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Affiliation(s)
- Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
| | | | - Sharon Walmsley
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
- Immunodeficiency Clinic, Toronto General Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Anna Samarina
- Saint Petersburg City HIV Centre, St. Petersburg, Russia, Saint Petersburg Medical University named after ac. Pavlov I.P., St. Petersburg, Russia
| | | | - He Hao-Lan
- Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou, China
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Wagner GJ, Bogart LM, Mutchler MG, McDavitt B, Mutepfa KD, Risley B. Increasing Antiretroviral Adherence for HIV-Positive African Americans (Project Rise): A Treatment Education Intervention Protocol. JMIR Res Protoc 2016; 5:e45. [PMID: 27025399 PMCID: PMC4829729 DOI: 10.2196/resprot.5245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/02/2015] [Indexed: 11/13/2022] Open
Abstract
Background HIV-positive African Americans have been shown to have lower adherence to antiretroviral therapy (ART) than those of other races/ethnicities, yet adherence interventions have rarely been tailored to the needs of this population. Objective We developed and will evaluate a treatment education adherence intervention (called Rise) that was culturally adapted to address the needs of African Americans living with HIV. Methods This randomized controlled trial will examine the effects of the Rise intervention on ART adherence and HIV viral load. African Americans on ART who report adherence problems will be recruited from the community and randomly assigned to receive the intervention or usual care for 6 months. The intervention consists of 6-10 individual counseling sessions, with more sessions provided to those who demonstrate lower adherence. Primary outcomes include adherence as monitored continuously with Medication Event Monitoring Systems (MEMS) caps, and viral load data received from the participant’s medical provider. Survey assessments will be administered at baseline and month 6. Results The trial is ongoing. Conclusions If effective, the Rise intervention will provide community-based organizations with an intervention tailored to address the needs of African Americans for promoting optimal ART adherence and HIV clinical outcomes. Trial Registration Clinicaltrials.gov NCT01350544; https://clinicaltrials.gov/ct2/show/NCT01350544 (Archived by WebCite at http://www.webcitation.org/6fjqqnmn0).
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, Health Unit, Santa Monica, CA, United States.
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Young JD, Patel M. HIV Subspecialty Care in Correctional Facilities Using Telemedicine. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 21:177-85. [PMID: 25788612 DOI: 10.1177/1078345815572863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the United States, prisons and jails contain a population at high risk for HIV infection with a relatively large proportion known to be HIV positive. However, many incarcerated persons lack access to subspecialty HIV care due to barriers of geography and travel. Telemedicine clinics can remove these barriers, increasing access to expert, multidisciplinary care. With telemedicine, correctional facilities can provide up-to-date, evidence-based HIV management, which may lead to improved compliance, greater virologic suppression, improved CD4 T-cell counts, fewer adverse drug interactions, and decreased transmission in the community. While HIV care in prisons is an example of harnessing this technology, telemedicine can be used for the diagnosis and management of multiple acute and chronic diseases for underserved populations.
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Affiliation(s)
- Jeremy D Young
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahesh Patel
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Beer L, Mattson CL, Bradley H, Skarbinski J. Understanding Cross-Sectional Racial, Ethnic, and Gender Disparities in Antiretroviral Use and Viral Suppression Among HIV Patients in the United States. Medicine (Baltimore) 2016; 95:e3171. [PMID: 27043679 PMCID: PMC4998540 DOI: 10.1097/md.0000000000003171] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/02/2016] [Accepted: 02/27/2016] [Indexed: 01/24/2023] Open
Abstract
To examine racial/ethnic and gender disparities in antiretroviral (ART) use and viral suppression among HIV-infected persons in care and identify factors that might account for observed disparities. The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. We used weighted interview and medical record data collected 06/2009 to 05/2012 to estimate the prevalence of ART use and viral suppression among gender-stratified racial/ethnic groups. We used χ² tests to identify significant differences in outcomes between white men versus other groups, and logistic regression models to identify the most parsimonious set of factors that could account for each observed difference. We found no significant disparity in ART use between white and Hispanic men, and no disparities between white men and white and Hispanic women after adjustment for disease stage, age, and poverty. Disparities in ART use between white men and black persons persisted after adjusting for other factors, but the observed differences were relatively small. Differences in ART use and adherence, demographic characteristics, and social determinants of health such as poverty, education, and insurance accounted for the observed disparities in viral suppression between white men and all groups except black men. In our model, accounting for these factors reduced the prevalence difference in viral suppression between white and black men by almost half. We found that factors associated with disparities differed among men and women of the same race/ethnicity, lending support to the assertion that gender affects access to care and health status among HIV-infected patients. In addition to supporting efforts to increase ART use and adherence among persons living with HIV, our analysis provides evidence for the importance of social determinants of health in understanding racial/ethnic and gender differences in ART use and viral suppression.
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Affiliation(s)
- Linda Beer
- From the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Adams LM, Balderson BH. HIV providers' likelihood to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention differs by patient type: a short report. AIDS Care 2016; 28:1154-8. [PMID: 26915281 DOI: 10.1080/09540121.2016.1153595] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP), the antiretroviral treatment regimen for HIV-negative people at high risk of acquiring HIV, has demonstrated efficacy across clinical trials in several patient populations. The Centers for Disease Control (CDC) have released detailed guidelines to aid providers in prescribing PrEP for their high-risk patients, including men who have sex with men (MSM), high-risk heterosexuals, and injection drug users (IDUs). Given that much attention in PrEP has focused on MSM patients, the present study used an online survey to assess factors involved in HIV care providers' (n = 363) decisions about prescribing PrEP, along with their willingness to prescribe PrEP to patients from various risk populations (e.g., MSM, heterosexuals, IDUs). The efficacy of PrEP was an important factor in providers' decisions about prescribing PrEP, as were considerations about patients' adherence to the regimen, regular follow-up for care, and medication costs. This survey's findings also suggest that providers' willingness to prescribe PrEP varies by patient group, with providers most willing to initiate the regimen with MSM who have an HIV-positive partner, and least willing to prescribe to high-risk heterosexuals or IDUs. In the context of the current CDC recommendations for PrEP that include MSM, heterosexuals, and IDUs, examining providers' rationales for and barriers against supporting this HIV prevention strategy across patient groups merits further attention.
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Affiliation(s)
- Leah M Adams
- a Group Health Research Institute , Seattle , WA , USA
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Rowell-Cunsolo TL, El-Bassel N, Hart CL. Black Americans and Incarceration: A Neglected Public Health Opportunity for HIV Risk Reduction. J Health Care Poor Underserved 2016; 27:114-130. [PMID: 27763462 PMCID: PMC5111428 DOI: 10.1353/hpu.2016.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Black Americans are incarcerated at disproportionate rates, largely due to racial differences in the application of drug laws. Human immunodeficiency virus (HIV) prevalence rates among Black Americans are also disproportionately high. Moreover, availability of and access to HIV prevention services in correctional settings are limited. Recognizing that Blacks are at an elevated risk of contracting HIV, and that incarceration worsens health outcomes, this paper addresses the importance of implementing comprehensive prison-based HIV programs and prevention interventions to improve the health of this vulnerable population. In the absence of a vaccine, prevention interventions can serve as an effective method of systematically addressing HIV-related health disparities. Prevention strategies offered within correctional settings provide a unique opportunity to engage a high-risk population when its members may be receptive to behavior modification.
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Affiliation(s)
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY
| | - Carl L. Hart
- Departments of Psychology and Psychiatry, Columbia University, New York, NY
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Dickson-Gomez J, Bodnar G, Petroll A, Johnson K, Glasman L. HIV Treatment for Alcohol and Non-Injection Drug Users in El Salvador. QUALITATIVE HEALTH RESEARCH 2015; 25:1719-1732. [PMID: 25595149 PMCID: PMC5027900 DOI: 10.1177/1049732314568322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since the mid-1990 s, many developing countries have introduced and expanded the availability of combination antiretroviral therapy (cART) to persons living with HIV (PLH). However, AIDS-related mortality continues to be high particularly among drug users. In this article, we present results from in-depth interviews with 13 HIV medical providers and 29 crack cocaine and alcohol using PLH in El Salvador. Providers endorsed negative attitudes toward substance using PLH and warned PLH that combining cART with drugs and alcohol would damage their livers and kidneys resulting in death. Upon diagnosis, PLH received little information about HIV treatment and many suffered depression and escalated their drug use. PLH reported suspending cART when they drank or used drugs because of providers' warnings. Substance using PLH were given few strategies and resources to quit using drugs. Messages from medical providers discourage drug users from initiating or adhering to antiretroviral therapy (ART) and may contribute to treatment abandonment.
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Affiliation(s)
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
| | - Andy Petroll
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kali Johnson
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura Glasman
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Djawe K, Buchacz K, Hsu L, Chen MJ, Selik RM, Rose C, Williams T, Brooks JT, Schwarcz S. Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons--San Francisco, 1981-2012. J Infect Dis 2015; 212:1366-75. [PMID: 26044289 PMCID: PMC11323282 DOI: 10.1093/infdis/jiv235] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 03/12/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI. DESIGN We used HIV surveillance data to conduct a survival analysis. METHODS We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012. RESULTS Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17). CONCLUSIONS Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era.
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Affiliation(s)
- Kpandja Djawe
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Ling Hsu
- HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health, University of California San Francisco
| | - Miao-Jung Chen
- HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health, University of California San Francisco
| | - Richard M. Selik
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Charles Rose
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Tiffany Williams
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
- ICF International, Assigned Full-time to Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - John T. Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Epidemiology Branch, Atlanta, Georgia
| | - Sandra Schwarcz
- HIV Epidemiology Section, AIDS Office, San Francisco Department of Public Health, University of California San Francisco
- Department of Epidemiology and Biostatistics, University of California San Francisco
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Ho A, Hameed H, Lee AW, Shih M. Potential Gains in Life Expectancy from Reductions in Leading Causes of Death, Los Angeles County: a Quantitative Approach to Identify Candidate Diseases for Prevention and Burden Disparities Elimination. J Racial Ethn Health Disparities 2015; 3:431-43. [DOI: 10.1007/s40615-015-0156-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/10/2015] [Accepted: 08/06/2015] [Indexed: 11/30/2022]
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Race and the Public Health Impact Potential of Pre-Exposure Prophylaxis in the United States. J Acquir Immune Defic Syndr 2015; 70:e30-2. [DOI: 10.1097/qai.0000000000000670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Trepka MJ, Niyonsenga T, Fennie KP, McKelvey K, Lieb S, Maddox LM. Sex and Racial/Ethnic Differences in Premature Mortality Due to HIV: Florida, 2000-2009. Public Health Rep 2015; 130:505-13. [PMID: 26327728 PMCID: PMC4529834 DOI: 10.1177/003335491513000513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to characterize premature mortality among people diagnosed with HIV infection from 2000 to 2009 in Florida, by sex and race/ethnicity, to estimate differences in premature mortality that could be prevented by linkage to HIV care and treatment. METHODS Florida surveillance data for HIV diagnoses (excluding concurrent AIDS diagnoses) were linked with vital records data to ascertain deaths through 2011. Years of potential life lost (YPLL) were obtained from the expected number of remaining years of life at a given age from the U.S. sex-specific period life tables. RESULTS Among 41,565 people diagnosed with HIV infection during the study period, 5,249 died, and 2,563 (48.8%) deaths were due to HIV/AIDS. Age-standardized YPLL (aYPLL) due to HIV/AIDS per 1,000 person-years was significantly higher for females than males (372.6, 95% confidence interval [CI] 349.8, 396.2 vs. 295.2, 95% CI 278.4, 312.5); for non-Hispanic black (NHB) females than non-Hispanic white (NHW) and Hispanic females (388.2, 95% CI 360.7, 416.9; 294.3, 95% CI 239.8, 354.9; and 295.0, 95% CI 242.9, 352.5, respectively); and for NHB males compared with NHW and Hispanic males (378.7, 95% CI 353.7, 404.7; 210.6, 95% CI 174.3, 250.8; and 240.9, 95% CI 204.8, 280.2, respectively). In multilevel modeling controlling for individual factors, NHB race was associated with YPLL due to HIV/AIDS for women (p=0.04) and men (p<0.001). CONCLUSION Among people diagnosed with HIV infection, females and NHB people had a disproportionately high premature mortality from HIV/AIDS, suggesting the need for enhanced efforts to improve linkage to and retention in care and medication adherence for these groups.
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Affiliation(s)
- Mary Jo Trepka
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Miami, FL
| | - Theophile Niyonsenga
- University of South Australia, School of Population Health, Adelaide, South Australia
| | - Kristopher P. Fennie
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Miami, FL
| | - Karma McKelvey
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Epidemiology, Miami, FL
| | - Spencer Lieb
- Florida Consortium for HIV/AIDS Research/The AIDS Institute, Tampa, FL
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The Epidemiology of Human Immunodeficiency Virus Infection and Care among Adult and Adolescent Females in the United States, 2008-2012. Womens Health Issues 2015; 25:711-9. [PMID: 26316020 DOI: 10.1016/j.whi.2015.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to determine epidemiological patterns in diagnoses of human immunodeficiency virus (HIV) infection and prevalence among females by age, race/ethnicity and transmission category, and essential steps in the continuum of HIV care. METHODS Using data from the National HIV Surveillance System, we estimated the number of females aged 13 years or older diagnosed with HIV infection in 2008 through 2012 and living with HIV at the end of 2011 in the United States. We determined percentages of females linked to care, retained in care, and virally suppressed in 18 jurisdictions with complete reporting of CD4 and viral load test results. RESULTS From 2008 to 2012, the estimated rate of HIV diagnoses among females decreased from 9.3 to 6.9 per 100,000 (-7.1% per year; 95% confidence interval [CI], -7.9, -6.3). In 2012, the diagnosis rate was highest among Blacks/African Americans (35.7), followed by Hispanics or Latinos (6.4), and Native Hawaiian Other Pacific Islander (5.1), and lowest among Whites (1.8). Most females diagnosed in 2012 were linked to care within 3 months of diagnosis (82.5%). About one-half (52.4%) of females living with HIV in 2011 received ongoing care in 2011 and 44.3% had a suppressed viral load. Viral suppression was lower among American Indian/Alaska Native (29.7%) and Black/African American (41.6%) compared with White females (46.5%). The percentage in care and with viral suppression was lower among younger compared with older females. CONCLUSION HIV diagnoses continue to decrease among females; however, disparities exist in HIV burden and viral suppression. Improvements in care and treatment outcomes are needed for all women with particular emphasis on younger women.
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