1
|
Pence BW, Darnell D, Ranna-Stewart M, Psaros C, Gaynes BN, Grimes L, Henderson S, Parman M, Filipowicz TR, Gaddis K, Dorsey S, Mugavero MJ. Provocative Findings From a Transdiagnostic Counseling Intervention to Improve Psychiatric Comorbidity and HIV Care Engagement Among People With HIV: A Pilot Randomized Clinical Trial. J Acquir Immune Defic Syndr 2024; 97:68-77. [PMID: 39116333 PMCID: PMC11315358 DOI: 10.1097/qai.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/19/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Depression, anxiety, post-traumatic stress, and alcohol/substance use disorders are prevalent among people with HIV (PWH), commonly co-occur, and predict worse HIV care outcomes. Transdiagnostic counseling approaches simultaneously address multiple co-occurring mental health disorders. METHODS We conducted a pilot individually randomized trial of the Common Elements Treatment Approach adapted for people with HIV (CETA-PWH), a transdiagnostic counseling intervention, compared with usual care at a large academic medical center in the southern United States. Participants were adults with HIV; at risk for HIV care disengagement; and with elevated symptoms of depression, anxiety, post-traumatic stress, and/or alcohol/substance use. Mental health and HIV care engagement were assessed at 4 and 9 months. RESULTS Among participants (n = 60), follow-up was high at 4 (92%) and 9 (85%) months. Intervention engagement was challenging: 93% attended ≥1 session, 43% attended ≥6 sessions in 3 months ("moderate dose"), and 30% completed treatment. Although not powered for effectiveness, mental health outcomes and HIV appointment attendance improved in CETA-PWH relative to usual care in intent-to-treat analyses; those receiving a moderate dose and completers showed progressively greater improvement. Viral load showed small differences between arms. The dose-response pattern was not explained by differences between those who did and did not complete treatment. CONCLUSIONS This pilot trial provides preliminary evidence for the potential of CETA-PWH to simultaneously address co-occurring mental health comorbidities and support HIV appointment attendance among PWH. Additional strategies may be an important part of ensuring that clients can engage in the full course of treatment and realize its full benefits.
Collapse
Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, the University of North Carolina at Chapel Hill
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, the University of Washington
| | | | | | - Bradley N. Gaynes
- Department of Epidemiology, the University of North Carolina at Chapel Hill
- Department of Psychiatry, the University of North Carolina at Chapel Hill
| | - LaKendra Grimes
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Savannah Henderson
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Mariel Parman
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | | | - Kathy Gaddis
- Division of Infectious Diseases, the University of Alabama at Birmingham
| | - Shannon Dorsey
- Department of Global Health, the University of Washington
| | | |
Collapse
|
2
|
Atkins K, Bruce J, Kay ES, Musgrove K, Kellar P, MacCarthy S. Transactional sex among adults accessing sexual health services in Alabama, 2008-2022: Prevalence, associated risk factors, and associations with HIV, HCV, and STI diagnosis. Ann Epidemiol 2024; 92:35-39. [PMID: 38360156 DOI: 10.1016/j.annepidem.2024.02.004] [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: 10/11/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The U.S. Deep South bears a disproportionate burden of HIV and other STIs. Transactional sex may influence these epidemics, but few studies have estimated its prevalence or correlates in the Deep South. METHODS We estimated the history of transactional sex among adults accessing an Alabama AIDS Service Organization from 2008-2022, using chi-square tests to examine its sociodemographic and behavioral correlates. We used modified Poisson regression with cluster-robust standard errors to estimate adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI) for the associations between transactional sex and new HIV, hepatitis C (HCV), and STI diagnoses. RESULTS Transactional sex was reported at 944/20,013 visits (4.7 %) and associated with older age, being a cisgender woman or gender minority, identifying as white, diverse drug use, and sharing of drug equipment. Compared to others, clients reporting transactional sex had increased prevalence of syphilis (apR 3.60, 95 % CI 1.16-11.19) and HCV (aPR 1.53, 95 % CI 1.24-1.88). CONCLUSION Using 14 years of community-based data, this study is the first to estimate the relationship between transactional sex and HIV, HCV, and STIs in Alabama and highlights the need address STI burden and diverse drug use among people who transact sex in the Deep South.
Collapse
Affiliation(s)
- Kaitlyn Atkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Josh Bruce
- Birmingham AIDS Outreach, Birmingham, AL, USA
| | - Emma Sophia Kay
- Birmingham AIDS Outreach, Birmingham, AL, USA; Department of Acute, Chronic, and Continuing Care University of Alabama at Birmingham School of Nursing Birmingham, AL, USA
| | | | | | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
3
|
Naidoo S, Paruk S, Ferreira L, Subramaney U. Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa. S Afr J Psychiatr 2024; 30:2108. [PMID: 38322178 PMCID: PMC10839230 DOI: 10.4102/sajpsychiatry.v30i0.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/20/2023] [Indexed: 02/08/2024] Open
Abstract
Background Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immunodeficiency virus (HIV) and violent offending. However, no such study had been conducted in South Africa (SA), despite the high prevalence of HIV and trauma in SA. Aim To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates. Setting The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa. Methods This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organization's Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. Human immunodeficiency virus data was confirmed from prison medical records. Results Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder (PTSD), alcohol use disorder, substance use disorder, borderline personality disorder, and HIV. Conclusion Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focussed care to improve inmates' mental health outcomes and decrease recidivism. Contribution This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a low- and middle-income, South African setting.
Collapse
Affiliation(s)
- Samantha Naidoo
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Liezel Ferreira
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ugasvaree Subramaney
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
4
|
As K, Adam E, Livingston M, Root C, Sales JM. Support for Trauma-informed Care Implementation Among Ryan White HIV Clinics in the Southeastern United States. AIDS Behav 2023; 27:939-947. [PMID: 36048293 DOI: 10.1007/s10461-022-03830-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/28/2022]
Abstract
Trauma histories are common among people with HIV and associated with poor HIV outcomes, underscoring the importance of integrating trauma-informed care (TIC) into HIV services. As part of the quantitative phase of an explanatory sequential mixed-methods study, we assessed individual and clinic-wide support (using the Attitudes Related to Trauma-informed Care-45 (ARTIC-45)) and factors influencing TIC support through surveys with 152 administrators, providers, and staff from 38 Ryan White Clinics (RWCs) in the Southeastern US. Mean responses to the ARTIC-45 Personal and System Support Subscales were 5.18 (SE = 0.09; range 1-7) and 4.45 (SE = 0.16; range 1-7), respectively. In bivariate analysis, higher personal and system support were associated with strong clinic leadership culture (personal support: β = 0.08, t-value = 2.66, p = 0.009; system support: β = 0.16, t-value = 4.71, p < 0.001) and lower staff burnout (personal support: β=-0.05, t-value=-3.10, p = 0.002; system support: β=-0.07, t-value=-3.63, p < 0.001). System support was also associated with rural clinic setting (β = 0.61, t-value = 2.34, p = 0.021), strong staff culture (β = 0.14, t-value = 4.70, p = < 0.001), and resource availability (β = 0.16, t-value = 5.76, p < 0.001), and negatively associated with academic clinic setting (β=-0.52, t-value=-2.25, p = 0.026). Thus, while there is encouraging individual support for TIC, RWCs need tools (training and/or resources) to foster leadership and staff culture and trauma support to enable their transition to trauma-informed HIV care.
Collapse
Affiliation(s)
- Kalokhe As
- Emory School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA. .,Emory Rollins School of Public Health, Department of Global Health, Atlanta, GA, USA. .,Claudia Nance Rollins Building, 1518 Clifton Rd, 5003, 30322, Office, Atlanta, GA, USA.
| | - E Adam
- Emory Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA
| | - M Livingston
- Emory Rollins School of Public Health, Department of Behavior, Social and Health Education Sciences, Atlanta, GA, USA
| | - C Root
- Emory School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - J M Sales
- Emory Rollins School of Public Health, Department of Behavior, Social and Health Education Sciences, Atlanta, GA, USA
| |
Collapse
|
5
|
Rimmler S, Golin C, Coleman J, Welgus H, Shaughnessy S, Taraskiewicz L, Lightfoot AF, Randolph SD, Riggins L. Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities. HEALTH EDUCATION & BEHAVIOR 2022; 49:1022-1032. [PMID: 35856333 PMCID: PMC9574897 DOI: 10.1177/10901981221109138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND African American women are at a disproportionate HIV risk compared with other U.S. women. Studies show that complex structural and social determinants, rather than individual behaviors, place African American women at greater risk of HIV infection; however, little is known about women's views of what puts them at risk. AIMS This study sought to comprehend the perceptions of African American women living in low-income housing regarding the factors that influence both their personal sexual health behaviors and use of HIV prevention services. METHODS We conducted seven focus groups with 48 African American women from 10 public housing communities in a small city in the southeastern United States. We analyzed the focus group transcripts using thematic data analysis to identify salient themes and points of interest related to the study aim. RESULTS Women identified factors related to the health care system (trustworthiness of the health care system), the external environment (racism, classism, patriarchal structures, and violence/crime), as well as predisposing (health beliefs, stigma, and gender norms), enabling (agency to negotiate gendered power), and need (perceived HIV risk and perceptions of partner characteristics) features of individuals in the population. CONCLUSION African American women living in public housing are especially vulnerable to HIV infection due to intersectional discrimination based on racism, classism, gender power dynamics, and community conditions. Our findings confirm the need to develop HIV intervention programming addressing intersectional identities of those making up the communities they plan to address, and being informed by those living in the communities they plan to act on.
Collapse
Affiliation(s)
- Shelby Rimmler
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Carol Golin
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public
Health, Chapel Hill, NC, USA
| | - James Coleman
- North Carolina Institute of Medicine,
Chapel Hill, NC, USA
| | - Hayley Welgus
- Gender and Development Consultant,
Chiang Mai, Thailand
| | | | - Leah Taraskiewicz
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Linda Riggins
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
6
|
McIntosh EC, Beam C, Spahr CM, Slavich GM, Thames AD. Prefrontal Cortex Volume Mediates the Relationship Between Lifetime Chronic Stressor Exposure and Cognition in People Living With and Without HIV. Psychosom Med 2022; 84:904-913. [PMID: 35980777 PMCID: PMC9553266 DOI: 10.1097/psy.0000000000001125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite considerable research documenting how stress affects brain and neurobehavioral outcomes, few studies have assessed stressor exposure occurring over the entire life span, and no studies have investigated these associations in people living with HIV (PLWH), despite the high stress and disease burden experienced by this population. To address this issue, we examined how cumulative lifetime chronic stressor exposure related to cognition and brain integrity (i.e., gray matter volume) in White and African American PLWH and HIV-uninfected (HIV-) adults. METHOD Participants were 91 community-dwelling adults (47.3% PLWH) who completed a comprehensive interview assessing lifetime stressor exposure using the Stress and Adversity Inventory and underwent neuropsychological testing and structural magnetic resonance imaging. Regional brain volumes were derived from T1-weighted images processed through Freesurfer. RESULTS As hypothesized, greater lifetime chronic stressor exposure was related to worse global cognition ( b = -0.06, standard error [SE] = 0.03, p = .032), processing speed ( b = -0.04, SE = 0.14, p = .041), and executive functioning ( b = -0.06, SE = 0.02, p = .02), and smaller prefrontal cortex (PFC) volume ( b = -16.20, SE = 5.78, p = .007). HIV status did not moderate any of these associations. Moreover, results from mediation analyses demonstrated that the relationship between lifetime chronic stressor exposure and processing speed was fully mediated by PFC volume. CONCLUSIONS These results highlight the critical role of the PFC in the maintenance of processing speed abilities and its vulnerability to cumulative stressor exposure. Specifically, the negative impact of lifetime chronic stressor exposure on cognition-particularly functions reliant on frontal lobe integrity-may be partly driven by smaller volumes in the PFC.
Collapse
|
7
|
Brown MJ, Adeagbo O. Trauma-Informed HIV Care Interventions: Towards a Holistic Approach. Curr HIV/AIDS Rep 2022; 19:177-183. [PMID: 35353271 PMCID: PMC10084732 DOI: 10.1007/s11904-022-00603-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The prevalence of trauma is higher among people living with HIV compared to the general population and people living without HIV. Trauma may be a major barrier in attaining HIV treatment outcomes, such as linkage to HIV care, engagement in HIV care, adherence to antiretroviral therapy (ART), and viral suppression. The purpose of this review was to highlight trauma-informed interventions that are geared towards improving treatment outcomes among people living with HIV. RECENT FINDINGS Recent studies suggest that a trauma-informed approach to developing interventions may help to improve treatment outcomes, such as engagement in care and adherence to ART. However, studies have also shown that depending on the operationalization of usual care, a trauma-informed approach may result in similar outcomes. Very few studies have examined the impact of trauma-informed interventions on HIV care and treatment outcomes. Additional research is needed on the acceptability, feasibility, and efficacy of trauma-informed interventions among affected populations such as older adults, and racial/ethnic and sexual minorities living with HIV.
Collapse
Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, 435C, Columbia, SC, 29208, USA. .,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. .,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Oluwafemi Adeagbo
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Sociology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
8
|
Ugwu LI, Onu DU, Nnadozie EE, Iorfa SK. Psychometric validation of the centrality of events scale in a Nigerian clinical sample. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.1910410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - Steven Kator Iorfa
- Department of Psychology, University of Nigeria, Nsukka, Enugu State, Nigeria
| |
Collapse
|
9
|
Menza TW, Lipira L, Bhattarai A, Leon VCD, Orellana ER. Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR. BMC Womens Health 2020; 20:219. [PMID: 33008421 PMCID: PMC7532610 DOI: 10.1186/s12905-020-01088-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/24/2020] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited. METHODS In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex. RESULTS Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent (95% CI: 1.8, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8% (95% CI: 13.0, 34.6%) of women who reported eleven ACEs (P < 0.001). Transactional sex was strongly associated with combination methamphetamine and opiate use as well as condomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low. CONCLUSIONS In a sample of women of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.
Collapse
Affiliation(s)
- Timothy W Menza
- HIV/STD/TB Section, Public Health Division, Oregon Health Authority, 800 NE Oregon Street, Portland, Oregon, 97232, USA.
- Oregon Health & Sciences University (OHSU), Portland, Oregon, USA.
- Multnomah County Health Department, Portland, Oregon, USA.
| | | | | | | | | |
Collapse
|
10
|
Ahmed A, Afshan G, Irshad Khan R, Afzal B, Jamali S, Farooq N, Saleem S, Naeem R, Khan U. Managing acute pain in HIV+/AIDS patients: knowledge and practice trends among emergency physicians of major tertiary care centers of a developing country. BMC Res Notes 2020; 13:255. [PMID: 32456673 PMCID: PMC7249315 DOI: 10.1186/s13104-020-05095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire. RESULTS Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for acute pain in these patients. Forty-two (50%) out of the 84 participants believed that routine doses of opioids were adequate for pain relief, while 42 (50%) agreed that pain management was more complex in these patients mainly due to presence of multiple coexisting problems and psychological issues. Only 26 (31%) respondents considered that pain was under-reported and under-treated in these patients, mainly because physicians were more focused on patients' other disease related complications and issues. Formulation of guidelines are recommended for effective acute pain management in these patients encompassing associated issues, including concomitant painful conditions, opioid dependence, psychiatric problems, etc.
Collapse
Affiliation(s)
- Aliya Ahmed
- Department of Anaesthesiology, 2nd-Floor Private Wing, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Gauhar Afshan
- Department of Anaesthesiology, 2nd-Floor Private Wing, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Robyna Irshad Khan
- Department of Anaesthesiology, 2nd-Floor Private Wing, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Badar Afzal
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Seemin Jamali
- Accident and Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Nighat Farooq
- Accident and Emergency Department, Civil Hospital Karachi, Karachi, Pakistan
| | - Sarosh Saleem
- Paediatrics Department, Indus Hospital, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
11
|
El-Akkad SED, Nolan S, Fairbairn N, Ye M, Wu A, Barrios R, Montaner J, Ti L. The impact of high-dose opioid prescription on mortality rates among people living with HIV: A retrospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102705. [PMID: 32143186 PMCID: PMC7302960 DOI: 10.1016/j.drugpo.2020.102705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/25/2019] [Accepted: 02/16/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES High-dose opioid use is associated with increased morbidity, mortality, and healthcare utilization. People living with HIV (PLHIV) are frequently prescribed these medications to manage their pain. However, little is known about the relationship between being prescribed high doses of opioids (> 90 MME/d) and mortality risk among this population. The objective of this study was to examine the trends in mortality and the relationship between high-dose opioid analgesic prescribing and mortality among PLHIV. METHODS Utilizing the STOP HIV/AIDS cohort--a population-level linked database of treatment of PLHIV in British Columbia--we conducted bivariable and multivariable generalized estimating equation (GEE) models with a Poisson distribution to examine the relationship between high-dose opioid prescription and all-cause mortality rates in the study sample. RESULTS Between 1996 and 2015, 9272 PLHIV were included in the study. Age- and sex-adjusted mortality rate (using the 2011 Canadian population as the reference) was 30.99 per 1000 person-years (95% confidence interval [CI]: 28.11-33.88). In a multivariable GEE model with adjustment for various demographic and clinical confounders, there was a positive and independent association between being prescribed high-dose opioids and all-cause mortality rates (adjusted rate ratio [ARR] = 3.01; 95%CI: 2.47-3.66). DISCUSSION We found that mortality rates were significantly higher among PLHIV who were prescribed high-dose opioids compared to those who were prescribed lower doses. Our results highlight the risk associated with the prescribing of high-dose opioids to manage HIV-related pain and emphasize the need to explore non-opioid approaches to pain management.
Collapse
Affiliation(s)
- Saif-El-Din El-Akkad
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Research Scientist & Health Administrative Data Lead, B.C. Centre on Substance Use Assistant Professor, Department of Medicine, University of British Columbia, 400-1045 Howe Street Vancouver, BC, Canada, V6Z 2A9
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Research Scientist & Health Administrative Data Lead, B.C. Centre on Substance Use Assistant Professor, Department of Medicine, University of British Columbia, 400-1045 Howe Street Vancouver, BC, Canada, V6Z 2A9
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Anthony Wu
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Julio Montaner
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6
| | - Lianping Ti
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Research Scientist & Health Administrative Data Lead, B.C. Centre on Substance Use Assistant Professor, Department of Medicine, University of British Columbia, 400-1045 Howe Street Vancouver, BC, Canada, V6Z 2A9.
| |
Collapse
|
12
|
Kalokhe AS, Riddick C, Piper K, Schiff J, Getachew B, Del Rio C, Sales JM. Integrating program-tailored universal trauma screening into HIV care: an evidence-based participatory approach. AIDS Care 2019; 32:209-216. [PMID: 31357876 DOI: 10.1080/09540121.2019.1640841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Trauma is prevalent among HIV-infected populations and associated with negative HIV care outcomes. While several agencies have called for integrating trauma-informed care into HIV services, uptake has been limited and effective methods have not been delineated. To develop comprehensive trauma screening strategies tailored to a large, urban HIV care center, we aimed to first understand provider and staff perceptions of the center's current level of trauma screening and barriers and facilitators to universal screening uptake. We used a mixed-methods convergent parallel design: quantitative assessments with 31 providers and staff and in-depth interviews with 19 providers and staff. Quantitative assessments highlighted center strengths (i.e. assessing effects of trauma, explaining care plans to patients, providing opportunities for questions) and gaps (i.e. asking about head injuries, emotional safety). Qualitative interviews suggested center screening practices were highly-variable and limited, identified gaps in interdepartmental communication regarding results of trauma screening that led to repeated screenings and potential patient re-traumatization, screening barriers (i.e. limited time, competing clinical priorities) and facilitators (i.e. provider-driven, standardized, non-disruptive screening with clear cut-points and follow-up steps). This study provides tangible strategies for the center to begin integrating universal trauma screening, many of which could be adapted by other U.S. HIV clinics.
Collapse
Affiliation(s)
- Ameeta S Kalokhe
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, USA
| | - Clara Riddick
- Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, USA
| | - Kaitlin Piper
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, USA
| | - Julia Schiff
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, USA
| | - Betelihem Getachew
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, USA
| | - Carlos Del Rio
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, USA
| | - Jessica M Sales
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, USA
| |
Collapse
|
13
|
Ogburn DF, Schoenbach VJ, Edmonds A, Pence BW, Powers KA, White BL, Dzialowy N, Samoff E. Depression, ART Adherence, and Receipt of Case Management Services by Adults with HIV in North Carolina, Medical Monitoring Project, 2009-2013. AIDS Behav 2019; 23:1004-1015. [PMID: 30547332 DOI: 10.1007/s10461-018-2365-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression among persons with HIV is associated with antiretroviral therapy (ART) interruption and discontinuation, virological failure, and poor clinical and survival outcomes. Case management services can address needs for emotional counseling and other supportive services to facilitate HIV care engagement. Using 2009-2013 North Carolina Medical Monitoring Project data from 910 persons engaged in HIV care, we estimated associations of case management utilization with "probable current depression" and with 100% ART dose adherence. After weighting, 53.2% of patients reported receiving case management, 21.7% reported depression, and 87.0% reported ART adherence. Depression prevalence was higher among those reporting case management (24.9%) than among other patients (17.6%) (p < 0.01). Case management was associated with depression among patients living above the poverty level [adjusted prevalence ratio (aPR), 2.05; 95% confidence interval (CI) 1.25-3.36], and not among other patients (aPR, 1.01; 95% CI 0.72-1.43). Receipt of case management was not associated with ART adherence (aPR, 1.00; 95% CI 0.95-1.05). Our analysis indicates a need for more effective depression treatment, even among persons receiving case management services. Self-reported ART adherence was high overall, though lower among persons experiencing depression (unadjusted prevalence ratio, 0.92; 95% CI 0.86-0.99). Optimal HIV clinical and prevention outcomes require addressing psychological wellbeing, monitoring of ART adherence, and effective case management services.
Collapse
Affiliation(s)
- Damon F Ogburn
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA.
| | - Victor J Schoenbach
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kimberly A Powers
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Becky L White
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Nicole Dzialowy
- North Carolina Department of Health and Human Services, Division of Public Health, Communicable Disease Branch, Raleigh, NC, 27603, USA
| | - Erika Samoff
- North Carolina Department of Health and Human Services, Division of Public Health, Communicable Disease Branch, Raleigh, NC, 27603, USA
| |
Collapse
|
14
|
Young-Wolff KC, Sarovar V, Sterling SA, Leibowitz A, McCaw B, Hare CB, Silverberg MJ, Satre DD. Adverse childhood experiences, mental health, substance use, and HIV-related outcomes among persons with HIV. AIDS Care 2019; 31:1241-1249. [PMID: 30887831 DOI: 10.1080/09540121.2019.1587372] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
While persons with HIV (PWH) have benefited from significant advances in treatment and resulting longevity, mental health problems remain elevated in this population. Adverse childhood experiences (ACEs) are common among PWH and may negatively affect mental health and HIV-related outcomes. We examined the association between ACEs, depression and anxiety symptoms, substance use, antiretroviral therapy (ART) adherence, and HIV-clinical indicators in a sample of 584 PWH at risk for unhealthy alcohol use enrolled in a primary care-based alcohol intervention study. The sample was 96.9% male, 63.0% non-Hispanic white, with an average age of 49.0 years. ACEs were highly prevalent: 82.5% reported ≥1 ACE, including 34.2% reporting 1-2 ACEs, 25.0% reporting 3-4 ACEs, and 23.3% reporting ≥5 ACEs. Adjusting for demographics, having 1-2, 3-4 or ≥5 ACEs was significantly associated with anxiety (ORs (95%CI): 3.41 (1.13-10.33), 4.36 (1.42-3.36), and 3.96 (1.28-12.19), respectively) and poorer mental health quality of life (Betas (SE): -3.21 (1.40), -6.23 (1.51), and -7.09 (1.54), respectively), but not with other outcomes. Trauma-informed interventions to reduce anxiety and improve mental health quality of life in PWH may reduce the negative health sequelae of ACEs.
Collapse
Affiliation(s)
- Kelly C Young-Wolff
- a Division of Research, Kaiser Permanente , Oakland , CA , USA.,b Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
| | - Varada Sarovar
- a Division of Research, Kaiser Permanente , Oakland , CA , USA
| | | | - Amy Leibowitz
- a Division of Research, Kaiser Permanente , Oakland , CA , USA
| | - Brigid McCaw
- c Family Violence Prevention Program, Kaiser Permanente , Oakland , CA , USA
| | - Charles B Hare
- d Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center , San Francisco , CA , USA
| | | | - Derek D Satre
- a Division of Research, Kaiser Permanente , Oakland , CA , USA.,b Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
| |
Collapse
|
15
|
Watson CWM, Sundermann EE, Hussain MA, Umlauf A, Thames AD, Moore RC, Letendre SL, Jeste DV, Morgan EE, Moore DJ. Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV. Health Psychol 2018; 38:33-42. [PMID: 30372103 DOI: 10.1037/hea0000688] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The causes of neurocognitive and everyday functioning impairment among aging people living with HIV (PLWH) are multifactorial. Exposure to stress and trauma can result in neurocognitive deficits via activation of neurological and other biological mechanisms. METHOD PLWH (n = 122) and persons without HIV (n = 95), 35-65 years of age, completed four questionnaires that were used to generate a trauma, economic hardship (food insecurity and low socioeconomic status), and stress composite variable (TES). Participants also completed a comprehensive neuropsychological battery and standardized self-reports of activities of daily living (ADLs). We examined the independent and interactive effects of TES and HIV status on neurocognitive performance and ADL declines. RESULTS PLWH had more traumatic events, more food insecurity, lower socioeconomic status, and higher perceived stress compared with HIV- individuals (all ps < .0001). Among PLWH, a higher composite TES score was associated with worse executive functioning (p = .02), worse learning (p = .02), worse working memory (p = .02), and more ADL declines (p < .0001), even after controlling for relevant demographic, psychiatric, substance use, and HIV disease covariates. On their own, individual TES components did not predict these outcomes. Conversely, no significant relationships were observed between TES and cognitive domains nor ADL declines among HIV- individuals. CONCLUSIONS A composite score of trauma, economic hardship, and stress was significantly associated with worse neurocognitive performance and functional declines among PLWH. These adverse experiences may contribute to neurocognitive and daily functioning difficulties commonly observed among PLWH. Longitudinal studies are needed to elucidate the relationships between economic/psychosocial adversities and cognitive/functional outcomes over time, and examine potential mediators, such as inflammatory biomarkers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | - Anya Umlauf
- Department of Psychiatry, University of California
| | | | | | | | - Dilip V Jeste
- Department of Psychiatry, Stein Institute for Research on Aging, and Department of Neuroscience, University of California
| | | | | |
Collapse
|
16
|
Schulte MT, Marelich WD, Payne DL, Tarantino N, Armistead LP, Murphy DA. Validation of a brief measure of HIV health-related anxiety among women living with HIV. Res Nurs Health 2018; 41:10.1002/nur.21876. [PMID: 29862527 PMCID: PMC6557685 DOI: 10.1002/nur.21876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/21/2018] [Indexed: 11/08/2022]
Abstract
Anxiety symptoms related to health are often present in populations coping with chronic illness, and among women living with HIV (WLWH), anxiety has been linked to a range of negative outcomes. This paper describes the validation of a four-item instrument designed to measure health-related anxiety (HRA) in WLWH by assessing the impact of thinking about HIV status and health on difficulty sleeping, lack of appetite, reduced desire to socialize, and difficulty concentrating at school or work. The scale was administered to 238 adult WLWH across three studies. Exploratory factor analysis revealed a one-factor solution; multi-group confirmatory factor invariance analyses supported the single factor model. For construct and criterion validity, correlations between the HRA scale and validated instruments measuring psychological, psychosocial, and physical distress were as predicted. Results support the validity of the HRA scale among WLWH as a brief measure of anxiety related to HIV status and health.
Collapse
Affiliation(s)
- Marya T. Schulte
- University of California, Integrated Substance Abuse Programs, Los Angeles, California
| | | | - Diana L. Payne
- University of California, Integrated Substance Abuse Programs, Los Angeles, California
| | | | - Lisa P. Armistead
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | - Debra A. Murphy
- University of California, Integrated Substance Abuse Programs, Los Angeles, California
| |
Collapse
|
17
|
Dillingham R, Ingersoll K, Flickinger TE, Waldman AL, Grabowski M, Laurence C, Wispelwey E, Reynolds G, Conaway M, Cohn WF. PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up. AIDS Patient Care STDS 2018; 32:241-250. [PMID: 29851504 PMCID: PMC5982157 DOI: 10.1089/apc.2017.0303] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mobile health interventions may help People Living with HIV (PLWH) improve engagement in care. We designed and piloted PositiveLinks, a clinic-affiliated mobile intervention for PLWH, and assessed longitudinal impact on retention in care and viral suppression. The program was based at an academic Ryan White Clinic serving a nonurban population in Central Virginia. The PL intervention included a smartphone app that connected participants to clinic staff and provided educational resources, daily queries of stress, mood and medication adherence, weekly quizzes, appointment reminders, and a virtual support group. Outcomes were analyzed using McNemar's tests for HRSA-1, visit constancy, and viral suppression and nonparametric Wilcoxon signed-rank tests for CD4 counts and viral loads. Of 77 participants, 63% were male, 49% black non-Hispanic, and 72% below the federal poverty level. Participants' achievement of a retention in care benchmark (HRSA-1) increased from 51% at baseline to 88% at 6 months (p < 0.0001) and 81% at 12 months (p = 0.0003). Visit constancy improved from baseline to 6 months (p = 0.016) and 12 months (p = 0.0004). Participants' mean CD4 counts increased from baseline to 6 months (p = 0.0007) and 12 months (p = 0.0005). The percentage of participants with suppressed viral loads increased from 47% at baseline to 87% at 6 months (p < 0.0001) and 79% at 12 months (p = 0.0007). This study is one of the first to demonstrate that a mobile health intervention can have a positive impact on retention in care and clinical outcomes for vulnerable PLWH. Next steps include integration with clinical practice and dissemination.
Collapse
Affiliation(s)
- Rebecca Dillingham
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tabor E. Flickinger
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ava Lena Waldman
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Marika Grabowski
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Colleen Laurence
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Erin Wispelwey
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Mark Conaway
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Wendy F. Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| |
Collapse
|
18
|
Childhood Adversities and Physical and Mental Health Outcomes in Adults Living with HIV: Findings from the Ontario HIV Treatment Network Cohort Study. AIDS Res Treat 2018; 2018:2187232. [PMID: 29686897 PMCID: PMC5852860 DOI: 10.1155/2018/2187232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
We sought to estimate the prevalence of childhood adversity and examine its relationship with health outcomes among people living with HIV. Study participants included 1409 adults living with HIV and receiving care in Toronto, Canada. Data on childhood adversity, health behaviors, HIV outcome measures, depression, and health-related quality of life (HRQOL) were collected through face-to-face interviews and medical records. Statistical analyses included multivariable linear and logistic regression modeling. The prevalence of any childhood adversity was 71% (individual types ranged from 11% to 44%) and higher prevalence was associated with younger age, Indigenous or African/Caribbean/Black ethnicity, lower socioeconomic status, and higher rates of cigarette smoking and nonmedicinal drug use. Greater number of childhood adversities was associated with greater odds of depression and decreasing mental HRQOL. HIV care providers need to screen for childhood adversities and address childhood trauma within the context of HIV care.
Collapse
|
19
|
Flickinger TE, DeBolt C, Waldman AL, Reynolds G, Cohn WF, Beach MC, Ingersoll K, Dillingham R. Social Support in a Virtual Community: Analysis of a Clinic-Affiliated Online Support Group for Persons Living with HIV/AIDS. AIDS Behav 2017; 21:3087-3099. [PMID: 27766448 DOI: 10.1007/s10461-016-1587-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Social support can improve outcomes for people living with HIV (PLWH) and could be provided through online support groups. The Positive Links smartphone app is a multicomponent intervention that allows users to interact in a clinic-affiliated anonymous online support group. We investigated how social support was exchanged in a group of 55 participants over 8 months, using an adaptation of the Social Support Behavior Code. Participant interviews assessed their experiences and perceptions of the app. Of 840 posts analyzed, 115 (14 %) were coded as eliciting social support and 433 (52 %) as providing social support. Messages providing support were predominantly emotional (41 %), followed by network (27 %), esteem (24 %), informational (18 %), and instrumental (2 %) support. Participants perceived connection and support as key benefits of the app. Technical issues and interpersonal barriers limited some participants in fully using the app. Mobile technology offers a useful tool to reach populations with barriers to in-person support and may improve care for PLWH.
Collapse
Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Claire DeBolt
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ava Lena Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Wendy F Cohn
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
- UVA Center for Global Health, P.O. Box 801379, Charlottesville, VA, 22908, USA.
| |
Collapse
|
20
|
Logie CH, Kennedy VL, Tharao W, Ahmed U, Loutfy MR. Engagement in and continuity of HIV care among African and Caribbean Black women living with HIV in Ontario, Canada. Int J STD AIDS 2016; 28:969-974. [PMID: 27956646 DOI: 10.1177/0956462416683626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Engagement in care is a key component of the HIV care cascade, yet there are knowledge gaps regarding how to assess HIV care engagement. This study aimed to develop a tool to assess HIV care engagement and to assess associations between HIV care engagement and quality of life (QOL) among African, Caribbean and Black (ACB) women living with HIV (WLWH). We conducted a cross-sectional survey with ACB WLWH across Ontario, Canada. We developed the 'HIV Engagement in and Continuity of Care Scale' (HECCS). We conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to test the scale's factor structure. We conducted structural equation modeling (SEM) with maximum likelihood estimation to examine the associations between the HECCS and QOL. EFA yielded four factors: access to care, care by doctor/health professionals, control of HIV care, and appointment timekeeping. The CFA of the HECCS demonstrated good model fit: χ2 (DF: 1; n = 173) = 1.175, p = 0.278; CFI: 0.998; Tucker-Lewis Index (TLI): 0.990; RMSEA: 0.032. The HECCS was associated with increased QOL. The model fit the data well: χ2 (DF: 31, n = 173) = 51.19, p = 0.013; CFI = 0.955; TLI = 0.934; RMSEA = 0.062. Engagement in and continuity of care is multifaceted. We recommend interventions to promote the institutional capacity to better engage ACB WLWH in HIV care.
Collapse
Affiliation(s)
- Carmen H Logie
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,2 Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Victoria L Kennedy
- 2 Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Uzma Ahmed
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Mona R Loutfy
- 2 Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,4 Department of Medicine, University of Toronto, Toronto, ON, Canada.,5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
21
|
Walcott M, Kempf MC, Merlin JS, Turan JM. Structural community factors and sub-optimal engagement in HIV care among low-income women in the Deep South of the USA. CULTURE, HEALTH & SEXUALITY 2016; 18:682-94. [PMID: 26670722 PMCID: PMC6047529 DOI: 10.1080/13691058.2015.1110255] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study describes the ways in which poverty and other structural factors create a risk environment for sub-optimal engagement in HIV care among low-income women living with HIV in the Southern USA, contributing to existing health disparities. We conducted a qualitative study in 2012, involving in-depth interviews with 14 stakeholders (service providers and representatives of community-based organisations) and 7 focus-group discussions with 46 women living with HIV (89% African American). A thematic approach in the context of the social ecological model guided data analysis. Data were coded and analysed using NVivo qualitative software. The findings suggested that structural community factors, such as poverty, poor employment opportunities, limited access to healthcare resources, stigma, transportation challenges and access to illicit substances, may work independently and in synergy to impact women's health seeking behaviour and decision-making, thereby influencing their ability to engage in HIV care. Interventions designed to improve engagement in HIV care should address structural factors to bolster low-income women's ability to engage in care.
Collapse
Affiliation(s)
- Melonie Walcott
- Department of Medicine (Infectious Diseases), University of Alabama at Birmingham, Birmingham, AL
| | - Mirjam-Colette Kempf
- Department of Family, Community & Health Systems, University of Alabama at Birmingham, Birmingham, AL
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica S. Merlin
- Department of Medicine (Infectious Diseases), University of Alabama at Birmingham, Birmingham, AL
| | - Janet M. Turan
- Department of Health Care Organization, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
22
|
Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis. AIDS 2015; 29:2183-94. [PMID: 26353027 DOI: 10.1097/qad.0000000000000842] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to estimate the odds of engagement in HIV care and treatment among HIV-positive women reporting intimate partner violence (IPV). DESIGN We systematically reviewed the literature on the association between IPV and engagement in care. Data sources included searches of electronic databases (PubMed, Web of Science, CINAHL and PsychoInfo), hand searches and citation tracking. METHODS Two reviewers screened 757 full-text articles, extracted data and independently appraised study quality. Included studies were peer-reviewed and assessed IPV alongside engagement in care outcomes: antiretroviral treatment (ART) use; self-reported ART adherence; viral suppression; retention in HIV care. Odds ratios (ORs) were pooled using random effects meta-analysis. RESULTS Thirteen cross-sectional studies among HIV-positive women were included. Measurement of IPV varied, with most studies defining a 'case' as any history of physical and/or sexual IPV. Meta-analysis of five studies showed IPV to be significantly associated with lower ART use [OR 0.79, 95% confidence interval (95% CI) 0.64-0.97]. IPV was associated with poorer self-reported ART adherence in six studies (OR 0.48, 95% CI 0.30-0.75) and lower odds of viral load suppression in seven studies (OR 0.64, 95% CI 0.46-0.90). Lack of longitudinal data and measurement considerations should temper interpretation of these results. CONCLUSION IPV is associated with lower ART use, half the odds of self-reported ART adherence and significantly worsened viral suppression among women. To ensure the health of HIV-positive women, it is essential for clinical programmes to address conditions that impact engagement in care and treatment. IPV is one such condition, and its association with declines in ART use and adherence requires urgent attention.
Collapse
|
23
|
Barroso J, Leserman J, Harmon JL, Hammill B, Pence BW. Fatigue in HIV-Infected People: A Three-Year Observational Study. J Pain Symptom Manage 2015; 50:69-79. [PMID: 25701691 PMCID: PMC4492863 DOI: 10.1016/j.jpainsymman.2015.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 12/18/2022]
Abstract
CONTEXT HIV-related fatigue remains the most frequent complaint of seropositive patients. OBJECTIVES To describe the natural course of fatigue in HIV infection, in a sample (n=128) followed for a three-year period. METHODS A longitudinal prospective design was used to determine what factors influenced changes in fatigue intensity and fatigue-related impairment of functioning in a community-dwelling sample of HIV-infected individuals. Participants were followed every six months for a three-year period. At each study visit, we collected data on a large number of physiological and psychosocial markers that have been shown to be related to fatigue in HIV-infected people. At three month intervals between study visits, we collected data on fatigue via mailed questionnaires. RESULTS Fatigue in HIV infection is largely a result of stressful life events, and is closely tied to the anxiety and depression that accompany such events. Fatigue did not remit spontaneously over the course of the study, indicating the need for interventions to ameliorate this debilitating symptom. CONCLUSION Intervening to help people who are suffering from HIV-related fatigue to deal with stressful life events may help to ameliorate this debilitating symptom.
Collapse
Affiliation(s)
- Julie Barroso
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.
| | - Jane Leserman
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James L Harmon
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Bradley Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian W Pence
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
24
|
Brownley JR, Fallot RD, Wolfson Berley R, Himelhoch SS. Trauma history in African-American women living with HIV: effects on psychiatric symptom severity and religious coping. AIDS Care 2015; 27:964-71. [PMID: 25742054 DOI: 10.1080/09540121.2015.1017441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Women living with HIV (WLHIV) have rates of post-traumatic stress disorder (PTSD) up to 5 times higher than the general population. Individuals living with HIV and a concurrent diagnosis of PTSD have poorer HIV-related outcomes; however, the prevalence and impact of PTSD on African-American WLHIV seeking mental health treatment is unknown. The aim of this study is to examine the associations between PTSD symptoms with psychiatric symptom severity and psychological/religious coping strategies in African-American WLHIV who are seeking mental health treatment. This is a cross-sectional study of 235 African-American WLHIV attending an urban community mental health clinic. Bivariate analyses were conducted to evaluate associations between a PTSD symptoms scale (PSS≥21 versus PSS<21) and (1) psychiatric severity, (2) coping strategies, and (3) religious coping strategies. Thirty-six percent reported symptoms consistent with PTSD (PSS≥21). These women were significantly more likely to have worse mental health symptoms and were more likely to employ negative psychological and religious coping strategies. On the contrary, women with a PSS<21 reported relatively low levels of mental health symptoms and were more likely to rely on positive psychological and religious coping strategies. Over one-third of African-American WLHIV attending an outpatient mental health clinic had symptoms associated with PTSD. These symptoms were associated with worse mental health symptoms and utilization of dysfunctional religious and nonreligious coping strategies. Untreated PTSD in WLHIV predicts poorer HIV-related health outcomes and may negatively impact comorbid mental health outcomes. Screening for PTSD in WLHIV could identify a subset that would benefit from evidence-based PTSD-specific therapies in addition to mental health interventions already in place. PTSD-specific interventions for WLHIV with PTSD may improve outcomes, improve coping strategies, and allow for more effective treatment of comorbid mental health disorders.
Collapse
Affiliation(s)
- Julie R Brownley
- a Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | | | | | | |
Collapse
|
25
|
The syndemic illness of HIV and trauma: implications for a trauma-informed model of care. PSYCHOSOMATICS 2014; 56:107-18. [PMID: 25597836 DOI: 10.1016/j.psym.2014.10.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND People living with HIV infection are disproportionately burdened by trauma and the resultant negative health consequences, making the combination of HIV infection and trauma a syndemic illness. Despite the high co-occurrence and negative influence on health, trauma and posttraumatic sequelae in people living with HIV infection often go unrecognized and untreated because of the current gaps in medical training and lack of practice guidelines. OBJECTIVE We set out to review the current literature on HIV infection and trauma and propose a trauma-informed model of care to target this syndemic illness. METHODS We searched PubMed, PsycINFO, and Cochrane review databases for articles that contained the following search terms: HIV AND either trauma (specifically violent trauma), PTSD, intimate partner violence (IPV), abuse, or trauma-informed care. Articles were limited to primary clinical research or metanalyses published in English. Articles were excluded if they referred to HIV-associated posttraumatic stress disorder or HIV-associated posttraumatic growth. RESULTS We confirm high, but variable, rates of trauma in people living with HIV infection demonstrated in multiple studies, ranging from 10%-90%. Trauma is associated with (1) increased HIV-risk behavior, contributing to transmission and acquisition of the virus; (2) negative internal and external mediators also associated with poor health and high-risk HIV behavior; (3) poor adherence to treatment; (4) poor HIV-related and other health outcomes; and (5) particularly vulnerable special populations. CONCLUSIONS Clinicians should consider using a model of trauma-informed care in the treatment of people living with HIV infection. Its adoption in different settings needs to be matched to available resources.
Collapse
|
26
|
Feldman MB, Betts DJ, Blausey D. Process and Outcome Evaluation of an Art Therapy Program for People Living With HIV/AIDS. ART THERAPY 2014. [DOI: 10.1080/07421656.2014.935593] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
27
|
Association between childhood physical abuse, unprotected receptive anal intercourse and HIV infection among young men who have sex with men in Vancouver, Canada. PLoS One 2014; 9:e100501. [PMID: 24963804 PMCID: PMC4070929 DOI: 10.1371/journal.pone.0100501] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/27/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in this population. Methods We explored the impact of child physical abuse (CPA) on HIV seroconversion in a cohort of gay/bisexual men aged 15 to 30 in Vancouver, Canada. Cox proportional hazard models were used, controlling for confounders. Results Among 287 participants, 211 (73.5%) reported experiencing CPA before the age of 17, and 42 (14.6%) reporting URAI in the past year. After a median of 6.6 years follow-up, 16 (5.8%) participants HIV-seroconverted. In multivariate analysis, CPA was significantly associated with HIV seroconversion (adjusted hazard ratio [AHR] = 4.89, 95% confidence interval (CI): 1.65–14.48), after controlling for potential confounders. Conclusion Our study uncovered a link between childhood physical violence and HIV incidence. Results highlight an urgent need for screening of young gay and bisexual men for histories of violence, and social and structural supports to prevent HIV transmission in this population.
Collapse
|
28
|
Scott-Sheldon LAJ, Walstrom P, Carey KB, Johnson BT, Carey MP. Alcohol use and sexual risk behaviors among individuals infected with HIV: a systematic review and meta-analysis 2012 to early 2013. Curr HIV/AIDS Rep 2014; 10:314-23. [PMID: 24078370 DOI: 10.1007/s11904-013-0177-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this meta-analytic study is to summarize the current science concerning the (a) prevalence of alcohol use, (b) prevalence of sexual risk behaviors, and (c) association between alcohol use and sexual risk behaviors among people livingwithHIV/AIDS (PLWHA). Studies were included if they sampled PLWHA, evaluated both alcohol use and sexual risk behavior (e.g., condom use, multiple partners), and were published between January 1, 2012, and April 1, 2013. Comprehensive electronic database searches located 728 published studies with relevant keywords; 17 studies (k =19 reports) were included. Findings indicate that a substantial proportion of PLWHA use alcohol and engage in sexual risk behaviors. Among PLWHA, alcohol use was significantly associated with unprotected sex (d +=0.23, 95 % CI=0.05, 0.40; k =5). Secondary prevention programs for PLWHA that address alcohol use in the context of sexual behavior are needed.
Collapse
|
29
|
Yiaslas TA, Kamen C, Arteaga A, Lee S, Briscoe-Smith A, Koopman C, Gore-Felton C. The relationship between sexual trauma, peritraumatic dissociation, posttraumatic stress disorder, and HIV-related health in HIV-positive men. J Trauma Dissociation 2014; 15:420-35. [PMID: 24354509 PMCID: PMC4119469 DOI: 10.1080/15299732.2013.873376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study tested a novel extension of P. P. Schnurr and B. L. Green's (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD-health relationship in HIV-positive individuals.
Collapse
|
30
|
Shittu R, Issa B, Olanrewaju G, Mahmoud A, Odeigah L, Sule A. Family dysfunction among depressed HIV/AIDS patients on HAART, in a secondary health institution, in north central Nigeria. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2014.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
31
|
Shittu RO, Issa BA, Olanrewaju GT, Mahmoud AO, Aderibigbe SA, Odeigah LO. A Comparison of Clinical Features of Depressed and Non-Depressed People Living with HIV/AIDS, in Nigeria, West Africa. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojmp.2014.31008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
32
|
Sloan EP. Retention in psychiatric treatment in a Canadian sample of HIV-positive women. AIDS Care 2013; 26:927-30. [DOI: 10.1080/09540121.2013.869538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
33
|
Pence BW, Whetten K, Shirey KG, Yao J, Thielman NM, Whetten R, Itemba D, Maro V. Factors associated with change in sexual transmission risk behavior over 3 years among HIV-infected patients in Tanzania. PLoS One 2013; 8:e82974. [PMID: 24367575 PMCID: PMC3867466 DOI: 10.1371/journal.pone.0082974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 11/07/2013] [Indexed: 02/06/2023] Open
Abstract
Background The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts. Methodology and Principal Findings The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6–13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11–21% at 6–36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex. Conclusions and Significance Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
Collapse
Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail: (BWP); (KW)
| | - Kathryn Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
- * E-mail: (BWP); (KW)
| | - Kristen G. Shirey
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jia Yao
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | - Nathan M. Thielman
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rachel Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | | | - Venance Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| |
Collapse
|
34
|
Zhang S, Senteio C, Felizzola J, Rust G. Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid enrollees, 2005-2007. Am J Public Health 2013; 103:e46-53. [PMID: 24134365 DOI: 10.2105/ajph.2013.301328] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined racial/ethnic differences in prenatal antiretroviral (ARV) treatment among 3259 HIV-infected pregnant Medicaid enrollees. METHODS We analyzed 2005-2007 Medicaid claims data from 14 southern states, comparing rates of not receiving ARVs and suboptimal versus optimal ARV therapy. RESULTS More than one third (37.3%) had zero claims for ARV drugs. Three quarters (73.4%) of 346 Hispanic women received no prenatal ARVs. After we adjusted for covariates, Hispanic women had 3.89 (95% confidence interval = 2.58, 5.87) times the risk of not receiving ARVs compared with Whites. Hispanic women often had only 1 or 2 months of Medicaid eligibility, perhaps associated with barriers for immigrants. Less than 3 months of eligibility was strongly associated with nontreatment (adjusted odds ratio = 29.0; 95% confidence interval = 13.4, 62.7). CONCLUSIONS Optimal HIV treatment rates in pregnancy are a public health priority, especially for preventing transmission to infants. Medicaid has the surveillance and drug coverage to ensure that all HIV-infected pregnant women are offered treatment. States that offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent HIV in children.
Collapse
Affiliation(s)
- Shun Zhang
- Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA. Charles Senteio is with the University of Michigan, School of Information, Ann Arbor. Jesus Felizzola is with the AIDS Education and Training Center, National Center for HIV Care in Minority Communities, HealthHIV, Washington, DC
| | | | | | | |
Collapse
|
35
|
Messer LC, Quinlivan EB, Parnell H, Roytburd K, Adimora AA, Bowditch N, DeSousa N. Barriers and facilitators to testing, treatment entry, and engagement in care by HIV-positive women of color. AIDS Patient Care STDS 2013; 27:398-407. [PMID: 23829330 PMCID: PMC3704120 DOI: 10.1089/apc.2012.0435] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development.
Collapse
Affiliation(s)
- Lynne C Messer
- School of Community Health, Portland State University, Portland, OR 97207, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Reif S, Proeschold-Bell RJ, Yao J, Legrand S, Uehara A, Asiimwe E, Quinlivan EB. Three types of self-efficacy associated with medication adherence in patients with co-occurring HIV and substance use disorders, but only when mood disorders are present. J Multidiscip Healthc 2013; 6:229-37. [PMID: 23836979 PMCID: PMC3699252 DOI: 10.2147/jmdh.s44204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adherence with medication regimens for human immunodeficiency virus (HIV) is a life-saving behavior for people with HIV infection, yet adherence is challenging for many individuals with co-occurring substance use and/or mood disorders. Medication-taking self-efficacy, which is the confidence that one can take one’s medication as prescribed, is associated with better adherence with HIV medication. However, little is known about the influence that other kinds of self-efficacy have on adherence with HIV medication, especially among HIV-infected individuals with co-occurring substance use and/or mood disorders. We sought to examine the relationship between adherence with HIV medication among substance users and three specific kinds of self-efficacy, ie, one’s confidence that one can communicate with medical providers, get support, and manage one’s mood. We further sought to examine whether symptoms of depression and anxiety moderate these relationships. Methods Patients were recruited from three HIV clinics in the southeastern United States as part of an integrated study of treatment for HIV and substance use. Results We interviewed 154 patients with HIV and substance use who reported taking HIV medications. Based on symptoms of depression and anxiety using the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale-Anxiety, 63% had probable depression and/or anxiety. Higher levels of self-efficacy in provider communication (β = 3.86, P < 0.01), getting needed support (β = 2.82, P < 0.01), and mood management (β = 2.29, P < 0.05) were related to better self-reported adherence with HIV medication among study participants with probable depression and/or anxiety. The three kinds of self-efficacy were not associated with medication adherence among participants with HIV and substance use only. Conclusion In the search for mutable factors to improve medication adherence among individuals triply diagnosed with HIV, substance use, and mood disorders, these findings support previous research indicating the benefit of enhancing self-efficacy, and further point to three specific kinds of self-efficacy that may benefit medication adherence, ie, provider communication, getting support, and mood management.
Collapse
Affiliation(s)
- Susan Reif
- Duke Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Wright PB, Curran GM, Stewart KE, Booth BM. A qualitative analysis of provider barriers and solutions to HIV testing for substance users in a small, largely rural southern state. J Rural Health 2013; 29:420-31. [PMID: 24088216 DOI: 10.1111/jrh.12021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Integrating HIV testing programs into substance use treatment is a promising avenue to help increase access to HIV testing for rural drug users. Yet few outpatient substance abuse treatment facilities in the United States provide HIV testing. The purpose of this study was to identify barriers to incorporating HIV testing with substance use treatment from the perspectives of treatment and testing providers in Arkansas. METHODS We used purposive sampling from state directories to recruit providers at state, organization, and individual levels to participate in this exploratory study. Using an interview guide, the first and second authors conducted semistructured individual interviews in each provider's office or by telephone. All interviews were recorded, transcribed verbatim, and entered into ATLAS.ti software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). We used constant comparison and content analysis techniques to identify codes, categories, and primary patterns in the data. FINDINGS The sample consisted of 28 providers throughout the state, 18 from the substance use system and 10 from the public/ community health system. We identified 7 categories of barriers: environmental constraints, policy constraints, funding constraints, organizational structure, limited inter- and intra-agency communication, burden of responsibility, and client fragility. CONCLUSIONS This study presents the practice-based realities of barriers to integrating HIV testing with substance use treatment in a small, largely rural state. Some system and/or organization leaders were either unaware of or not actively pursuing external funds available to them specifically for engaging substance users in HIV testing. However, funding does not address the system-level need for coordination of resources and services at the state level.
Collapse
Affiliation(s)
- Patricia B Wright
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | | |
Collapse
|
38
|
Wilson E, Tanzosh T, Maldarelli F. HIV diagnosis and testing: what every healthcare professional can do (and why they should). Oral Dis 2013; 19:431-9. [PMID: 23347510 DOI: 10.1111/odi.12047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 11/27/2022]
Abstract
Over the last thirty years, the human immunodeficiency virus (HIV) epidemic has matured. In the United States, HIV has changed from an explosive outbreak to an endemic disease; currently, an estimated 1.1 million people are infected with HIV, including a substantial number who are unaware of their status. With recent findings demonstrating the high transmissibility of HIV early in infection, and the potential benefit of early initiation of treatment, it is essential to identify as many infected individuals as possible. The Centers for Disease Control and Prevention (CDC) has expanded HIV testing to include any healthcare setting, including dental offices. Testing advances, including oral testing, have reduced the window period of HIV infection. Dental care represents a key, reliable, independent, and confidential link between the healthcare system and the general population that has been under-utilized in the effort to control the HIV epidemic. HIV testing is straightforward, and knowledge of the types of testing will afford dentists an important opportunity to help advance and preserve the health of their patients and to promote the public health of their community. Here, we review the basics of HIV testing and discuss new changes in the approach to HIV diagnostics.
Collapse
Affiliation(s)
- E Wilson
- HIV Drug Resistance Program, NCI, NIH, Bethesda, MD, USA
| | | | | |
Collapse
|
39
|
Ironson G, O'Cleirigh C, Leserman J, Stuetzle R, Fordiani J, Fletcher M, Schneiderman N. Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial. J Consult Clin Psychol 2012; 81:284-98. [PMID: 23244367 DOI: 10.1037/a0030814] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression. METHOD HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up. RESULTS Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline. CONCLUSIONS A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men.
Collapse
Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, FL 33146, USA.
| | | | | | | | | | | | | |
Collapse
|
40
|
Gaskins SW, Payne Foster P, Sowell RL, Lewis TL, Gardner A, Parton JM. Making decisions: the process of HIV disclosure for rural African American men. Am J Mens Health 2012; 6:442-52. [PMID: 22406765 DOI: 10.1177/1557988312439405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
The purpose of this study was to identify and describe the process of HIV disclosure for rural African American men-a population disproportionately affected by HIV/AIDS. Forty men were interviewed about their experience of making an HIV disclosure. Grounded theory methodology guided data collection and analysis. The core category or variable that emerged from the data was a process-Making Decisions: The Process of HIV Disclosure. Five categories accounted for variations in disclosures: (a) beliefs and knowledge about HIV/AIDS, (b) influencing factors, (c) disclosure decisions, (d) disclosure efficacy, and (e) outcomes of disclosure. Most of the men had disclosed to others; however, the disclosures were selective, and the decisions were iterative. The majority of the men did not disclose their diagnosis for several months to several years. The findings provide a framework of the many factors related to HIV disclosure that can guide health care providers in counseling persons living with HIV/AIDS in making disclosure decisions.
Collapse
|
41
|
Abstract
Women bear an increasing burden of the HIV epidemic and face high rates of morbidity and mortality. Trauma has been increasingly associated with the high prevalence and poor outcomes of HIV in this population. This meta-analysis estimates rates of psychological trauma and posttraumatic stress disorder (PTSD) in HIV-positive women from the United States. We reviewed 9,552 articles, of which 29 met our inclusion criteria, resulting in a sample of 5,930 individuals. The findings demonstrate highly disproportionate rates of trauma exposure and recent PTSD in HIV-positive women compared to the general population of women. For example, the estimated rate of recent PTSD among HIV-positive women is 30.0% (95% CI 18.8-42.7%), which is over five-times the rate of recent PTSD reported in a national sample of women. The estimated rate of intimate partner violence is 55.3% (95% CI 36.1-73.8%), which is more than twice the national rate. Studies of trauma-prevention and trauma-recovery interventions in this population are greatly needed.
Collapse
|
42
|
Reif SS, Pence BW, LeGrand S, Wilson ES, Swartz M, Ellington T, Whetten K. In-home mental health treatment for individuals with HIV. AIDS Patient Care STDS 2012; 26:655-61. [PMID: 23050767 PMCID: PMC3495109 DOI: 10.1089/apc.2012.0242] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mental health problems are highly prevalent among individuals with HIV and are consistently associated with negative health outcomes. However, mental illness often remains untreated due to significant psychosocial and physical barriers to treatment participation. The Collaborative HIV/AIDS Mental Health Program (CHAMP) assessed the outcomes associated with providing 9 months of in-home mental health counseling for 40 individuals with HIV and a Major Axis I mental disorder. The evidence-based Illness Management and Recovery Model was adapted for use with HIV-positive individuals for the study using a community-based participatory research approach. Study participants were surveyed at baseline, 5 and 9 months to assess for changes in health outcomes. Thirty-five percent of study participants were female, 80% African American, 33% self-identified as MSM and the average participant age was 43. Forty percent of participants were on psychotropic medication at baseline. Participants had an average of 8 counseling visits (median 9). Statistically significant decreases in the global Brief Symptom Inventory (BSI) score and a number of BSI symptoms dimensions including anxiety, depression, obsessive compulsive, phobic anxiety and hostility were detected, indicating a reduction of psychiatric symptoms. Statistically significant improvement was also identified for the SF-12 mental health scale, adaptive coping, overall social support and emotional support. No differences in psychiatric outcomes were identified by gender, race/ethnicity, or sexual preference. Findings from the CHAMP Study suggest that the use of in-home mental health treatment may be beneficial in engaging and treating HIV-positive individuals with comorbid mental health disorders.
Collapse
Affiliation(s)
- Susan S Reif
- Center for Health Policy and Inequalities Research, Duke University, Charlotte, North Carolina 28207, USA.
| | | | | | | | | | | | | |
Collapse
|
43
|
Whetten K, Reif S, Toth M, Jain E, Leserman J, Pence BW. Relationship between trauma and high-risk behavior among HIV-positive men who do not have sex with men (MDSM). AIDS Care 2012; 24:1453-60. [PMID: 22909318 DOI: 10.1080/09540121.2012.712665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The incidence of heterosexual HIV transmission continues to increase in the USA. However, little is known about factors that influence high-risk behavior among men who do not have sex with men (MDSM). This study examines the association of childhood sexual abuse and high-risk behaviors among MDSM. The Coping with HIV/AIDS in the Southeast (CHASE) study included 611 HIV-positive individuals in the Southeastern US Bivariate statistics were used to examine the influence of childhood sexual abuse among MDSM, men who have sex with men (MSM), and women. Study findings indicated that among MDSM with HIV, childhood sexual abuse predicted a higher number of sexual partners, alcohol and drug use problems, depression, post-traumatic stress disorder (PTSD), and less trust in medical providers. Similar statistically significant relationships between childhood sexual abuse and negative outcomes were not found for MSM and women with the exception of childhood sexual abuse predicting PTSD and alcohol use in women. Study findings indicate a need for more in-depth research to examine the role of childhood sexual abuse in shaping adult risk behaviors among MDSM as well as a need to assess for and address childhood sexual abuse in this population.
Collapse
Affiliation(s)
- Kathryn Whetten
- Center for Health Policy and Inequalities Research (CHPIR) , Duke Global Health Institute (DGHI), Sanford Institute of Public Policy, Duke University, Durham, NC, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Spies G, Afifi TO, Archibald SL, Fennema-Notestine C, Sareen J, Seedat S. Mental health outcomes in HIV and childhood maltreatment: a systematic review. Syst Rev 2012; 1:30. [PMID: 22742536 PMCID: PMC3441909 DOI: 10.1186/2046-4053-1-30] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/16/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND High rates of childhood maltreatment have been documented in HIV-positive men and women. In addition, mental disorders are highly prevalent in both HIV-infected individuals and victims of childhood maltreatment. However, there is a paucity of research investigating the mental health outcomes associated with childhood maltreatment in the context of HIV infection. The present systematic review assessed mental health outcomes in HIV-positive individuals who were victims of childhood maltreatment. METHODS A systematic search of all retrospective, prospective, or clinical trial studies assessing mental health outcomes associated with HIV and childhood maltreatment. The following online databases were searched on 25-31 August 2010: PubMed, Social Science Citation Index, and the Cochrane Library (the Cochrane Central Register of Controlled Trials and the Cochrane Developmental, Psychosocial and Learning Problems, HIV/AIDS, and Depression, Anxiety and Neurosis registers). RESULTS We identified 34 studies suitable for inclusion. A total of 14,935 participants were included in these studies. A variety of mixed mental health outcomes were reported. The most commonly reported psychiatric disorders among HIV-positive individuals with a history of childhood maltreatment included: substance abuse, major depressive disorder, and posttraumatic stress disorder. An association between childhood maltreatment and poor adherence to antiretroviral regimens was also reported in some studies. CONCLUSION A broad range of adult psychopathology has been reported in studies of HIV-infected individuals with a history of childhood maltreatment. However, a direct causal link cannot be well established. Longer term assessment will better delineate the nature, severity, and temporal relationship of childhood maltreatment to mental health outcomes.
Collapse
Affiliation(s)
- Georgina Spies
- South African Research Chairs Initiative (SARChI), PTSD program, Francie van Zijl Drive, Department of Psychiatry, University of Stellenbosch, Cape Town, 7505, South Africa
| | | | | | | | | | | |
Collapse
|
45
|
Prevalence of psychological trauma and association with current health and functioning in a sample of HIV-infected and HIV-uninfected Tanzanian adults. PLoS One 2012; 7:e36304. [PMID: 22606252 PMCID: PMC3351441 DOI: 10.1371/journal.pone.0036304] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 04/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In high income nations, traumatic life experiences such as childhood sexual abuse are much more common in people living with HIV/AIDS (PLWHA) than the general population, and trauma is associated with worse current health and functioning. Virtually no data exist on the prevalence or consequences of trauma for PLWHA in low income nations. METHODOLOGY/PRINCIPAL FINDINGS We recruited four cohorts of Tanzanian patients in established medical care for HIV infection (n = 228), individuals newly testing positive for HIV (n = 267), individuals testing negative for HIV at the same sites (n = 182), and a random sample of community-dwelling adults (n = 249). We assessed lifetime prevalence of traumatic experiences, recent stressful life events, and current mental health and health-related physical functioning. Those with established HIV infection reported a greater number of childhood and lifetime traumatic experiences (2.1 and 3.0 respectively) than the community cohort (1.8 and 2.3). Those with established HIV infection reported greater post-traumatic stress disorder (PTSD) symptomatology and worse current health-related physical functioning. Each additional lifetime traumatic experience was associated with increased PTSD symptomatology and worse functioning. CONCLUSIONS/SIGNIFICANCE This study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
Collapse
|
46
|
Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr 2012; 59:409-16. [PMID: 22107822 DOI: 10.1097/qai.0b013e31824150bb] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Traumatic life histories are highly prevalent in people living with HIV/AIDS and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics. METHODS In 611 outpatient people living with HIV/AIDS, we tested whether trauma's influence on later health and behaviors was mediated by coping styles, self-efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse. RESULTS In models adjusting only for sociodemographic and transmission category confounders (estimating total effects), pasttrauma exposure was associated with 7 behavioral and health outcomes including increased odds or hazard of recent unprotected sex [odds ratio (OR) = 1.17 per each additional type of trauma, 95% confidence interval = 1.07 to 1.29], medication nonadherence (OR = 1.13, 1.02 to 1.25), hospitalizations (hazard ratio = 1.12, 1.04 to 1.22), and HIV disease progression (hazard ratio = 1.10, 0.98 to 1.23). When all hypothesized mediators were included, the associations of trauma with health care utilization outcomes were reduced by about 50%, suggesting partial mediation (eg, OR for hospitalization changed from 1.12 to 1.07), whereas point estimates for behavioral and incident health outcomes remained largely unchanged, suggesting no mediation (eg, OR for unprotected sex changed from 1.17 to 1.18). Trauma remained associated with most outcomes even after adjusting for all hypothesized psychosocial mediators. CONCLUSIONS These data suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.
Collapse
|
47
|
Nightingale VR, Sher TG, Mattson M, Thilges S, Hansen NB. The effects of traumatic stressors and HIV-related trauma symptoms on health and health related quality of life. AIDS Behav 2011; 15:1870-8. [PMID: 21667297 DOI: 10.1007/s10461-011-9980-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study identified relations among traumatic stressors, HIV-related trauma symptoms, comorbid medical conditions, and health related quality of life (HRQL) in individuals with HIV. Participants (N = 118) completed a structured clinical interview on HIV as a traumatic stressor and other severe traumatic stressors and completed the Impact of Event Scale to assess HIV-related trauma symptoms and the Medical Outcomes Study 36-item Short Form (SF-36) to assess HRQL. Medical chart reviews determined comorbid conditions. Path analysis findings indicated participants with prior severe traumatic stressors experienced their HIV diagnosis as traumatic and in turn were more likely to have current HIV-related trauma symptoms which were negatively related to HRQL. HIV as a traumatic stressor was related to coronary artery diseases and HRQL. Traumatic stressors and HIV-related trauma symptoms impact health in individuals with HIV and highlight the need for psychological interventions prior to diagnosis and throughout treatment.
Collapse
Affiliation(s)
- Vienna R Nightingale
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06510, USA.
| | | | | | | | | |
Collapse
|
48
|
Kemppainen JK, Wantland D, Voss J, Nicholas P, Kirksey KM, Corless IB, Willard S, Holzemer WL, Robinson L, Hamilton MJ, Sefcik E, Eller LS, Huang E, Arudo J, Moezzi S, Rivero-Mendez M, Rosa M, Human S, Cuca Y, Lindgren T, Portillo CJ, Maryland M. Self-care behaviors and activities for managing HIV-related anxiety. J Assoc Nurses AIDS Care 2011; 23:111-23. [PMID: 21839652 DOI: 10.1016/j.jana.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/13/2011] [Indexed: 11/25/2022]
Abstract
The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.
Collapse
|
49
|
Soller M, Kharrazi N, Prentiss D, Cummings S, Balmas G, Koopman C, Israelski D. Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity. AIDS Care 2011; 23:1351-9. [PMID: 21767117 DOI: 10.1080/09540121.2011.565024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. METHODS Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. RESULTS Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. DISCUSSION While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.
Collapse
Affiliation(s)
- Marie Soller
- San Mateo County Behavioral Health and Recovery Services, Psychiatry Residency, San Mateo, CA, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Menezes P, Eron JJ, Leone PA, Adimora AA, Wohl DA, Miller WC. Recruitment of HIV/AIDS treatment-naïve patients to clinical trials in the highly active antiretroviral therapy era: influence of gender, sexual orientation and race. HIV Med 2011; 12:183-91. [PMID: 20807254 PMCID: PMC2998588 DOI: 10.1111/j.1468-1293.2010.00867.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the USA, women, racial/ethnic minorities and persons who acquire HIV infection through heterosexual intercourse represent an increasing proportion of HIV-infected persons, and yet are frequently underrepresented in clinical trials. We assessed the demographic predictors of trial participation in antiretroviral-naïve patients. METHODS Patients were characterized as trial participants if highly active antiretroviral therapy (HAART) was initiated within a clinical trial. Prevalence ratios (PRs) were obtained using binomial regression. RESULTS Between 1996 and 2006, 30% of 738 treatment-naïve patients initiated HAART in a clinical trial. Trial participation rates for men who have sex with men (MSM), heterosexual men, and women were respectively 36.5, 29.6 and 24.3%. After adjustment for other factors, heterosexual men appeared less likely to participate in trials compared with MSM [PR 0.79, 95% confidence interval (CI) 0.57, 1.11], while women were as likely to participate as MSM (PR 0.97, 95% CI 0.68, 1.39). The participation rate in Black patients (25.9%) was lower compared with non-Black patients (37.5%) (adjusted PR 0.80, 95% CI 0.60, 1.06). CONCLUSIONS In our clinical setting, gender did not appear to impact participation in HIV treatment trials, but Black patients were slightly less likely to participate in these trials. Considering the substantial proportion of HIV-infected patients who are Black, future trials need to consider strategies to incorporate such underrepresented populations.
Collapse
Affiliation(s)
- P Menezes
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | |
Collapse
|