Health Communication and the HIV Continuum of Care

Healthy Choices Intervention is Associated with Reductions in Stigma Among Youth Living with HIV in the United States (ATN 129)

Considering the lack of validated stigma reduction interventions for youth living with HIV (YLWH), we evaluated effects of the Healthy Choices intervention on HIV-related stigma among YLWH. We analyzed data from the Adolescent Medicine Trials Network protocol 129, multi-site randomized controlled trial, applying latent growth curve modeling with two linear slopes estimating changes in Berger's Stigma Scale pre-intervention, 16, 28, and 52 weeks post-intervention, as well as the trajectory of stigma scores over the follow-up period (N = 183). Expected value for the growth intercept was statistically significant (B_intercept = 2.53; 95% CI 2.32, 2.73; p < 0.001), as were differences in the change from baseline to 16-week follow-up (B_{intercept slope1} = - 0.02; 95% CI - 0.04, 0.01; p = 0.034). Expected value of the slope factor measuring growth over the follow-up period was non-significant suggesting that stigma scores were stable from 28 to 52 weeks. Our findings warrant replication and additional research comparing effects of this intervention to counterfactual controls.

Cost-Effectiveness Analysis Combining Medical and Mental Health Services for Older Adults with HIV in New York City

Older adults with the human immunodeficiency virus or HIV (OAWH), people 50 years and older, are aging with the disease and experience low quality of life. Mental health disorders trigger and worsen health inequalities with larger impacts on the quality of life of OAWH. This paper evaluated two rival health interventions using a standard decision-analytic model and quantified the cost per quality-adjusted life-years (QALY) to understand the differential in cost and effectiveness of an additional unit of perfect health. HIV medical care was compared with a combined strategy that includes both HIV medical and behavioral care. Primary data from a convenience sample (n=139) collected in New York City and outcomes for healthy older adults from the literature were used in this study. The incremental cost-effectiveness ratio (ICER) evaluating the economic cost and health benefits of the new intervention was $36,166 per QALY, which is less than the willingness to pay ($75,000). The ICER for Hispanics was $35,325 and for White/Caucasians was $40,499. Integrated medical plus behavioral care is cost-effective and improves quality of life among OAWH. Given the high rates of mental health disorders along with an underutilization of behavioral care among OAWH, timely and effective mental health programs are paramount to increase quality of life.

Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic

Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.

Using Social Media to Enhance Provider Network for HIV and Harm Reduction Service Integration in Vietnam

Social media can potentially serve as a platform to coordinate medical care among fragmented health sectors. This paper describes procedures of using social media to enhance antiretroviral therapy (ART) and methadone maintenance treatment (MMT) providers' virtual network for integrated service for HIV-positive people who inject drugs (PWID) in Vietnam. A total of 88 ART and MMT treatment providers participated in person group sessions followed by online virtual support to improve service integration. In-person reunions were held to reinforce Facebook participation and network activities. Content analysis was used to identify keywords and topic categories of the online information exchange. Both MMT and ART providers were actively engaged in online communications. Referral and treatment adherence were the two most frequently discussed topic areas by both the MMT and ART providers. Frequent cross-agency connections were observed. Online provider networks and communities could be built and useful to support treatment providers to improve service integration.

Perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa

BACKGROUND

This study researched the perceptions of patients diagnosed with diabetes concerning diabetes-related health communication strategies in the Free State province in South Africa. The prolongation and quality of life of patients diagnosed with diabetes are affected by lifestyle choices. An enabler of risk reduction is health communication which informs, influences and motivates individuals to adopted health-focused lifestyles.

AIM

This study sought to describe the perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa.

SETTING

This study was carried out in primary health care centres and community health care centres within the Free State province in South Africa.

METHODS

A qualitative, descriptive and exploratory research design was used in this study. Thirty-four patients diagnosed with type two diabetes for at least a year were purposively included in this study. Semi-structured interviews in Afrikaans, English, Sotho and Xhosa were conducted. Data analysis was through inductive reasoning and thematic analysis.

RESULTS

The majority of the respondents were older women having been diagnosed with diabetes for more than 5 years, with at least primary school education and of diverse South African ethnicities. The main prompting questions operationalised the term 'perception', probing their feelings, experiences and knowledge of health-related communication strategies as presented by a variety of information sources. After recording interviews, data were analysed according to themes, categories and sub-categories.

CONCLUSIONS

The study highlights factors that encourage patients to seek help and foster attitudes of compliance. Practical problems regarding the management of diabetes are underlined. The role of family, as well as the patient-caregiver relationship, in the acceptance and management of the disease is revealed. Societal perception of male symptomology is shown. The study offers information to stakeholders and health care workers for continued successful management of diabetes in communities.

From HIV prevention to non-communicable disease health promotion efforts in sub-Saharan Africa: A Narrative Review

OBJECTIVE

To synthesize published literature on noncommunicable disease (NCD) behavior change communication (BCC) interventions in sub-Saharan Africa (SSA) among persons living with HIV (PLHIV) and in the general population to inform efforts to adopt similar HIV and NCD BCC intervention activities.

METHODS

We conducted a literature review of NCD BCC interventions and included 20 SSA-based studies. Inclusion criteria entailed describing a BCC intervention targeting any four priority NCDs (cardiovascular disease, type 2 diabetes, cervical cancer, and depression) or both HIV and any of the NCDs. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to assess potential public health impact of these studies. We also solicited expert opinions from 10 key informants on the topic of HIV/NCD health promotion in five SSA countries.

RESULTS

The BCC interventions reviewed targeted multiple parts of the HIV and NCD continuum at both individual and community levels. Various strategies (i.e. health education, social marketing, motivational interviewing, mobile health, and peer support) were employed. However, few studies addressed more than one dimension of the RE-AIM framework. Opinions solicited from the key informants supported the feasibility of integrating HIV and NCD BCC interventions in SSA potentially improving access, service provision and service demand, especially for marginalized and vulnerable populations.

CONCLUSION

Although HIV/NCD integration can improve effectiveness of preventive services at individual and community levels, potential public health impact of such approaches remain unknown as reach, adoptability, and sustainability of both integrated and nonintegrated NCD BCC approaches published to date have not been well characterized.

How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.