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Lee DU, Kwon J, Han J, Chang K, Kolachana S, Bahadur A, Lee KJ, Fan GH, Malik R. The Impact of Race and Sex on the Clinical Outcomes of Homeless Patients With Alcoholic Liver Disease: Propensity Score Matched Analysis of US Hospitals. J Clin Gastroenterol 2024; 58:708-717. [PMID: 37983807 PMCID: PMC11035492 DOI: 10.1097/mcg.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Among patients with alcoholic liver disease (ALD), homelessness poses significant medical and psychosocial risks; however, less is known about the effects of race and sex on the hospital outcomes of admitted homeless patients with ALD. METHODS The National Inpatient Sample database from 2012 to 2017 was used to isolate homeless patients with ALD, and the cohort was further stratified by race and sex for comparisons. Propensity score matching was utilized to minimize covariate confounding. The primary endpoints of this study include mortality, hospital length of stay, and hospital costs; secondary endpoints included the incidence of liver complications. RESULTS There were 3972 females/males postmatch, as well as 2224 Blacks/Whites and 4575 Hispanics/Whites postmatch. In multivariate, there were no significant differences observed in mortality rate, length of stay, and costs between sexes. Comparing liver outcomes, females had a higher incidence of hepatic encephalopathy [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04, P <0.001]. In comparing Blacks versus Whites, Black patients had higher hospitalization costs (aOR 1.13, 95% CI: 1.03-1.24, P =0.01); however, there were no significant differences in mortality, length of stay, or liver complications. In comparing Hispanics versus Whites, Hispanic patients had longer length of hospital stay (aOR 1.12, 95% CI: 1.06-1.19, P <0.001), greater costs (aOR 1.15, 95% CI: 1.09-1.22, P <0.001), as well as higher prevalence of liver complications including varices (aOR 1.04, 95% CI: 1.02-1.06, P <0.001), hepatic encephalopathy (aOR 1.03, 95% CI: 1.02-1.04, P <0.001), and hepatorenal syndrome (aOR 1.01, 95% CI 1.00-1.01, P =0.03). However, there was no difference in mortality between White and Hispanic patients. CONCLUSIONS Black and Hispanic ALD patients experiencing homelessness were found to incur higher hospital charges; furthermore, Hispanic patients also had greater length of stay and higher incidence of liver-related complications compared with White counterparts.
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Affiliation(s)
- David U Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD
| | - Jean Kwon
- Division of Gastroenterology, Tufts Medical Center, Liver Center, Boston, MA
| | - John Han
- Division of Gastroenterology, Tufts Medical Center, Liver Center, Boston, MA
| | - Kevin Chang
- Division of Gastroenterology, Tufts Medical Center, Liver Center, Boston, MA
| | - Sindhura Kolachana
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD
| | - Aneesh Bahadur
- Division of Gastroenterology, Tufts Medical Center, Liver Center, Boston, MA
| | - Ki Jung Lee
- Division of Gastroenterology, Tufts Medical Center, Liver Center, Boston, MA
| | - Gregory H Fan
- Division of Gastroenterology, Tufts Medical Center, Liver Center, Boston, MA
| | - Raza Malik
- Division of Gastroenterology, Albany Medical Center, Liver Center, Albany, NY
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Forthal S, Choi S, Yerneni R, Macinski S, Levey W, Kerwin J, Ahadzi M, Fish D, Anderson BJ, Neighbors C. Impact of supportive housing health homes program on medicaid utilization for persons diagnosed with HIV (PDWH). AIDS Care 2023; 35:1885-1890. [PMID: 36524897 PMCID: PMC10272282 DOI: 10.1080/09540121.2022.2158302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACTUnstable housing among persons diagnosed with HIV (PDWH) has been consistently linked to poor HIV-related care engagement. We examined the relationship between enrollment in a supportive housing program and health care utilization (use of outpatient services, emergency department (ED) visits, and hospitalizations) for a group of unstably housed, Medicaid and Health Homes (HH)-enrolled PDWH in New York State. We analyzed monthly longitudinal data consisting of linked supportive housing data, HH data, and Medicaid claims from New York State (excluding New York City) between 2012 and 2017 using time series models. Participants who had at least six consecutive months of supportive housing at month t had 20% higher odds of using an outpatient service, 19% lower odds of visiting the ED, and 24% lower odds of being hospitalized compared to those with less than six consecutive months of supportive housing after adjusting for covariates. Supportive housing may promote better medical management by increasing outpatient visits among chronically homeless PDWH.
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Affiliation(s)
- Sarah Forthal
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
| | - Sugy Choi
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Rajeev Yerneni
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
| | - Sarah Macinski
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Wendy Levey
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Joseph Kerwin
- AIDS Institute, New York State Department of Health, Albany, New York
| | - Martina Ahadzi
- Office of Health Insurance Programs, New York State Department of Health, Albany, New York
| | - Douglas Fish
- Office of Health Insurance Programs, New York State Department of Health, Albany, New York
| | - Bridget J. Anderson
- AIDS Institute, New York State Department of Health, Albany, New York
- New York State Center for Community Health, Department of Health, Albany, New York
| | - Charles Neighbors
- Department of Data Science, Partnership to End Addiction, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Sharma R, Dale SK. Using Network Analysis to Assess the Effects of Trauma, Psychosocial, and Socioeconomic Factors on Health Outcomes Among Black Women Living with HIV. AIDS Behav 2023; 27:400-415. [PMID: 35927538 PMCID: PMC10712664 DOI: 10.1007/s10461-022-03774-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Black women living with HIV (BWLWH) face intersectional adversities impacting their wellbeing. This study utilized network analysis to assess the associations among adversities linked to racism, sexism, HIV stigma, and socioeconomic status (income, housing, education) and determine which adversities predict mental health outcomes, HIV viral load, and medication adherence more consistently among BWLWH. 119 BWLWH aged 18 years or older completed self-report measures on sociodemographics, adversity factors, and mental health outcomes. Viral load count was obtained through blood draws, and medication adherence was measured via Wisepill adherence monitoring device. Multiple regression analysis was used to assess if the more central factors in the network also predicted health outcomes more consistently than the less central factors. The four most central factors in the network were income, housing, gendered racial microaggression (GRM) frequency, and GRM appraisal. Multiple regression analysis revealed that GRM frequency, GRM appraisal, and the number of traumas contributed uniquely and were positively associated with both depressive symptoms and posttraumatic stress disorder symptoms. HIV-related discrimination contributed uniquely and was positively associated with HIV viral load.
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Affiliation(s)
- Ratanpriya Sharma
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
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4
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Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
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Wagner GJ, Seelam R, Hoffman R, Ghosh-Dastidar B. Mediators and moderators of ART adherence effects of supporting treatment adherence readiness through training (START): evidence that START helps vulnerable clients achieve better adherence. AIDS Care 2022; 34:1249-1256. [PMID: 34802352 PMCID: PMC9123093 DOI: 10.1080/09540121.2021.2006133] [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: 10/01/2020] [Accepted: 11/09/2021] [Indexed: 01/26/2023]
Abstract
Supporting Treatment Adherence Readiness through Training (START) is an HIV antiretroviral adherence intervention, based on the Information Motivation and Behavioral skills (IMB) model, that significantly improved adherence in our randomized controlled trial. To understand how and for whom START had its effects on adherence, we examined mediators and moderators. Ninety-nine HIV-patients (53 control, 46 intervention) who enrolled in the trial and provided month 6 electronic monitored adherence data. The intervention was associated with increased adherence-related knowledge and lower impulsive/careless problem solving, but had no effects on other IMB-related constructs. Neither of these variables mediated the adherence effects of the intervention (based on linear regression models with bootstraping for unbiased standard errors). Four variables interacted with the intervention to moderate its effects: the intervention group had consistent high adherence across the range of depression and time since HIV diagnosis, compared to lower adherence with higher values in the usual care control; those with unstable housing or frequent drug use had higher adherence if in the intervention group compared to the control group. These findings suggest that START provides support that enables its recipients to cope with and overcome challenges (e.g., depression, unstable housing, drug use) that would typically impede adherence.Trial registration: ClinicalTrials.gov identifier: NCT02329782.
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6
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Bleasdale J, Leone LA, Morse GD, Liu Y, Taylor S, Przybyla SM. Socio-Structural Factors and HIV Care Engagement among People Living with HIV during the COVID-19 Pandemic: A Qualitative Study in the United States. Trop Med Infect Dis 2022; 7:259. [PMID: 36288000 PMCID: PMC9607497 DOI: 10.3390/tropicalmed7100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 08/22/2023] Open
Abstract
Achieving HIV prevention goals will require successful engagement in each stage of the HIV continuum. The present study sought to understand the ways in which socio-structural factors influence HIV care engagement among people living with HIV (PLH) within the context of the ongoing COVID-19 pandemic. Twenty-five PLH were recruited from January to October 2021. Semi-structured interviews discussed various socio-contextual factors that influenced engagement in HIV-related care as a result of the pandemic. A thematic content analysis reported semantic level themes describing factors influencing HIV care following an integrated inductive-deductive approach. Qualitative analysis revealed three themes that either supported or hindered engagement in care within the context of the COVID-19 pandemic: (1) social determinants of health, (2) social support, and (3) modes of healthcare delivery. The results underscore the need to assess socio-structural factors of health as means to promote successful engagement in the HIV care continuum and shed new insights to guide future practice in the era of COVID-19.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Shelby Taylor
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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7
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Molecular Epidemiology of Individuals Experiencing Unstable Housing or Living Homeless at HIV Diagnosis: Analysis of HIV Surveillance Data in King County, Washington. AIDS Behav 2022; 26:3459-3468. [PMID: 35445995 DOI: 10.1007/s10461-022-03689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/01/2022]
Abstract
We examined patterns of genetic clustering among individuals diagnosed with HIV between 2010 and 2018 using data from King County, Washington's National HIV Surveillance System. Among 2,371 individuals newly diagnosed with HIV, 231 (10%) experienced unstable housing or were living homeless at the time of diagnosis. Among the 1,658 (70%) people with an available HIV-1 pol gene sequence, 1,071 (65%) were identified to be part of 296 genetic clusters. In our analysis, housing status was not associated with genetic clustering (OR 1.02; 95%CI:0.75,1.39). After adjusting for demographic and behavioral factors, people who were living homeless at HIV diagnosis had 35% lower odds of being identified as part of a genetic cluster (AOR 0.65; 95%CI:0.44,0.95) compared to people with stable housing. Our findings highlight that people experiencing unstable housing are disproportionately burdened by HIV, and that within this population in King County, being in a genetic cluster is predominantly associated with substance use.
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8
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Jones DL, Salazar AS, Rodriguez VJ, Balise RR, Starita CU, Morgan K, Raccamarich PD, Montgomerie E, Nogueira NF, Barreto Ojeda I, Maddalon M, Rodriguez NLY, Brophy T, Martinez T, Alcaide ML. Severe Acute Respiratory Syndrome Coronavirus 2: Vaccine Hesitancy Among Underrepresented Racial and Ethnic Groups With HIV in Miami, Florida. Open Forum Infect Dis 2021; 8:ofab154. [PMID: 34621912 PMCID: PMC8083672 DOI: 10.1093/ofid/ofab154] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) disproportionally affect underrepresented ethnoracial groups in the United States. Medical mistrust and vaccine hesitancy will likely impact acceptability of SARS-CoV-2 vaccines. This study examined SARS-CoV-2 vaccine hesitancy among underrepresented ethnoracial groups with HIV and identified factors that may reduce vaccine uptake. METHODS We conducted a cross-sectional study of adults ≥18 years of age with HIV residing in Miami, Florida. Participants were invited to participate in the ACTION (A Comprehensive Translational Initiative on Novel Coronavirus) cohort study. A baseline survey was administered from April to August 2020 and followed by a coronavirus disease 2019 (COVID-19) vaccine hesitancy survey from August to November 2020. The COVID-19 vaccine hesitancy survey was adapted from the Strategic Advisory Group of Experts survey. Comparisons by race and ethnicity were performed using the Freedman-Haltmann extension of the Fisher exact test. RESULTS A total of 94 participants were enrolled; mean age was 54.4 years, 52% were female, 60% were Black non-Latinx, and 40% were non-Black Latinx. Black non-Latinx participants were less likely to agree that vaccinations are important for health when compared to non-Black Latinx (67.8% vs 92.1%, P = .009), less likely to agree that vaccines are effective in preventing disease (67.8% vs 84.2%, P = .029), less likely to believe that vaccine information is reliable and trustworthy (35.7% vs 71.1%, P = .002), and less likely to believe vaccines were unnecessary because COVID-19 would disappear soon (11% vs 21%, P = .049). CONCLUSIONS Medical mistrust, vaccine hesitancy, and negative sentiments about SARS-CoV-2 vaccines are prevalent among underrepresented ethnoracial groups with HIV, particularly Black non-Latinx. Targeted strategies to increase vaccine uptake in this population are warranted.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | | | - Raymond R Balise
- Division of Biostatistics, Department of Public Health
Sciences, University of Miami Miller School of Medicine,
Miami, Florida, USA
| | - Claudia Uribe Starita
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Kristiana Morgan
- Division of Biostatistics, Department of Public Health
Sciences, University of Miami Miller School of Medicine,
Miami, Florida, USA
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Patricia D Raccamarich
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Emily Montgomerie
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Irma Barreto Ojeda
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Marissa Maddalon
- University of Miami School of Nursing and Health
Studies, Miami, Florida, USA
| | - Nicolle L Yanes Rodriguez
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami,
Florida, USA
| | - Theodora Brophy
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Thais Martinez
- University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine,
University of Miami Miller School of Medicine, Miami,
Florida, USA
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Brief Report: Associations Between Self-Reported Substance Use Behaviors and PrEP Acceptance and Adherence Among Black MSM in the HPTN 073 Study. J Acquir Immune Defic Syndr 2021; 85:23-29. [PMID: 32452970 DOI: 10.1097/qai.0000000000002407] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention. Black men who have sex with men (MSM) accounted for the largest proportion of new HIV diagnoses in the United States relative to other racial/ethnic groups. Black MSM who use substances are at an increased risk for HIV infection and are ideal candidates for PrEP, but barriers to maintaining PrEP adherence remain a concern. We assessed whether substance use behaviors are associated with initiation and adherence to PrEP among a sample of black MSM in the United States. METHODS Data for this analysis come from the HIV Prevention Trails Network Study 073 (HPTN 073). Substance use behaviors-including alcohol, marijuana, poppers (ie, alkyl nitrites), and stimulants (ie, methamphetamine/cocaine use) including use of these substances before/during condomless anal intercourse (CAI)-were assessed longitudinally through self-report. PrEP adherence was assessed by pharmacological testing in blood. Generalized estimating equations were used to evaluate association between substance use behaviors and PrEP initiation and adherence. RESULTS Among 226 HIV-negative black MSM, the majority (60%) were 25+ years of age. Most of the substance use behaviors were not significantly associated with PrEP initiation or adherence. However, stimulant use before/during CAI was significantly associated with lower odds of PrEP adherence (adjusted odds ratio = 0.21, 95% confidence interval = 0.07 to 0.61; P = <0.01). CONCLUSIONS These findings suggest that PrEP adherence is feasible among black MSM who use substances. However, black MSM who engage in stimulant use before/during CAI may present a unique group for additional study and support with enhanced behavioral health and support services.
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10
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Trajectories of Viral Suppression in People Living With HIV Receiving Coordinated Care: Differences by Comorbidities. J Acquir Immune Defic Syndr 2021; 84:387-395. [PMID: 32598118 DOI: 10.1097/qai.0000000000002351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND In March of 2013, the Los Angeles County (LAC) Division of HIV and STD Programs implemented a clinic-based Medical Care Coordination (MCC) Program to increase viral suppression (VS) (<200 c/mL) among people living with HIV (PLWH) at high risk for poor health outcomes. OBJECTIVE This study aimed to estimate trajectories of VS and to assess whether these trajectories differed by stimulant use, housing instability, and depressive symptom severity as reported by PLWH participating in MCC. METHODS Data represent 6408 PLWH in LAC receiving services from the MCC Program and were obtained from LAC HIV surveillance data matched to behavioral assessments obtained across 35 Ryan White Program clinics participating in MCC. Piecewise mixed-effects logistic regression with a random intercept estimated probabilities of VS from 12 months before MCC enrollment through 36 months after enrollment, accounting for time by covariate interactions for 3 comorbid conditions: housing instability, stimulant use, and depressive symptoms. RESULTS The overall probability of VS increased from 0.35 to 0.77 within the first 6 months in the MCC Program, and this probability was maintained up to 36 months after enrollment. Those who reported housing instability, stimulant use, or multiple comorbid conditions did not achieve the same probability of VS by 36 months as those with none of those comorbidities. CONCLUSIONS Findings suggest that MCC improved the probability of VS for all patient groups regardless of the presence of comorbidities. However, those with comorbid conditions will still require increased support from patient-centered programs to address disparities in VS.
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Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021. [DOI: https://doi.org.10.1097/qai.0000000000002570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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12
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Bogart LM, Ojikutu BO, Tyagi K, Klein DJ, Mutchler MG, Dong L, Lawrence SJ, Thomas DR, Kellman S. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr 2021; 86:200-207. [PMID: 33196555 PMCID: PMC7808278 DOI: 10.1097/qai.0000000000002570] [Citation(s) in RCA: 288] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. METHODS Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. RESULTS Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = -5.19 (2.08), P = 0.02]. DISCUSSION To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.
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Affiliation(s)
| | - Bisola O. Ojikutu
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
- Infectious Disease Division, Massachusetts General Hospital, Boston, MA
- Division of Global Health Equity, Harvard Medical School, Boston, MA
| | - Keshav Tyagi
- Community-Based Research, APLA Health & Wellness; and
| | | | - Matt G. Mutchler
- Community-Based Research, APLA Health & Wellness; and
- Department of Health Science, California State University, Dominguez Hills
| | | | | | | | - Sarah Kellman
- Community-Based Research, APLA Health & Wellness; and
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Increases in social support co-occur with decreases in depressive symptoms and substance use problems among adults in permanent supportive housing: an 18-month longitudinal study. BMC Psychol 2021; 9:6. [PMID: 33407857 PMCID: PMC7789599 DOI: 10.1186/s40359-020-00507-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Social support is a well-known protective factor against depressive symptoms and substance use problems, but very few studies have examined its protective effects among residents of permanent supportive housing (PSH), a housing program for people with a history of chronic homelessness. We utilized unconditional latent growth curve models (LGCMs) and parallel process growth models to describe univariate trajectories of social support, depressive symptoms, and substance use problems and to examine their longitudinal associations in a large sample of adults residing in PSH. METHODS Participants were 653 adult PSH residents in North Texas (56% female; 57% Black; mean age: 51 years) who participated in a monthly health coaching program from 2014 to 2017. Their health behaviors were assessed at baseline and tracked every six months at three follow-up visits. RESULTS Unconditional LGCMs indicated that over time, social support increased, whereas depressive symptoms and substance use problems decreased. However, their rates of change slowed over time. Further, in parallel process growth models, we found that at baseline, individuals with greater social support tended to have less severe depressive symptoms and substance use problems (coefficients: - 0.67, p < 0.01; - 0.52, p < 0.01, respectively). Individuals with a faster increase in social support tended to have steeper rates of reduction in both depressive symptoms (coefficient: - 0.99, p < 0.01) and substance use problems (coefficient: - 0.98, p < 0.01), respectively. CONCLUSIONS This study suggests that plausibly, increases in social support, though slowing over time, still positively impact depressive symptoms and substance use problems among PSH residents. Future PSH programs could emphasize social support as an early component as it may contribute to clients' overall health.
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Mantsios A, Murray M, Karver TS, Davis W, Margolis D, Kumar P, Swindells S, Bredeek UF, García Del Toro M, Garcia Gasalla M, Rubio García R, Antela A, Hudson K, Griffith S, Kerrigan D. Efficacy and Freedom: Patient Experiences with the Transition from Daily Oral to Long-Acting Injectable Antiretroviral Therapy to Treat HIV in the Context of Phase 3 Trials. AIDS Behav 2020; 24:3473-3481. [PMID: 32410051 DOI: 10.1007/s10461-020-02918-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Long-acting injectable antiretroviral therapy (LA ART) may be an alternative for people living with HIV (PLHIV) with adherence challenges or who prefer not to take pills. Using in-depth interviews, this study sought to understand the experiences of PLHIV (n = 53) participating in Phase 3 LA ART trials in the United States and Spain. The most salient consideration when contemplating LA ART was its clinical efficacy; many participants reported wanting to ensure that it worked as well as daily oral ART, including with less frequent dosing (every 8 versus 4 weeks). While injection side effects were often reported, most participants felt that regimen benefits outweighed such drawbacks. Participants described the main benefit of LA ART as the "freedom" it afforded both logistically and psychosocially, including through reduced HIV stigma. Findings highlight the importance of patient-provider communication related to weighing potential benefits and side effects and the continued need to address HIV stigma.
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Affiliation(s)
| | | | | | | | | | | | - Susan Swindells
- University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - U Fritz Bredeek
- Metropolis Medical San Francisco, San Francisco, CA, 94109, USA
| | | | | | | | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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15
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Padilla M, Frazier EL, Carree T, Luke Shouse R, Fagan J. Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States - Medical Monitoring Project, 2009-2015. AIDS Care 2019; 32:594-599. [PMID: 31650855 DOI: 10.1080/09540121.2019.1683808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Homelessness is a challenge to retention in HIV care and adherence to antiretroviral therapy. We describe the sociodemographic and behavioral characteristics of HIV-positive adults who reported recent homelessness. The Medical Monitoring Project is a complex sample survey of HIV-positive adults receiving medical care in the United States. We used weighted interview and medical record data collected from June 2009 to May 2015 to estimate the prevalence of depression, substance use, and HIV risk behaviors among adults experiencing recent homelessness. From 2009 to 2015, 8.3% of HIV-positive adults experienced recent homelessness. Homeless adults were more likely than housed adults to have major depression, to binge drink, use non-injection drugs, use injection drugs, and smoke. Over 60% of homeless adults were sexually active during the past year, with homeless adults reporting more condomless sex with an HIV-negative or unknown status sex partner than housed adults. Programs attempting to improve the health outcomes of HIV-positive homeless persons and reduce ongoing HIV transmission can focus on providing basic needs, such as housing, and ancillary services, such as mental health counseling or substance abuse treatment and counseling.
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Affiliation(s)
- Mabel Padilla
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma L Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamara Carree
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,ICF International, Atlanta, GA, USA
| | - R Luke Shouse
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Fagan
- 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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16
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Zewde N, Eliason E, Allen H, Gross T. The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016. Am J Public Health 2019; 109:1379-1383. [PMID: 31415189 DOI: 10.2105/ajph.2019.305230] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the effect of the Affordable Care Act (ACA) Medicaid expansions on national rates of home eviction and eviction initiation in the United States.Methods. Using nationally representative administrative data from The Eviction Lab at Princeton University, we estimated the effects of the ACA Medicaid expansions on county-level evictions and filings from 2000 to 2016 with a difference-in-difference regression design.Results. We found that Medicaid expansions were associated with an annual reduction in the rate of evictions by 1.15 per 1000 renter-occupied households (P < .001), a reduction of 1.59 eviction filings per 1000 renter-occupied households (P < .001), and a reduction in the average number of evictions by 46 (P < .05). We found additional evidence that increasing rates of African American residents in a county was associated with a greater rate of evictions filed, and increased rates of poverty and rent burdens relative to income were associated with more evictions both filed and completed.Conclusions. Evictions decreased after Medicaid expansion, demonstrating further evidence of the substantive financial protections afforded by this coverage. The reduction in the eviction filing rate suggests that Medicaid expansion could be reducing evictions by preventing the court proceeding entirely.
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Affiliation(s)
- Naomi Zewde
- Naomi Zewde, Erica Eliason, and Heidi Allen are with Columbia University School of Social Work, New York, NY. Tal Gross is with Boston University Questrom School of Business, Boston, MA
| | - Erica Eliason
- Naomi Zewde, Erica Eliason, and Heidi Allen are with Columbia University School of Social Work, New York, NY. Tal Gross is with Boston University Questrom School of Business, Boston, MA
| | - Heidi Allen
- Naomi Zewde, Erica Eliason, and Heidi Allen are with Columbia University School of Social Work, New York, NY. Tal Gross is with Boston University Questrom School of Business, Boston, MA
| | - Tal Gross
- Naomi Zewde, Erica Eliason, and Heidi Allen are with Columbia University School of Social Work, New York, NY. Tal Gross is with Boston University Questrom School of Business, Boston, MA
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Rajabiun S, Tryon J, Feaster M, Pan A, McKeithan L, Fortu K, Cabral HJ, Borne D, Altice FL. The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness. Am J Public Health 2018; 108:S539-S545. [PMID: 32941777 DOI: 10.2105/ajph.2018.304736] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017.Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervention. HIV outcomes included linkage and retention in care, antiretroviral therapy prescription, and viral suppression collected via chart review.Results. In the 12 months after the intervention, 59.6% transitioned to more stable housing. Compared with those who became or remained unstably housed, participants with greater stability achieved significantly higher rates of retention (adjusted odds ratio [AOR] = 2.12; 95% confidence interval [CI] = 1.11, 4.05), were more likely to be prescribed antiretroviral therapy (AOR = 2.06; 95% CI = 1.62, 2.63), and had higher rates of viral suppression (AOR = 1.62; 95% CI = 1.03, 2.55).Conclusions. The use of patient navigators to create a network of services for PLWH who are unstably housed can improve housing stability and lead to improvements in HIV-related outcomes.
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Affiliation(s)
- Serena Rajabiun
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Janell Tryon
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Matt Feaster
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Amy Pan
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Lisa McKeithan
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Karen Fortu
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Howard J Cabral
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Deborah Borne
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
| | - Frederick L Altice
- Serena Rajabiun is with Boston University School of Social Work, Center for Innovation in Social Work and Health, Boston, MA. Serena Rajabiun is also a Guest Editor for this supplement issue. Janell Tryon and Deborah Borne are with San Francisco Department of Public Health, San Francisco, CA. Matt Feaster is with Department of Public Health, City of Pasadena, Pasadena, CA. Amy Pan is with the Institute for Public Health, San Diego State University, San Diego, CA. Lisa McKeithan is with Commwell Health, Dunn, NC. Karen Fortu is with Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center, Boston. Howard J. Cabral is with Boston University School of Public Health, Department of Biostatistics, Boston. Frederick L. Altice is with the Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, and Yale School of Epidemiology and Public Health, New Haven, CT
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Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care. Soc Sci Med 2018; 211:78-86. [PMID: 29913303 DOI: 10.1016/j.socscimed.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 01/06/2023]
Abstract
RATIONALE Both the HIV epidemic and incarceration disproportionately affect Black men in the United States. A critical period for incarcerated Black men living with HIV/AIDS is re-entry into the community, which is often associated with adverse health outcomes. Additionally, Black men living with HIV/AIDS involved in the criminal justice system are burdened by multiple, intersecting disadvantaged identities and social positions. OBJECTIVE This study aimed to examine community re-entry experiences among Black men living with HIV/AIDS from an intersectional perspective. METHOD In-depth, semi-structured interviews were conducted with 16 incarcerated Black men in Wisconsin, at pre-release from prison and six months after re-entry. Thematic analysis guided by intersectionality theory was used to analyze interview transcripts. RESULTS Seven emerged themes included Intersectional Identities and Social Positions, Family Support, Neighborhood Violence, Relationship with Law Enforcement, Employment, Mental Health Concerns, and Medical Care and Medication Management. Intersecting identities and social positions interact with factors at multiple levels to inform health and HIV care. A conceptual framework was developed to illustrate relationships among themes. CONCLUSIONS Findings demonstrate the relevance of intersectionality theory in HIV care with Black men involved in criminal justice system. Incorporating a social-ecological perspective into intersectionality framework could be useful in theoretical and empirical research. Disenfranchised communities may particularly benefit from interventions that address community- and systemic-level issues.
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Regular Marijuana Use is Associated with Poor Viral Suppression in HIV-Infected Adolescents and Young Adults. AIDS Behav 2018; 22:1363-1372. [PMID: 29094229 DOI: 10.1007/s10461-017-1961-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is a paucity of data regarding the impact of drug use on HIV suppression and care retention among adolescents and young adults (AYAs). We recruited a clinic-based sample of HIV infected AYAs to assess the prevalence of self-reported drug use. Clinical data, including retention and viral suppression, were abstracted from the electronic medical record. Logistic regression was used to evaluate marijuana and illicit drug use associations and to identify other risk factors. Of 200 participants (mean age 21, 2.4 years, 69% horizontally infected), 46% reported current drug use, with marijuana as the most commonly used drug. Any illicit drug use (aOR 1.99, 95% CI 1.06-3.73, p = 0.032) and lower education (aOR 2.11, 95% CI 1.09-4.08, p = 0.046) were associated with poor viral suppression in multivariable analyses. Considering marijuana use only, an association with poor viral suppression was more pronounced (aOR 2.10, 95% CI 1.12-3.94, p = 0.021). Drug use did not have a significant association with retention in care, but AYAs who were retained in HIV care were less likely to have poorly suppressed HIV (aOR 0.22, 95% CI 0.10-0.49, p < 0.001). High prevalence of marijuana use among HIV infected AYAs, and its association with poorly suppressed HIV, demonstrates the need for intervention strategies to decrease its consumption.
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