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Kerr J, Yigit I, Long DM, Paulino-Ramírez R, Waters J, Hao J, Nyblade L, Varas-Díaz N, Naar S, Bond CL, Budhwani H, Turan JM. HIV and intersectional stigma among people living with HIV and healthcare workers and antiretroviral therapy adherence in the Dominican Republic. Int J STD AIDS 2024:9564624241259801. [PMID: 39037457 DOI: 10.1177/09564624241259801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND HIV-related stigma, discrimination, and social marginalization undermines optimal HIV care outcomes. More research examining the impact of HIV-related stigma, discrimination, other interlocking forms of oppression, and antiretroviral therapy (ART) adherence is needed to optimize HIV treatment programming. This study uses data from two clinics in the Dominican Republic to examine client and healthcare worker (HCW) perceptions of HIV and intersectional stigmas among people living with HIV. METHODS Surveys exploring demographics, HIV-related stigma, various dimensions of discrimination (race/ethnicity, HIV status, sexual orientation), healthcare engagement, and medication adherence were collected from 148 clients and 131 HCWs. Analysis of variance was conducted to examine differences in stigma by clinic and logistic regressions were used to determine predictors of optimal client medication adherence. RESULTS Perceived discrimination in healthcare facilities due to clients' sexual orientation retained significance in crude and multivariable logistic regression models and was negatively associated with ART adherence (aOR:0.79; 95% CI:0.66, 0.95). DISCUSSION Findings highlight the importance of implementing strategies to address stigma, discrimination, and social marginalization, particularly within healthcare facilities.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Ibrahim Yigit
- Institute on Digital Health and Innovation, Florida State University, Tallahassee, FL, USA
| | - Dustin M Long
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical and Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
| | - Jiaying Hao
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Nyblade
- Center for Health Behavior and Implementation Science, Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Nelson Varas-Díaz
- Department of Global and Sociocultural Studies, Florida International University, Miami, FL, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA
| | - Christyenne L Bond
- Institute on Digital Health and Innovation, Florida State University, Tallahassee, FL, USA
| | - Henna Budhwani
- Institute on Digital Health and Innovation, Florida State University, Tallahassee, FL, USA
| | - Janet M Turan
- School of Medicine, Koç University, Istanbul, Turkey
- Department of Health Policy and Organization, University of Alabama at Birmingham, Birmingham, AL, USA
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Nguyen MX, Li C, Muessig K, Gaynes BN, Go VF. A Systematic Review of Interventions for Young Men Who Have Sex With Men and Young Transgender Women Living with HIV. AIDS Behav 2024; 28:1485-1511. [PMID: 37768429 DOI: 10.1007/s10461-023-04166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Young men who have sex with men (YMSM) and young transgender women (YTGW) have unique challenges to HIV care. We conducted a systematic review to summarize behavioral and structural interventions exclusively targeting YMSM and YTGW living with HIV. We screened 6546 records published through August 19th, 2022 from six databases. For eligibility, studies needed to involve structural or behavioral interventions exclusively targeting YMSM and/or YTGW living with HIV or presenting disaggregated data in this group. Quality assessment was performed using the ICROMS checklist. Twenty studies from 18 interventions were included in the review. There was considerable heterogeneity in intervention characteristics, including population, location, content and format of the interventions and targeted outcomes. Half of the interventions were described as pilot studies, and all but one study was conducted in the United States. The most common outcomes included the HIV care continuum, followed by HIV knowledge and self-efficacy, HIV-risk behaviors and mental health. The evidence base remained sparse, and the results on effectiveness were inconsistent, with some interventions reporting improved outcomes among participants after receiving treatment and others not reporting any meaningful changes. Although there has been some progress in the development of interventions targeting this group, we highlighted several directions for future research. Interventions expanding to low-resource settings, addressing structural barriers, and targeting different aspects of health among participants are warranted. Rigorous studies with larger sample sizes that follow participants over longer periods are necessary to increase the strength of the evidence.
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Affiliation(s)
- Minh X Nguyen
- Department of Epidemiology, Hanoi Medical University, Room 411, Building A7, 1 Ton That Tung, Dong Da, Hanoi, Vietnam.
| | - Chunyan Li
- Tokyo College, The University of Tokyo, Tokyo, Japan
| | - Kate Muessig
- College of Nursing, Florida States University, Tallahassee, FL, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 PMCID: PMC11194036 DOI: 10.1080/10826084.2024.2330906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L. Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Lee JJ, Chepkorir J, Alharthi A, Adeleye KK, Warren NE. Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01945-x. [PMID: 38416293 DOI: 10.1007/s40615-024-01945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.
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Affiliation(s)
- Jennifer J Lee
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | | | - Abeer Alharthi
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Khadijat K Adeleye
- University of Massachusetts Amherst College of Nursing, Amherst, MA, USA
| | - Nicole E Warren
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Bromberg DJ, Machavariani E, Madden LM, Dumchev K, LaMonaca K, Earnshaw VA, Pykalo I, Filippovych M, Haddad MS, Dvoriak S, Altice FL. Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge. J Int AIDS Soc 2024; 27:e26202. [PMID: 38379179 PMCID: PMC10879646 DOI: 10.1002/jia2.26202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma has undermined the scale-up of evidence-based HIV prevention and treatment. Negative beliefs influence clinicians' discriminatory behaviour and ultimately have wide-ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced. METHODS In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence-based care. Nested linear mixed-effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians. RESULTS There were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough-minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID. CONCLUSIONS Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re-engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.
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Affiliation(s)
- Daniel J. Bromberg
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | | | - Lynn M. Madden
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- APT FoundationNew HavenConnecticutUSA
| | | | | | | | - Iryna Pykalo
- Ukrainian Institute on Public Health PolicyKyivUkraine
| | | | - Marwan S. Haddad
- Center for Key Populations, Community Health Center, Inc.MiddletownConnecticutUSA
| | | | - Frederick L. Altice
- Yale School of Public Health, Yale UniversityNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDS, Yale UniversityNew HavenConnecticutUSA
- Yale School of Medicine, Yale UniversityNew HavenConnecticutUSA
- University of DelawareNewarkDelawareUSA
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Annor F, Nartey YA, Abbew ET, Cudjoe O, Ayisi-Addo S, Ashinyo A, Obiri-Yeboah D. Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review. Int J STD AIDS 2024; 35:80-95. [PMID: 37793133 DOI: 10.1177/09564624231205335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population. METHODS We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework. RESULTS HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care. CONCLUSIONS The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.
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Affiliation(s)
- Francis Annor
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Yvonne Ayerki Nartey
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Tabitha Abbew
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Obed Cudjoe
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ayisi-Addo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Anthony Ashinyo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Cummins B, Johnson K, Schneider JA, Del Vecchio N, Moshiri N, Wertheim JO, Goyal R, Skaathun B. Leveraging social networks for identification of people with HIV who are virally unsuppressed. AIDS 2024; 38:245-254. [PMID: 37890471 PMCID: PMC10843229 DOI: 10.1097/qad.0000000000003767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES This study investigates primary peer-referral engagement (PRE) strategies to assess which strategy results in engaging higher numbers of people with HIV (PWH) who are virally unsuppressed. DESIGN We develop a modeling study that simulates an HIV epidemic (transmission, disease progression, and viral evolution) over 6 years using an agent-based model followed by simulating PRE strategies. We investigate two PRE strategies where referrals are based on social network strategies (SNS) or sexual partner contact tracing (SPCT). METHODS We parameterize, calibrate, and validate our study using data from Chicago on Black sexual minority men to assess these strategies for a population with high incidence and prevalence of HIV. For each strategy, we calculate the number of PWH recruited who are undiagnosed or out-of-care (OoC) and the number of direct or indirect transmissions. RESULTS SNS and SPCT identified 256.5 [95% confidence interval (CI) 234-279] and 15 (95% CI 7-27) PWH, respectively. Of these, SNS identified 159 (95% CI 142-177) PWH OoC and 32 (95% CI 21-43) PWH undiagnosed compared with 9 (95% CI 3-18) and 2 (95% CI 0-5) for SPCT. SNS identified 15.5 (95% CI 6-25) and 7.5 (95% CI 2-11) indirect and direct transmission pairs, whereas SPCT identified 6 (95% CI 0-8) and 5 (95% CI 0-8), respectively. CONCLUSION With no testing constraints, SNS is the more effective strategy to identify undiagnosed and OoC PWH. Neither strategy is successful at identifying sufficient indirect or direct transmission pairs to investigate transmission networks.
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Affiliation(s)
- Breschine Cummins
- Department of Mathematical Sciences, Montana State University, Bozeman, MT
| | - Kara Johnson
- Department of Mathematical Sciences, Montana State University, Bozeman, MT
| | - John A. Schneider
- Department of Medicine, University of Chicago
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | | | | | - Joel O. Wertheim
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Ramírez-Ortiz D, Fernandez SB, Jean-Gilles M, Flores A, Santander TG, Dawit R, Ibarra C, Ward MK, Brock P, Ladner R, Devieux J, Trepka MJ. Barriers and facilitators to retention in care and treatment adherence among racially/ethnically diverse women with HIV in South Florida: a qualitative study. Women Health 2023; 63:562-576. [PMID: 37482891 PMCID: PMC10403283 DOI: 10.1080/03630242.2023.2238848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
Women, particularly those from racial/ethnic minority groups, experience disparities in HIV care and treatment, and in achieving viral suppression. This study identified barriers and facilitators influencing retention in HIV care and treatment adherence among women belonging to racial/ethnic minority groups. We conducted semi-structured interviews with 74 African American, Hispanic/Latina and Haitian cisgender women receiving care from the Ryan White HIV/AIDS Program in Miami-Dade County, Florida in 2019. Data were analyzed using a thematic analysis approach. The most salient barriers faced by women were competing life priorities, mental health and substance use issues, medication-related concerns and treatment burden, negative experiences with HIV care services, transportation and parking issues and stigma and discrimination. Important facilitators identified by women included taking personal responsibility for health, social support, and patient-friendly and supportive HIV care services. Our findings suggest that HIV care could be enhanced for this population by understanding the non-HIV needs of the women in care, provide more flexible and relevant services in response to the totality of these needs, and simplify and expand access to care and supportive services.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- FIU Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia B. Fernandez
- FIU Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Florida International University, Miami, Florida, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Annette Flores
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | | | - Rahel Dawit
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Melissa K. Ward
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- FIU Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | | | - Robert Ladner
- Behavioral Science Research Corporation, Miami, Florida, USA
| | - Jessy Devieux
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, Miami, Florida, USA
- FIU Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Hale AJ, Mathur S, Dejace J, Lidofsky SD. Statewide Assessment of the Hepatitis C Virus Care Cascade for Incarcerated Persons in Vermont. Public Health Rep 2023; 138:265-272. [PMID: 35264027 PMCID: PMC10031835 DOI: 10.1177/00333549221077070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Incarcerated persons in the United States have a high burden of hepatitis C virus (HCV) infection. This study assessed the impact of a statewide effort in Vermont to treat HCV in this group. METHODS We performed a retrospective, observational cohort study of all HCV-infected persons who were imprisoned in Vermont during the 19-month study period (December 2018-June 2020). The cascade of care comprised opt-out HCV screening, full access to direct-acting antiviral treatment (without hepatic fibrosis-based treatment restrictions), HCV specialist involvement, and medication-assisted treatment for patients with opioid use disorder. The primary outcome was sustained virologic response at 12 weeks after treatment completion (SVR12). RESULTS The study included 217 HCV-infected patients; the median age was 35 years (range, 18-73 years), 89% were male, 76% had opioid use disorder, 67% had a psychiatric comorbidity, and 9% had cirrhosis. Of the 217 patients, 98% had a liver fibrosis assessment, 59% started direct-acting antiviral treatment, 55% completed direct-acting antiviral treatment, and 51% achieved documented SVR12. Of the 129 HCV-infected persons who started direct-acting antiviral treatment, 92% completed therapy and 86% achieved documented SVR12. Psychiatric comorbidity was not significantly associated with achieving SVR12 (odds ratio = 0.67; 95% CI, 0.27-1.65; P = .38), nor was receiving medication-assisted treatment for patients with opioid use disorder (odds ratio = 1.45; 95% CI, 0.62-2.56; P = .45). CONCLUSIONS This study reports the highest SVR12 rate achieved in a state incarcerated population to date. HCV treatment in incarcerated populations is a practical and efficacious strategy that should serve a foundational role in HCV elimination.
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Affiliation(s)
- Andrew J. Hale
- University of Vermont Medical Center,
Burlington, VT, USA
- Larner College of Medicine, University
of Vermont, Burlington, VT, USA
| | - Shivani Mathur
- Larner College of Medicine, University
of Vermont, Burlington, VT, USA
| | - Jean Dejace
- University of Vermont Medical Center,
Burlington, VT, USA
- Larner College of Medicine, University
of Vermont, Burlington, VT, USA
| | - Steven D. Lidofsky
- University of Vermont Medical Center,
Burlington, VT, USA
- Larner College of Medicine, University
of Vermont, Burlington, VT, USA
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Frola CE, Aristegui I, Figueroa MI, Radusky PD, Cardozo N, Zalazar V, Cesar C, Patterson P, Fink V, Gun A, Cahn P, Sued O. Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study. PLoS One 2023; 18:e0279996. [PMID: 36662723 PMCID: PMC9858466 DOI: 10.1371/journal.pone.0279996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023] Open
Abstract
In Argentina, transgender women (TGW) have a high HIV prevalence (34%). However, this population shows lower levels of adherence, retention in HIV care and viral suppression than cisgender patients. The World Health Organization (WHO) recommends the transition to dolutegravir (DTG)-based regimens to reduce adverse events and improve adherence and retention. The purpose of this study was to determine retention, adherence and viral suppression in naïve TGW starting a DTG-based first-line antiretroviral treatment (ART) and to identify clinical and psychosocial factors associated with retention. We designed a prospective, open-label, single-arm trial among ART-naïve HIV positive TGW (Clinical Trial Number: NCT03033836). Participants were followed at weeks 4, 8, 12, 24, 36 and 48, in a trans-affirmative HIV care service that included peer navigators, between December, 2015 and May, 2019. Retention was defined as the proportion of TGW retained at week 48 and adherence was self-reported. Viral suppression at <50 copies/mL was evaluated using snapshot algorithm and as per protocol analysis. Of 75 TGW screened, 61 were enrolled. At baseline, median age was 28 y/o., HIV-1-RNA (pVL) 46,908 copies/mL and CD4+ T-cell count 383 cells/mm3. At week 48, 77% were retained and 72% had viral suppression (97% per protocol). The regimen was well tolerated and participants reported high adherence (about 95%). Eleven of the fourteen TGW who discontinued or were lost to follow-up had undetectable pVL at their last visit. Older age was associated with better retention. DTG-based treatment delivered by a trans-competent team in a trans-affirmative service was safe and well tolerated by TGW and associated with high retention, high adherence and high viral suppression at 48 weeks among those being retained.
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Affiliation(s)
- Claudia E. Frola
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Division of Infectious Diseases, Juan A. Fernández Hospital, Buenos Aires, Argentina
| | - Inés Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
| | | | - Pablo D. Radusky
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nadir Cardozo
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | | | - Carina Cesar
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | - Valeria Fink
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Ana Gun
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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Carey JW, Roland KB, Bessler PA, Tesfaye C, Randall LA, Frew PM. Overcoming Challenges to HIV Medical Care-seeking and Treatment Among Data-to-Care Program Clients in Baton Rouge and New Orleans, Louisiana. J Assoc Nurses AIDS Care 2023; 34:71-82. [PMID: 36524875 PMCID: PMC10988392 DOI: 10.1097/jnc.0000000000000375] [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] [Indexed: 12/23/2022]
Abstract
ABSTRACT Data to Care (D2C) uses US public health surveillance data to identify persons with diagnosed HIV who are not receiving adequate medical care. These persons are linked to care and ancillary social services through personalized outreach. We conducted semistructured interviews with 36 adults with HIV in Louisiana who were engaged for the first time or reengaged back into HIV care through D2C efforts. Before D2C program staff contact, nearly 40% were not contemplating HIV care. Program clients cited barriers to HIV care, including difficulties with appointment scheduling and transportation, health care service and drug costs, low motivation, and competing non-HIV health needs. Thirty-four of the 36 clients said that D2C staff helped them overcome these barriers. Clients also described psychosocial support from D2C staff. After receiving D2C program assistance, more than 90% of clients reported consistently receiving HIV medical care and taking medications. Our findings suggest that D2C staff successfully identified client needs and provided tailored assistance.
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Affiliation(s)
- James W. Carey
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention
| | | | | | - Casey Tesfaye
- Research Support Services, Incorporated, Evanston, Illinois
| | - Laura A. Randall
- Emory University, Atlanta, GA, and Merck and Co., Incorporated, Kenilworth, NJ
| | - Paula M. Frew
- Emory University, Atlanta, GA, and Merck and Co., Incorporated, Kenilworth, NJ
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12
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Grieb SM, Harris R, Rosecrans A, Zook K, Sherman SG, Greenbaum A, Lucas GM, Page KR. Awareness, perception and utilization of a mobile health clinic by people who use drugs. Ann Med 2022; 54:138-149. [PMID: 36799361 PMCID: PMC8741230 DOI: 10.1080/07853890.2021.2022188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION People who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs. METHODS Semi-structured interviews were conducted with 31 PWUD - 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) - to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory. RESULTS Clients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients. DISCUSSION MHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.KEY MESSAGESPeople who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.
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Affiliation(s)
- Suzanne M Grieb
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Harris
- Baltimore City Health Department, Baltimore, MD, USA
| | - Amanda Rosecrans
- Baltimore City Health Department, Baltimore, MD, USA.,Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Zook
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen R Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Leite BO, Magno L, Soares F, MacCarthy S, Brignol S, Bastos FI, Dourado I. HIV prevalence among transgender women in Northeast Brazil – Findings from two Respondent Driven Sampling studies. BMC Public Health 2022; 22:2120. [DOI: 10.1186/s12889-022-14589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
The HIV epidemic still high among key-populations in Brazil, especially among transgender women (TGW). The aim of this study was to investigate the prevalence of HIV infection among TGW and to analyze factors associated with HIV seropositivity across two cross-sectional surveys conducted in Salvador, Bahia, one of the largest urban centers of Brazil.
Methods
The studies were conducted between 2014 and 2016 and 2016-2017 and employed Respondent-Driven Sampling (RDS) sampling, comprising 127 and 161 TGW residents of Salvador, Bahia. The outcome was the positive rapid antigen testing for HIV infection. Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained using binomial logistic regression.
Results
The HIV prevalence was 9.0% (95%CI: 4.2-18.2) and 24.3% (95%CI: 16.2-34.9). In the first study, factors associated with HIV prevalence were experiencing discrimination by the family (OR 8.22; 95%CI: 1.49-45.48) and by neighbors (OR 6.55; 95%CI: 1.12-38.14) as well as having syphilis (OR 6.56; 95%CI:1.11-38.65); in the subsequent study gender-based discrimination (OR 8.65; 95%CI:1.45-51.59) and having syphilis (OR 3.13; 95%CI: 1.45-51.59) were associated with testing positive for HIV.
Conclusion
We found disproportionately high HIV prevalence among TGW, which underscores the context of vulnerability for this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care and services for this population.
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14
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Pala AN, Kempf MC, Konkle-Parker D, Wilson TE, Tien PC, Wingood G, Neilands TB, Johnson MO, Weiser SD, Logie CH, Turan JM, Turan B. Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV. AIDS 2022; 36:1769-1776. [PMID: 35876640 PMCID: PMC9529955 DOI: 10.1097/qad.0000000000003342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV). DESIGN We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data. METHODS Participants were WHIV ( N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates. RESULTS We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load. CONCLUSION The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.
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Affiliation(s)
| | - Mirjam-Colette Kempf
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, 94121, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Torsten B. Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA, 94121, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
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15
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López Rios J, Lentz C, Balán IC, Grosskopf N, D'Angelo A, Stief M, Grov C. Engagement in Care Among Newly Diagnosed HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From the Together 5,000 Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:349-364. [PMID: 36181497 PMCID: PMC9619412 DOI: 10.1521/aeap.2022.34.5.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
One-quarter of gay, bisexual, and other men who have sex with men (GBMSM) with diagnosed HIV are not engaged in HIV care. Between 2018 and 2019, 50 GBMSM completed qualitative interviews 3 months after receiving an HIV-positive result. Interviews explored barriers to and facilitators of engagement and retention in HIV testing and care. Thematic analysis revealed five major themes: (1) reason for HIV testing (e.g., self-testing), (2) linkage to care (e.g., appointment/logistic issues and social support as encouragement), (3) barriers to engagement in care (e.g., financial burden, competing priorities, and fear/stigma), (4) facilitators of engagement (e.g., financial assistance, patient-provider relationships, auxiliary support services, and health agency), and (5) PrEP as a missed prevention opportunity. Addressing individual-, social-, and policy-level barriers could improve GBMSM's engagement in HIV care. Further, capitalizing on GBMSM's health agency through partnerships with local agencies and fostering better patient-provider relationships could optimize HIV care continuity.
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Affiliation(s)
- Javier López Rios
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | - Iván C Balán
- Center for Translational Behavioral Science, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida
| | - Nicholas Grosskopf
- Department of Health and Human Performance, York College of the City University of New York, Queens, New York
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Alexa D'Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Matthew Stief
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
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16
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Arora AK, Engler K, Lessard D, Kronfli N, Rodriguez-Cruz A, Huerta E, Lemire B, Routy JP, Wittmer R, Cox J, de Pokomandy A, Del Balso L, Klein M, Sebastiani G, Vedel I, Quesnel-Vallée A, Lebouché B. Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The 'ASAP' Study. J Pers Med 2022; 12:1497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described "initially experiencing distress". At linkage, almost all MLWH discussed "navigating the health system with difficulty". At treatment initiation, almost all MLWH expressed "being satisfied with treatment", particularly due to a lack of side effects. Regarding care retention, all MLWH noted "facing psychosocial or health-related challenges beyond HIV". Regarding ART adherence, most MLWH expressed "being satisfied with treatment" with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned "finding more peace of mind since becoming undetectable". Regarding their perceived health-related quality of life, most MLWH indicated "being helped by a supportive social network". Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients' concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Edmundo Huerta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Benoit Lemire
- Pharmacy Department, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - René Wittmer
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Joseph Cox
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 1A2, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Lina Del Balso
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Marina Klein
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Giada Sebastiani
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 1A2, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, QC H3A 0G5, Canada
| | - ASAP Migrant Advisory Committee
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
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17
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Socio-Ecological Influences on HIV Care Engagement: Perspectives of Young Black Men Who Have Sex with Men Living with HIV in the Southern US. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01364-w. [PMID: 35976604 PMCID: PMC9383690 DOI: 10.1007/s40615-022-01364-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023]
Abstract
Young Black men who have sex with men (MSM) living with HIV evidence the lowest rates of linkage to care and viral suppression of all US MSM. Kentucky, identified by the US Department of Health and Human Services as a "hot spot" state with elevated HIV incidence compared to the rest of the country, exhibits similar racialized outcomes. Structural, interpersonal, and individual drivers of engagement along the HIV care continuum among people living with HIV have been identified, primarily through quantitative designs. However, the mechanisms by which these factors shape HIV care engagement, and the ways they may combine or reinforce each other, as well as from the lived experience of young Black MSM living with HIV, have been studied to a lesser extent. In this study, a purposive sample of n = 29 HIV-positive young Black MSM (age M = 25 years old; 38% retained in care) residing in Kentucky participated in in-depth interviews. Factors that were most influential on engagement varied along the continuum, with health insurance status and knowledge of HIV being relatively more influential to diagnosis, and housing stability, psychological processes, and interpersonal relationships being more influential on retention. For some participants, barriers to care at multiple levels had a mutually influencing and intensifying impact on care engagement. Additional efforts to center the voices of young Black MSM living with HIV will help illuminate acceptable and sustainable interventions for increasing their care engagement and narrowing persistent racial disparities in HIV morbidity and mortality.
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Skerritt L, Kaida A, Savoie É, Sánchez M, Sarmiento I, O’Brien N, Burchell AN, Bartlett G, Boucoiran I, Kestler M, Rouleau D, Loutfy M, de Pokomandy A. Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study. J Pers Med 2022; 12:jpm12071079. [PMID: 35887575 PMCID: PMC9320512 DOI: 10.3390/jpm12071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Engagement along the HIV care cascade in Canada is lower among women compared to men. We used Fuzzy Cognitive Mapping (FCM), a participatory research method, to identify factors influencing satisfaction with HIV care, their causal pathways, and relative importance from the perspective of women living with HIV. Building from a map of factors derived from a mixed-studies review of the literature, 23 women living with HIV in Canada elaborated ten categories influencing their satisfaction with HIV care. The most central and influential category was “feeling safe and supported by clinics and healthcare providers”, followed by “accessible and coordinated services” and “healthcare provider expertise”. Participants identified factors that captured gendered social and health considerations not previously specified in the literature. These categories included “healthcare that considers women’s unique care needs and social contexts”, “gynecologic and pregnancy care”, and “family and partners included in care.” The findings contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.
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Affiliation(s)
- Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Margarite Sánchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
- Viva Women, Vancouver, BC V5Z 0C9, Canada
| | - Iván Sarmiento
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Nadia O’Brien
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Ann N. Burchell
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Isabelle Boucoiran
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | | | - Danielle Rouleau
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Mona Loutfy
- Women’s College Research Institute, Toronto, ON M5S 1B2, Canada;
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-843-2090
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19
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Bush J, Blackwell CW. Social Media as a Recruitment Strategy with Transgender-Identified Individuals: Using an Ethical Lens to Direct Methodology. J Transcult Nurs 2022; 33:603-614. [PMID: 35699438 DOI: 10.1177/10436596221101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Researchers are limited when using traditional recruitment methods to access hidden and vulnerable populations, including transgender persons. Social media platforms such as Facebook can provide access to the transgender population and facilitate recruitment of a representative sample. There is little regulatory guidance for using social media as a recruitment strategy. Methodology: This article presents recruitment recommendations based on a study that generated a diverse sample of transgender-identified persons using Facebook as the sole recruitment method. Results: Despite taking precautions, computer bots penetrated the initial survey. A second survey distribution collected data from a diverse sample of transgender-identified individuals. Discussion: Researchers should design social media recruitment methods with attention to privacy and transparency. Thus, using social media platforms such as Facebook to recruit transgender participants that otherwise would be challenging to reach is a viable and ethically sound alternative to traditional recruitment methods.
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Affiliation(s)
- Jake Bush
- University of West Florida, Pensacola, USA
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20
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Dasgupta S, Tie Y, Beer L, Weiser J. Unmet needs for ancillary care services are associated with HIV clinical outcomes among adults with diagnosed HIV. AIDS Care 2022; 34:606-614. [PMID: 34180733 PMCID: PMC8712612 DOI: 10.1080/09540121.2021.1946001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Ancillary care services are essential for supporting care engagement and viral suppression among persons with HIV. Estimating unmet needs for ancillary care services may help address care barriers and improve clinical outcomes, but recent, nationally representative estimates are lacking. Using CDC Medical Monitoring Project data from 2015-2018, we report representative estimates of unmet needs for ancillary care services and associations with HIV clinical outcomes among U.S. adults with HIV. Data were collected through interview and medical record abstraction. We described weighted percentages for all characteristics and associations with HIV clinical outcomes using prevalence ratios with predicted marginal means, adjusting for potential confounding. Substantial unmet needs were reported; unmet needs were higher among persons with social determinants of poor health, persons who engaged in drug use or binge drinking, and those who experienced depression or anxiety. Having unmet needs for care was associated with adverseHIV clinical outcomes, with a dose response effect between number of unmet needs and outcomes. Expanding ancillary care access based on a comprehensive care model, strengthening partnerships between providers to connect patients to essential services, and tailoring services based on need may help reduce disparities in unmet needs and improve outcomes.
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Affiliation(s)
- Sharoda Dasgupta
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Andriano TM, Arnsten J, Patel VV. Social determinants of health and HIV Pre-Exposure Prophylaxis (PrEP) interest and use among young Black and Latinx sexual minority men. PLoS One 2022; 17:e0267031. [PMID: 35427397 PMCID: PMC9012374 DOI: 10.1371/journal.pone.0267031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2022] [Indexed: 12/01/2022] Open
Abstract
Young Black and Latinx sexual minority men (YBLSMM) have low use of HIV pre-exposure prophylaxis (PrEP), despite high rates of new HIV diagnosis. While unmet social determinants of health (SDOH) have been associated with low uptake of preventive health services, this association is unknown for PrEP. To understand the relationship between SDOH and PrEP adoption in this population, we analyzed data from an online survey of HIV-negative YBLSMM aged 18-29 in New York City (n = 143). Participants completed a 17-item SDOH needs scale measuring basic, health/social-services, and economic needs. We used regression models to examine associations of unmet SDOH with outcomes of intention to use PrEP and current PrEP use. Of those not on PrEP (n = 114), 69 (61%) intended to use PrEP. More unmet SDOH needs overall were associated with intention to use PrEP (OR 1.4; 95% CI 1.1, 2.0), as were more unmet basic needs (OR 1.7; 95% CI 1.1, 2.5) and more unmet economic needs (OR 1.3; 95% CI 1.0, 1.7). Unmet SDOH needs were not associated with current PrEP use. Findings suggest that intention to use PrEP among YBLSMM is a likely marker of unmet SDOH needs, as YBLSMM with unmet needs may have limited resources to support moving from intention to actual use. Future research should evaluate programs engaging YBLSMM intending to use PrEP with interventions to screen for and address SDOH.
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Affiliation(s)
- Tyler M Andriano
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Julia Arnsten
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
| | - Viraj V. Patel
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
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22
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Jolayemi O, Bogart LM, Storholm ED, Goodman-Meza D, Rosenberg-Carlson E, Cohen R, Kao U, Shoptaw S, Landovitz RJ. Perspectives on preparing for long-acting injectable treatment for HIV among consumer, clinical and nonclinical stakeholders: A qualitative study exploring the anticipated challenges and opportunities for implementation in Los Angeles County. PLoS One 2022; 17:e0262926. [PMID: 35113892 PMCID: PMC8812879 DOI: 10.1371/journal.pone.0262926] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/09/2022] [Indexed: 01/01/2023] Open
Abstract
Long-acting injectable (LAI) antiretroviral therapy (ART) is a novel HIV treatment option for people with HIV. The first LAI ART regimen for HIV treatment received regulatory approval in the United States in January 2021. In February 2020, we collected qualitative data from 18 consumers and 23 clinical and non-clinical stakeholders to catalog anticipated individual-consumer, healthcare system, and structural levels barriers and facilitators to LAI ART implementation in Los Angeles County, California. Thematic analysis was guided by the CFIR implementation science model. CFIR constructs of intervention characteristics, individual characteristics, outer and inner setting, intervention characteristics, and implementation process emerged in analysis. Under intervention characteristics, anticipated facilitators included the relative advantage of LAI ART over pills for adherence and reduced treatment management burden and related anxiety; anticipated barriers included non-adherence to injection appointments, concerns of developing HIV resistance, discomfort with injection and cost. Anticipated facilitators based on individual characteristics included overall acceptability based on knowledge and positive beliefs about LAI ART. Participant noted several characteristics of the outer setting that could negatively impact implementation, such as medical mistrust, external policies, and LAI ART eligibility (i.e., to be virally suppressed prior to initiation). Participants were optimistic about the potential to decrease stigma but expressed that provider willingness for adoption could be hindered by challenges in organizational inner setting related to payment authorizations, increased staffing needs, medication procurement and storage, and provider and healthcare system readiness. Results from this pre-implementation study may inform rollout and scale-up of LAI ART in Los Angeles County.
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Affiliation(s)
- Oluwadamilola Jolayemi
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA, United States of America
| | - Erik D. Storholm
- RAND Corporation, Santa Monica, CA, United States of America
- School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Elena Rosenberg-Carlson
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Rebecca Cohen
- Division of HIV and STD Programs, County of Los Angeles Department of Public Health, Los Angeles, CA, United States of America
| | - Uyen Kao
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Raphael J. Landovitz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Center for Clinical AIDS Research and Education, University of California, Los Angeles, CA, United States of America
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23
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Li L, Lin C, Liang LJ, Nguyen DB, Pham LQ, Le TA, Nguyen TA. Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam. AIDS Behav 2022; 26:123-131. [PMID: 34228251 PMCID: PMC8733056 DOI: 10.1007/s10461-021-03363-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam’s four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.
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24
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Erly S, Khosropour CM, Hajat A, Sharma M, Reuer J, Grimm M, Kwaiser K, Dombrowski JC. Characterization of the Population Affected by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017-2019. J Acquir Immune Defic Syndr 2022; 89:27-33. [PMID: 34596081 PMCID: PMC8665124 DOI: 10.1097/qai.0000000000002824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State. METHODS Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems. RESULTS From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25-34 vs 35-44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months). CONCLUSIONS Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.
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Affiliation(s)
- Steven Erly
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Health, Office of Infectious Disease, Washington State, Olympia, WA
| | | | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA; and
| | - Jen Reuer
- Department of Health, Office of Infectious Disease, Washington State, Olympia, WA
| | - Martha Grimm
- Department of Health, Office of Infectious Disease, Washington State, Olympia, WA
| | - Kelse Kwaiser
- Department of Health, Office of Infectious Disease, Washington State, Olympia, WA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA
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25
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Shaw SY, Ireland L, McClarty LM, Loeppky C, Bullard J, Van Caeseele P, Keynan Y, Kasper K, Moses S, Blanchard JF, Becker ML. Healthcare utilization among persons living with HIV in Manitoba, Canada, prior to HIV diagnosis: A case-control analysis. Int J STD AIDS 2021; 33:265-274. [PMID: 34894866 DOI: 10.1177/09564624211051615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding care patterns of persons living with HIV prior to diagnosis can inform prevention opportunities, earlier diagnosis, and engagement strategies. We examined healthcare utilization among HIV-positive individuals and compared them to HIV-negative controls. METHODS Data were from a retrospective cohort from Manitoba, Canada. Participants included individuals living with HIV presenting to care between 2007 and 2011, and HIV-negative controls, matched (1:5) by age, sex, and region. Data from population-based administrative databases included physician visits, hospitalizations, drug dispensation, and chlamydia and gonorrhea testing. Diagnoses associated with physician visits were classified according to International Classification of Diseases chapters. Conditional logistic regression models were used to compare cases/controls, with adjusted odds ratios (AORs) and their 95% confidence intervals (95% CI) reported. RESULTS A total of 193 cases and 965 controls were included. Physician visits and hospitalizations were higher for cases, compared to controls. In the 2 years prior to case date, cases were more likely to be diagnosed with "blood disorders" (AOR: 4.2, 95% CI: 2.0-9.0), be treated for mood disorders (AOR: 2.4, 95% CI: 1.6-3.4), and to have 1+ visits to a hospital (AOR: 2.2, 95% CI: 1.4-3.6). CONCLUSION Opportunities exist for prevention, screening, and earlier diagnosis. There is a need for better integration of healthcare services with public health.
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Affiliation(s)
- Souradet Y Shaw
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Population Health Surveillance, Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Laurie Ireland
- Nine Circles Community Health Centre, Winnipeg, MB, Canada
| | - Leigh M McClarty
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carla Loeppky
- Manitoba Health, Seniors, and Active Living, Winnipeg, MB, Canada.,Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Paul Van Caeseele
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Yoav Keynan
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, MB, Canada.,Manitoba HIV Program, Winnipeg, MB, Canada
| | - Ken Kasper
- Manitoba HIV Program, Winnipeg, MB, Canada.,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Moses
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James F Blanchard
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Marissa L Becker
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba HIV Program, Winnipeg, MB, Canada
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26
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Pulitzer Z, Box M, Hansen L, Tiruneh YM, Nijhawan AE. Patient, medical and legal perspectives on reentry: the need for a low-barrier, collaborative, patient-centered approach. HEALTH & JUSTICE 2021; 9:37. [PMID: 34855029 PMCID: PMC8638478 DOI: 10.1186/s40352-021-00161-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Worldwide, the United States has the highest incarceration rate per capita. Thousands of people are released from US correctional facilities each year, including many who are impacted by HIV infection and substance use disorder (SUD), two frequently comorbid conditions that present multiple challenges upon reentry. Reentry and care engagement research involving justice-involved people with HIV (PWH) with comorbid SUD has been largely limited to the perspective of those released. To formulate effective interventions for this population aimed at maintaining health and reducing recidivism, it is crucial to collect data from formerly incarcerated individuals with firsthand experience of the reentry process as well as other actors within the reentry framework. Insights from medical and legal service providers working in reentry systems have the potential to address key implementation concerns. To inform an intervention aimed at helping recently-released individuals PWH and SUD, we conducted a qualitative study to assess barriers and facilitators to community reentry from the perspectives of diverse consumers and providers of medical, legal, and reentry services. RESULTS Fifteen stakeholders within XXX County participated in in-person interviews. Results indicated that 1) Patients/clients emphasized psychosocial support and individual attitude more than medical and legal participants, who chiefly focused on logistical factors such as finances, housing, and transportation; 2) Patients/clients expressed both medical and legal needs during the reentry period, though medical providers and participants from legal entities mainly expressed concerns limited to their respective scopes of work; 3) All three participant groups underscored the need for a low-barrier, collaborative, patient-centered approach to reentry with the goal of achieving self-sufficiency. CONCLUSIONS Findings support and extend existing literature detailing the barriers and facilitators to successful reentry. Our findings underscore the notion that an effective reentry intervention addresses both medical and legal needs, includes an individualized approach that incorporates psychosocial needs, and focuses on establishing self-sufficiency.
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Affiliation(s)
- Zoe Pulitzer
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Maria Box
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Laura Hansen
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Yordanos M Tiruneh
- University of Texas Health Sciences Center at Tyler, 11937 US-271, Tyler, TX, 75708-3154, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Parkland Health and Hospital Systems, Correctional Health, Dallas, TX, 75235, USA.
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27
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Gil RM, Freeman TL, Mathew T, Kullar R, Fekete T, Ovalle A, Nguyen D, Kottkamp A, Poon J, Marcelin JR, Swartz TH. Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Communities and the Coronavirus Disease 2019 Pandemic: A Call to Break the Cycle of Structural Barriers. J Infect Dis 2021; 224:1810-1820. [PMID: 34323998 PMCID: PMC9103180 DOI: 10.1093/infdis/jiab392] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities. Many disparities mirror those of the human immunodeficiency virus (HIV)/AIDS epidemic. These health inequities have repeated throughout history due to the structural oppression of LGBTQ+ people. We aim to demonstrate that the familiar patterns of LGBTQ+ health disparities reflect a perpetuating, deeply rooted cycle of injustice imposed on LGBTQ+ people. Here, we contextualize COVID-19 inequities through the history of the HIV/AIDS crisis, describe manifestations of LGBTQ+ structural oppression exacerbated by the pandemic, and provide recommendations for medical professionals and institutions seeking to reduce health inequities.
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Affiliation(s)
- Raul Macias Gil
- Department of Infectious Diseases, Kaiser Permanente Northern
California, Napa/Solano, California, USA
| | - Tracey L Freeman
- Medical Scientist Training Program, University of Pittsburgh-Carnegie Mellon
University, Pittsburgh,
Pennsylvania, USA
| | - Trini Mathew
- Division of Infectious Diseases and International Medicine, Beaumont
Hospital, Royal Oak, Michigan, USA
| | - Ravina Kullar
- Expert Stewardship, Inc, Newport Beach,
California, USA
| | - Thomas Fekete
- Department of Medicine, Temple University Lewis Katz School of
Medicine, Philadelphia, Pennsylvania, USA
| | - Anais Ovalle
- Division of Infectious Diseases, Dartmouth Hitchcock Medical
Center, Dartmouth, New Hampshire, USA
| | - Don Nguyen
- Medical Scientist Training Program, University of Pittsburgh-Carnegie Mellon
University, Pittsburgh,
Pennsylvania, USA
| | - Angélica Kottkamp
- Division of Infectious Diseases, New York University Grossman School of
Medicine, New York, New York, USA
| | - Jin Poon
- Department of Family Medicine, Kaiser Permanente Northern
California, Vallejo, California, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, University of Nebraska Medical
Center, Omaha, Nebraska, USA
| | - Talia H Swartz
- Division of Infectious Diseases, Department of Medicine, Icahn School of
Medicine at Mount Sinai, New York, New York, USA
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28
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Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review. AIDS Behav 2021; 25:3574-3604. [PMID: 33866444 PMCID: PMC8053369 DOI: 10.1007/s10461-021-03262-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.
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29
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Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV. Community Ment Health J 2021; 57:1328-1339. [PMID: 33387180 DOI: 10.1007/s10597-020-00756-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.
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30
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Rhodes SD, Kuhns LM, Alexander J, Alonzo J, Bessler PA, Courtenay-Quirk C, Denson DJ, Evans K, Galindo CA, Garofalo R, Gelaude DJ, Hotton AL, Johnson AK, Mann-Jackson L, Muldoon A, Ortiz R, Paul JL, Perloff J, Pleasant K, Reboussin BA, Refugio Aviles L, Song EY, Tanner AE, Trent S. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021. [PMID: 34370565 DOI: 10.1521/aeap.2021.33.4.345]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa M Kuhns
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Jorge Alonzo
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Damian J Denson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaiji Evans
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Garofalo
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy K Johnson
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abigail Muldoon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Reyna Ortiz
- Chicago House and Social Service Agency, Chicago, Illinois
| | | | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Kevin Pleasant
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Amanda E Tanner
- University of North Carolina Greensboro, Greensboro, North Carolina
| | - Scott Trent
- Triad Health Project, Greensboro, North Carolina
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31
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Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KK, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vallée A, Lebouché B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2021; 35:288-307. [PMID: 34375137 PMCID: PMC8380795 DOI: 10.1089/apc.2021.0079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Kedar K.V. Mate
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Joseph Cox
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
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Rhodes SD, Kuhns LM, Alexander J, Alonzo J, Bessler PA, Courtenay-Quirk C, Denson DJ, Evans K, Galindo CA, Garofalo R, Gelaude DJ, Hotton AL, Johnson AK, Mann-Jackson L, Muldoon A, Ortiz R, Paul JL, Perloff J, Pleasant K, Reboussin BA, Refugio Aviles L, Song EY, Tanner AE, Trent S. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:345-360. [PMID: 34370565 PMCID: PMC8565450 DOI: 10.1521/aeap.2021.33.4.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa M Kuhns
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Jorge Alonzo
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Damian J Denson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaiji Evans
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Garofalo
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy K Johnson
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abigail Muldoon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Reyna Ortiz
- Chicago House and Social Service Agency, Chicago, Illinois
| | | | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Kevin Pleasant
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Amanda E Tanner
- University of North Carolina Greensboro, Greensboro, North Carolina
| | - Scott Trent
- Triad Health Project, Greensboro, North Carolina
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Gebrezgi MT, Trepka MJ, Gbadamosi SO, Fennie KP, Ramirez-Ortiz D, Li T, Fernandez SB, Brock P, Ladner RA, Sheehan DM. Development and Validation of Vulnerable and Enabling Indices for HIV Viral Suppression among People with HIV Enrolled in the Ryan White Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137048. [PMID: 34280985 PMCID: PMC8297082 DOI: 10.3390/ijerph18137048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). METHODS We used Ryan White Program (RWP) data and principal component analysis to develop general and gender- and racial/ethnic-specific indices. We assessed internal reliability (Cronbach's alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. RESULTS Three general factors accounting for 79.2% of indicators' variability surfaced: mental health, drug use, and socioeconomic status (Cronbach's alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender- or racial/ethnic-specific indices did not improve psychometric performance. DISCUSSION General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender- and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations.
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Affiliation(s)
- Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Semiu O. Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
| | - Kristopher P. Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bayshore Rd, Sarasota, FL 34243, USA;
| | - Daisy Ramirez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA;
| | - Sofia B. Fernandez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
| | - Petra Brock
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Coral Gables, FL 33134, USA; (P.B.); (R.A.L.)
| | - Robert A. Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Blvd, Coral Gables, FL 33134, USA; (P.B.); (R.A.L.)
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA; (M.T.G.); (M.J.T.); (S.O.G.); (D.R.-O.); (S.B.F.)
- Research Centers in Minority Institutions (RCMI), Florida International University, 11200 SW 8th St., AHC 5, Room 479, Miami, FL 33199, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St., Miami, FL 33199, USA
- Correspondence:
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Wilson EC, Turner C, Arayasirikul S, Woods T, Tryon J, Franza K, Lin R. HIV Care Engagement Among Trans Women of Color in San Francisco Bay Area Demonstration Projects: Findings from the Brandy Martell Project and TransAccess. AIDS Behav 2021; 25:31-39. [PMID: 31620900 DOI: 10.1007/s10461-019-02697-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the San Francisco Bay Area (SFBA), trans women of color are disproportionately affected by HIV and have poor HIV care outcomes. The Brandy Martell Project and TransAccess were two demonstration projects aimed at increasing HIV care engagement and retention among trans women of color in the SFBA. Both projects took place in clinics with a long history of providing trans health care and social services. Both also relied on peer navigation to address systems barriers and promote HIV care linkage and engagement. Our analysis was to identify associations between intervention exposure and primary HIV care visits, ART prescription, and retention in HIV care. Using GEE, we estimated the association between intervention exposure measures (receipt of intervention, intervention dose, intervention provider, and peer dose) and any primary HIV care visit or ART prescription over the 12-month period. Overall, the Brandy Martell Project and TransAccess interventions had significantly positive associations with HIV care outcomes measured. Peer navigation also had a significantly positive association with HIV care outcomes. These interventions demonstrate promise for engaging and retaining trans women of color in HIV care, and call for future investment in this highly underserved community.
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Affiliation(s)
- E C Wilson
- Department of Public Health, Center for Public Health Research, San Francisco, San Francisco, CA, USA.
| | - C Turner
- Department of Public Health, Center for Public Health Research, San Francisco, San Francisco, CA, USA
| | - S Arayasirikul
- Department of Public Health, Center for Public Health Research, San Francisco, San Francisco, CA, USA
| | - T Woods
- Brandy Martell Project, TransVision Program, Tri City Health Center, Fremont, CA, USA
| | - J Tryon
- TransAccess Program, API Wellness Center, San Francisco, CA, USA
| | - K Franza
- TransAccess Program, API Wellness Center, San Francisco, CA, USA
| | - R Lin
- TransAccess Program, API Wellness Center, San Francisco, CA, USA
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Sangaramoorthy T, Haddix M, Agopian A, Yellin H, Mouhanna F, Abdi H, Dorsey K, Peterson J, Kharfen M, Castel AD. Measuring Unmet Needs among Persons Living with HIV at Different Stages of the Care Continuum. AIDS Behav 2021; 25:1954-1967. [PMID: 33537918 DOI: 10.1007/s10461-020-03125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Unmet needs can impede optimal care engagement, impacting the health and well-being of people living with HIV (PLWH); yet, whether unmet needs differ by care engagement status is not well understood. Using surveys and qualitative interviews, we examined and compared unmet needs for PLWH (n = 172) at different levels of care engagement. Unmet needs varied only slightly by care status. Survey findings revealed that provision of housing, emergency financial assistance, employment assistance, and food security were the greatest unmet need; for those in care, housing was the greatest unmet need, whereas for those sporadically in care or out of care, employment assistance was the greatest unmet needs. Qualitative interviews likewise illustrated that a lack of financial resources including insurance, housing, employment, and transportation presented barriers to care engagement across all care groups. Our findings indicate that unmet needs among PLWH are complex and multi-faceted across care engagement status.
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Affiliation(s)
| | - Meredith Haddix
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anya Agopian
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hannah Yellin
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Farah Mouhanna
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hibo Abdi
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Kerri Dorsey
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - James Peterson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - Amanda D Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
- Department of Epidemiology, The Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, Washington, DC, 20052, USA.
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Aronson ID, Zhang J, Rajan S. The importance of content and choice in a technology-based intervention to increase HIV testing. INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 2021; 59:354-365. [PMID: 35173555 PMCID: PMC8845491 DOI: 10.1080/14635240.2021.1918568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 04/14/2021] [Indexed: 06/14/2023]
Abstract
Although the Centers for Disease Control and Prevention recommends routine HIV testing in emergency departments and other facilities, many patients are never offered testing, and those who are offered testing frequently decline. In response, our team developed and evaluated a series of differently configured technology-based interventions to explore how we can most effectively increase HIV testing among reluctant patients. The current study examines how different videos (onscreen physician vs. onscreen community member), and different intervention configurations (enabling some participants to select a video while others are assigned to watch a video or to view bullet-point text), could potentially increase self-efficacy to test for HIV among patients who had never tested. Analyses of data from 285 emergency department patients in New York City who declined HIV testing offered by hospital staff indicated that participants reported highly significant differences in self-efficacy depending on their history of previous testing, whether they were enabled to select a video or were assigned a video, and which video they watched. Participants who reported no previous testing reported significantly lower pre-test self-efficacy compared to those who had tested at least once before. Among those who had not previously tested, the greatest pre-post increases in self-efficacy were reported by participants who were randomly enabled to select an intervention video and chose to watch video depicting a physician. Our findings highlight the importance, not only of intervention content, but how that content is delivered to specific participants. These findings may inform more effective technology-based behavioral health interventions.
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Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, USA
- School of Global Public Health, New York University, New York, USA
| | - Jingru Zhang
- Teachers College, Columbia University, New York, USA
| | - Sonali Rajan
- Teachers College, Columbia University, New York, USA
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Levy B, Correia HE, Chirove F, Ronoh M, Abebe A, Kgosimore M, Chimbola O, Machingauta MH, Lenhart S, White KAJ. Modeling the Effect of HIV/AIDS Stigma on HIV Infection Dynamics in Kenya. Bull Math Biol 2021; 83:55. [PMID: 33818710 PMCID: PMC8021528 DOI: 10.1007/s11538-021-00891-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
Stigma toward people living with HIV/AIDS (PLWHA) has impeded the response to the disease across the world. Widespread stigma leads to poor adherence of preventative measures while also causing PLWHA to avoid testing and care, delaying important treatment. Stigma is clearly a hugely complex construct. However, it can be broken down into components which include internalized stigma (how people with the trait feel about themselves) and enacted stigma (how a community reacts to an individual with the trait). Levels of HIV/AIDS-related stigma are particularly high in sub-Saharan Africa, which contributed to a surge in cases in Kenya during the late twentieth century. Since the early twenty-first century, the United Nations and governments around the world have worked to eliminate stigma from society and resulting public health education campaigns have improved the perception of PLWHA over time, but HIV/AIDS remains a significant problem, particularly in Kenya. We take a data-driven approach to create a time-dependent stigma function that captures both the level of internalized and enacted stigma in the population. We embed this within a compartmental model for HIV dynamics. Since 2000, the population in Kenya has been growing almost exponentially and so we rescale our model system to create a coupled system for HIV prevalence and fraction of individuals that are infected that seek treatment. This allows us to estimate model parameters from published data. We use the model to explore a range of scenarios in which either internalized or enacted stigma levels vary from those predicted by the data. This analysis allows us to understand the potential impact of different public health interventions on key HIV metrics such as prevalence and disease-related death and to see how close Kenya will get to achieving UN goals for these HIV and stigma metrics by 2030.
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Affiliation(s)
- Ben Levy
- Department of Mathematics, Fitchburg State University, Fitchburg, MA, USA
| | - Hannah E Correia
- Harvard Data Science Initiative, Harvard University, Cambridge, MA, USA.,Department of Biostatistics, Harvard University, Boston, MA, USA
| | - Faraimunashe Chirove
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg, South Africa
| | - Marilyn Ronoh
- School of Mathematics, University of Nairobi, Nairobi, Kenya
| | - Ash Abebe
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg, South Africa
| | - Moatlhodi Kgosimore
- Department of Biometry and Mathematics, Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - Obias Chimbola
- Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - M Hellen Machingauta
- Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana
| | - Suzanne Lenhart
- Mathematics Department, University of Tennessee, Knoxville, TN, USA
| | - K A Jane White
- Department of Mathematical Sciences, University of Bath, Bath, UK.
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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39
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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Abstract
Introduction The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Program seeks to enhance vulnerable family engagement with health and social services through a care coordination model. Besides servicing families in Sydney, HHAN has also established place-based initiatives (PBIs) in areas of disadvantage such as Redfern. The Redfern PBI co-locates HHAN with housing, drug and alcohol services, and financial and legal services. This integration aims to facilitate service access and multi-agency support for vulnerable families in Redfern. Hence, this study aims to evaluate for whom, when and why HHAN's PBI at Redfern works, or not, and what are its outcomes. Methods The project utilises critical realist methodology to undertake a qualitative evaluation of the impact of the PBI on clients, services and the community. Purposive sampling was used to identify 21 participants including HHAN clients, HHAN staff and stakeholders (HHAN partners). In-depth, semi-structured interviews were audio-recorded, transcribed, coded and analysed using a context (C), intervention (I), mechanism (M) outcome (O) (CIMO) approach to abductive analysis. Results Five key CIMO configurations of the Redfern PBI emerged - whole-of-family involvement, flexibility, trust, building connections and co-location. Whilst each theory had specific outcomes, overall client outcomes included improved access to services, better outlook, empowerment and engagement with services. Service outcomes included increased collaboration and foundation for integration between HHAN and other services. Negative outcomes included lack of full integration, the risk associated with integration and difficulty evaluating impact. Conclusion This study successfully refined the program theory for subsequent use in later implementation of critical realist evaluation studies.
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Norberg A, Nelson J, Holly C, Jewell ST, Lieggi M, Salmond S. Experiences of HIV-infected adults and healthcare providers with healthcare delivery practices that influence engagement in US primary healthcare settings: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:1154-1228. [PMID: 30994499 DOI: 10.11124/jbisrir-2017-003756] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem that has claimed the lives of more than 34 million people worldwide. The health of people living with HIV (PLWH) is optimized by ongoing engagement in HIV care, yet many people living with HIV either do not enter or fall out of care. Access to care and ongoing engagement in care for antiretroviral (ARV) medication adherence and psychoeducational support are critical to achieving the desired outcomes of reducing the risk of further HIV transmission and HIV related morbidity and mortality, and managing other commonly co-occurring health, social and behavioral conditions, thereby maximizing wellness. OBJECTIVE The objective of the review was to identify, evaluate and synthesize existing qualitative evidence on the experiences of HIV-infected adults with healthcare systems/practices/processes, and the experiences of healthcare providers with healthcare systems/practices/processes that impact engagement in primary healthcare settings in the United States (US). INCLUSION CRITERIA The review included studies reporting on the qualitative experiences of HIV-infected adults, aged 18-65 years, with healthcare systems, practices and processes and their healthcare providers (physicians, nurses and others providing care to these patients in the primary care healthcare setting). Qualitative studies including but not limited to designs such as phenomenology, ethnography, grounded theory, action research and qualitative descriptive were included. Studies published in languages other than English and conducted outside of the US were excluded. METHODS Using a three-step search strategy, databases of published and unpublished articles were searched from 1997 to 2017. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Findings were rated according to their level of credibility, categorized based on similarity in meaning and subjected to a meta-synthesis. RESULTS A total of 1038 qualitative articles were identified of which 41 were included after critical appraisal. Meta-synthesis generated four synthesized findings: i) What I want from my provider: to be a respectful, empathetic and holistic partner in my care; ii) I cannot do it alone: the critical importance of actively guiding and assisting patients during transitions and securing the needed resources; iii) Help me to understand my illness and care needs; iv) One-stop care that is de-stigmatizing and welcoming to diverse cultures keeps clients in care. These synthesized findings were derived from 243 study findings that were subsequently aggregated into 19 categories. Of the 243 study findings, 240 were rated unequivocal and three were rated credible. The overall ConQual for each of the four synthesized findings was moderate due to common dependability issues across the included studies. A total of 1597 participants were included. Only two studies were included from 1997 to 2000. The majority of included studies were published from 2005 to 2017. CONCLUSIONS The synthesized findings illustrate clear quality indicators for primary care practice, emphasizing the patient-provider-care team partnership and shared decision making that is holistic, takes into account a patient's whole life, responsibilities and stressors, and reframes HIV associated misperceptions/myths. The review also highlights the importance of helping patients navigate and interact with the healthcare system by offering one-stop services that assist with multiple medical care needs and "wraparound" services that provide the needed care coordination to assist with critical quality of life needs such as food, housing, transportation, and assistance with applying for health insurance and medication.
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Affiliation(s)
- Andrea Norberg
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA
| | - John Nelson
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA
| | - Cheryl Holly
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
| | - Sarah T Jewell
- George F. Smith Library of the Health Sciences, Rutgers, The State University of New Jersey, Newark, USA
| | - Michelle Lieggi
- Fishbon Library, University of California San Francisco Medical Center, San Francisco, USA
| | - Susan Salmond
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
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Meunier É, Siegel K, Sundelson AE, Schrimshaw EW. Stages of Adoption of "Treatment as Prevention" Among HIV-Negative Men Who Have Sex with Men Who Engage in Exchange Sex. AIDS Patient Care STDS 2020; 34:380-391. [PMID: 32931316 PMCID: PMC7480714 DOI: 10.1089/apc.2020.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Prior research found low acceptability of HIV treatment as prevention (TasP; or Undetectable = Untransmittable) among HIV-negative men who have sex with men (MSM). This study reports on qualitative data regarding TasP adoption in a sample of 170 self-reported HIV-negative MSM who had engaged in exchange sex (received money, drugs, or other things in exchange for sex). We classified participants along five stages of TasP adoption: 1-unaware of TasP (11.2%); 2-aware, but perceived ineffective (17.1%); 3-perceived effective, but unwilling to use (35.3%); 4-willing to rely on TasP, but had never done so (24.1%); and 5-had relied on TasP (12.4%). Obstacles to TasP adoption included the following: not believing that it could completely prevent HIV transmission; deeply ingrained fears of HIV/AIDS; concerns about viral load fluctuation; and reluctance to trust a partner's claimed undetectable status. TasP promotion efforts, which can decrease barriers to HIV testing and HIV stigma, will be more effective if tailored to the obstacles specific to each stage of TasP adoption.
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Affiliation(s)
- Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne E. Sundelson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric W. Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
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Irvine MK, Levin B, Robertson MM, Penrose K, Carmona J, Harriman G, Braunstein SL, Nash D. PROMISE (Program Refinements to Optimize Model Impact and Scalability based on Evidence): a cluster-randomised, stepped-wedge trial assessing effectiveness of the revised versus original Ryan White Part A HIV Care Coordination Programme for patients with barriers to treatment in the USA. BMJ Open 2020; 10:e034624. [PMID: 32718922 PMCID: PMC7389516 DOI: 10.1136/bmjopen-2019-034624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Growing evidence supports combining social, behavioural and biomedical strategies to strengthen the HIV care continuum. However, combination interventions can be resource-intensive and challenging to scale up. Research is needed to identify intervention components and delivery models that maximise uptake, engagement and effectiveness. In New York City (NYC), a multicomponent Ryan White Part A-funded medical case management intervention called the Care Coordination Programme (CCP) was launched at 28 agencies in 2009 in order to address barriers to care and treatment. Effectiveness estimates based on >7000 clients enrolled by April 2013 and their controls indicated modest CCP benefits over 'usual care' for short-term and long-term viral suppression, with substantial room for improvement. METHODS AND ANALYSIS Integrating evaluation findings and CCP service-provider and community-stakeholder input on modifications, the NYC Health Department packaged a Care Coordination Redesign (CCR) in a 2017 request for proposals. Following competitive re-solicitation, 17 of the original CCP-implementing agencies secured contracts. These agencies were randomised within matched pairs to immediate or delayed CCR implementation. Data from three 9-month periods (pre-implementation, partial implementation and full implementation) will be examined to compare CCR versus CCP effects on timely viral suppression (TVS, within 4 months of enrolment) among individuals with unsuppressed HIV viral load newly enrolling in the CCR/CCP. Based on current enrolment (n=933) and the pre-implementation outcome probability (TVS=0.54), the detectable effect size with 80% power is an OR of 2.75 (relative risk: 1.41). ETHICS AND DISSEMINATION This study was approved by the NYC Department of Health and Mental Hygiene Institutional Review Board (IRB, Protocol 18-009) and the City University of New York Integrated IRB (Protocol 018-0057) with a waiver of informed consent. Findings will be disseminated via publications, conferences, stakeholder meetings, and Advisory Board meetings with implementing agency representatives. TRIAL REGISTRATION NUMBER Registered with ClinicalTrials.gov under identifier: NCT03628287, V.2, 25 September 2019; pre-results.
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Affiliation(s)
- Mary K Irvine
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health (MSPH), Columbia University, New York, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Katherine Penrose
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jennifer Carmona
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Graham Harriman
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Sarah L Braunstein
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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Gaines MT, Duke CC, Henny KD. Mental Health Screening Practices Among Primary Care Providers in High HIV Burden Areas of the South: Does Having Patients with HIV Matter? J Behav Health Serv Res 2020; 48:103-111. [PMID: 32621164 DOI: 10.1007/s11414-020-09719-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mental health (MH) disorders are associated with HIV-related risk and health outcomes. Primary care providers (PCPs) conducting MH screenings can link persons living with HIV (PWH) to appropriate services, particularly in HIV burden areas of Southeastern States (the South). Little data exist on PCPs' MH screening practices. Depression, MH history, and substance use screenings among PCPs were examined in the South. Rao-Scott chi-square (χ2[df]) statistics (p ≤ 0.05) analyzed MH screening between PCPs with and without PWH patients. Compared with PCPs without PWH patients, PCPs with PWH patients routinely screened for substance use more frequently (50.6% vs. 43.2%; χ2[1] = 20.3; p < 0.0001). Compared with PCPs without PWH patients, PCPs with PWH patients routinely screened for depression less frequently (36.2% vs. 50.9%; χ2[1] = 32.0; p < 0.0001). Providers increasing MH screenings will improve HIV-related outcomes in the South.
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Affiliation(s)
- Malendie T Gaines
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | | | - Kirk D Henny
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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45
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Pasipanodya EC, Montoya JL, Watson CWM, Marquine MJ, Hoenigl M, Garcia R, Kua J, Gant V, Trambley J, Moore DJ. Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study. PLoS One 2020; 15:e0233217. [PMID: 32516317 PMCID: PMC7282643 DOI: 10.1371/journal.pone.0233217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants’ comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.
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Affiliation(s)
| | - Jessica L. Montoya
- University of California-San Diego, San Diego, California, United States of America
| | - Caitlin W.-M. Watson
- University of California-San Diego, San Diego, California, United States of America
- San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, United States of America
| | - María J. Marquine
- University of California-San Diego, San Diego, California, United States of America
| | - Martin Hoenigl
- University of California-San Diego, San Diego, California, United States of America
| | - Rogelio Garcia
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - John Kua
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - Verna Gant
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - Joel Trambley
- Universal Health Services Southern California Medical Education Consortium, Temecula, California, United States of America
| | - David J. Moore
- University of California-San Diego, San Diego, California, United States of America
- * E-mail:
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Demeke HB, Luo Q, Beer L, Weiser J. Antiretroviral prescription, retention in care and viral suppression by place of birth among adults with diagnosed HIV in the United States-2015-2017, medical monitoring project. AIDS Care 2020; 33:86-91. [PMID: 32156156 DOI: 10.1080/09540121.2020.1738007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV clinical outcomes have not been fully assessed by place of birth at the national level. We analyzed the Medical Monitoring Project data, an annual cross-sectional survey designed to produce nationally representative estimates on adults with diagnosed HIV in the United States, collected during 2015-2017 (n = 7617). We compared sociodemographic, behavioral, and clinical outcomes by place of birth using Rao-Scott chi-square tests (P < .05). Overall, 13.6% of adults with diagnosed HIV were non-US-born. During the past 12 months, a higher percentage of non-US-born than US-born adults, respectively, were prescribed ART (89.4% vs. 84.1%), retained in care (87.1% vs. 80.0%), virally suppressed at the last test (77.2% vs. 70.9%), and had sustained viral suppression (70.9% vs. 63.3%). A lower percentage of non-US-born adults reported binge drinking (13.0% vs. 16.1%), using non-injection drugs (15.3% vs. 31.7%), and suffering from depression (15.9% vs. 23.3%) or anxiety (10.0% vs. 20.2%). A significantly higher percentage of non-US-born adults had Ryan White HIV/AIDS Program (RWHAP) coverage (54.4% vs. 43.1%) and attended a RWHAP-funded health care facility (73.9% vs. 66.6%). Factors contributing to better HIV clinical outcomes among non-US-born persons may include access to RWHAP coverage, lower levels of substance use, and better mental health.
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Affiliation(s)
- Hanna B Demeke
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Pagkas-Bather J, Jaramillo J, Henry J, Grandberry V, Ramirez LF, Cervantes L, Stekler JD, Andrasik MP, Graham SM. What's PrEP?: peer navigator acceptability among minority MSM in Washington. BMC Public Health 2020; 20:248. [PMID: 32070318 PMCID: PMC7029512 DOI: 10.1186/s12889-020-8325-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023] Open
Abstract
Background Peer navigation is a promising strategy to link at-risk minority men who have sex with men (MSM) to HIV prevention services including pre-exposure prophylaxis (PrEP). Methods Thirty-two Black and 63 Latinx HIV-negative MSM living in western Washington completed a survey examining attitudes towards peer navigation and PrEP. Factor analysis derived a score for peer navigator acceptability, and linear regression identified associations with this outcome. Results Forty-eight percent were interested in peer navigation. Being insured, higher sexual stigma, and higher PHQ-9 score were associated with higher acceptability, while higher income and having a regular medical provider were associated with lower acceptability. In multivariable analysis, higher sexual stigma predicted higher acceptability, while higher income predicted lower acceptability. Men preferred that peers be matched on sexual orientation, race, age and culture. Conclusion Peer navigation interventions to reach minority men should address stigma, focus on lower-income men, and try to match peers to clients to the extent possible.
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Affiliation(s)
- Jade Pagkas-Bather
- Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Medicine, Section of Infectious Diseases & Global Health, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
| | - Jahn Jaramillo
- Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Jsani Henry
- Seattle & King County Public Health HIV/STD Program, Seattle, WA, USA
| | | | | | | | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Susan M Graham
- Department of Medicine, University of Washington, Seattle, WA, USA
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48
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Yanes-Lane M, Dussault C, Linthwaite B, Cox J, Klein MB, Sebastiani G, Lebouché B, Kronfli N. Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review. J Viral Hepat 2020; 27:205-220. [PMID: 31638294 DOI: 10.1111/jvh.13220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Elimination of hepatitis C virus (HCV) among short-term sentenced prison populations will require improved access to HCV care and specific strategies dedicated to linkage upon release. Prison-based HCV care has lagged behind HIV care, but much can be learned from HIV studies. We performed a systematic review to identify individual-, provider- and system-level barriers and facilitators to linkage to HCV and HIV care among released inmates. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials and Embase, and performed a grey literature search for English articles published up to November 2018. Two searches were conducted, one each for HCV and HIV; 323 and 684 unique articles were identified of which two and 27 studies were included, respectively. Facilitators to linkage to HCV care included social support, having an existing primary care provider, and receipt of methadone, whereas barriers included a perceived lack of healthcare information and a lack of specialized linkage to care programs. The principal facilitators to linkage to HIV care included social support, treatment for substance use and mental illness, the provision of education, case management, discharge planning and transportation assistance. Important barriers were unstable housing, age <30 years, HIV-related stigma, poor providers' attitudes and the lack of post-release reintegration assistance. While HCV care-specific studies are needed, much can be learned from linkage to HIV care studies. Ultimately, a multi-pronged approach, addressing several individual-level social determinants of health, and key provider- and system-level barriers may be an appropriate starting point for the development of HCV linkage to care strategies.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV trials Network, Vancouver, British Columbia, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
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Zhang C, McMahon J, Leblanc N, Braksmajer A, Crean HF, Alcena-Stiner D. Association of Medical Mistrust and Poor Communication with HIV-Related Health Outcomes and Psychosocial Wellbeing Among Heterosexual Men Living with HIV. AIDS Patient Care STDS 2020; 34:27-37. [PMID: 31755736 DOI: 10.1089/apc.2019.0200] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Studies have suggested that effective patient-provider relationships may reduce health disparities and foster engagement across the HIV care continuum among people living with HIV/AIDS. However, no studies have explored specific mechanisms between medical mistrust/poor communication and HIV-related/psychosocial health outcomes among HIV-positive men of color who have sex with women (MCSW) in the United States. From 2011 to 2012, the research team recruited 317 eligible participants in New York City. Using validated explanatory and predictive modeling strategies, we explored the associations between mistrust/poor communication and HIV-related/psychosocial health outcomes among this group. Subgroup analyses were further conducted to assess the different effects of non-Hispanic black and Hispanic men. A total of 313 males (204 black, 93 Hispanic, and 16 others) reported that valid responses were included in the current analysis. In the explanatory models, both mistrust and poor communication were negatively associated with various HIV-related and psychosocial outcomes among this group of HIV-positive MCSW. In the predictive models, predictors of mistrust for the overall sample and the black subsample were nearly the same. On the contrary, predictors of poor communication were substantially different when comparing black and Hispanic HIV-positive MCSW. Our findings confirm that patient-provider relationship quality is associated with poor HIV-related and psychosocial outcomes in black and Hispanic MCSW. A different set of multi-level predictors are associated with mistrust and poor communication comparing black and Hispanic MCSW. We call for interventions addressing patient-provider relationship quality that are tailored differently for black and Hispanic men.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Natalie Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Amy Braksmajer
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Hugh F. Crean
- School of Nursing, University of Rochester Medical Center, Rochester, New York
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Bockting W, MacCrate C, Israel H, Mantell JE, Remien RH. Engagement and Retention in HIV Care for Transgender Women: Perspectives of Medical and Social Service Providers in New York City. AIDS Patient Care STDS 2020; 34:16-26. [PMID: 31846348 DOI: 10.1089/apc.2019.0067] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Transgender women are less likely to engage in HIV care and adhere to antiretroviral medications than other at-risk populations. Health care and social service providers, in addition to consumers, have experiences that can elucidate barriers and facilitators to care and inform interventions. Guided by the social/ecological model, we conducted interviews with 19 providers working with transgender women. At the health systems level, perceived barriers included lack of care accessibility and security, providers' misunderstanding of the transgender community, and lack of cultural competency of information systems and staff. At the community level, barriers included HIV stigma. At the family level, barriers included rejection and housing instability. At the individual level, barriers included conflicts between HIV- and transgender care, medication side effects, competing priorities, mental health issues and substance abuse, and low health literacy. Facilitators included provider competence in transgender health, improved access to care, and patient empowerment. Findings indicate the need for an integrated care model.
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Affiliation(s)
- Walter Bockting
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Caitlin MacCrate
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Hayley Israel
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
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