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Ford JS, Mousa MA, Voong S, Matsumoto CG, Chechi T, Tran N, May L. Risk factors for HIV infection at a large urban emergency department: a cross-sectional study. Sex Transm Infect 2023; 99:404-408. [PMID: 37015802 DOI: 10.1136/sextrans-2022-055513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES In 2019, the US Preventative Services Task Force released updated guidelines recommending HIV screening in all individuals aged 15-64 years and all pregnant females. In the current study, we aimed to identify risk factors for HIV infection in an emergency department (ED) population. METHODS We performed a cross-sectional study that employed a post hoc risk factor analysis of ED patients ≥18 years who were screened for HIV between 27 November 2018 and 26 November 2019, at a single urban, quaternary referral academic hospital. Patients were screened using HIV antigen/antibody testing and diagnoses were confirmed using HIV-1/HIV-2 antibody testing. The outcome of interest was the number of positive HIV tests. Multiple logistic regression models were used to identify risk factors associated with HIV positivity. RESULTS 14 335 adult patients were screened for HIV (mean age: 43±14 years; 52% female). HIV seroprevalence was 0.7%. Independent risk factors for HIV positivity included male sex (adjusted OR (aOR) 3.1 (95% CI 1.7 to 5.6)), unhoused status (aOR 2.9 (95% CI 1.7 to 4.9)), history of illicit drug use (aOR 1.8 (95% CI 1.04 to 3.13)) and Medicare insurance status (aOR 2.2 (95% CI 1.1 to 4.4)). CONCLUSIONS The study ED services a high-risk population with regard to HIV infection. These data support universal screening of ED patients for HIV. Risk factor profiles could improve targeted screening at institutions without universal HIV testing protocols.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mohammad A Mousa
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Stephanie Voong
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Cynthia G Matsumoto
- Department of Population Health and Accountable Care, University of California Davis Health, Sacramento, CA, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Larissa May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
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McElyea J, Bistransin K, Bana S, Alvarez KS, Brown LS, Persaud D, King H. Impact of a clinical pharmacist within an HIV PrEP program for patients experiencing homelessness. J Am Pharm Assoc (2003) 2023; 63:324-329. [PMID: 36184385 DOI: 10.1016/j.japh.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) continues to be a concern in the United States despite pre-exposure prophylaxis (PrEP) being a highly recommended preventative option. Homeless populations have a significantly increased risk of HIV acquisition, and recent literature found attrition to PrEP care being concentrated in demographics common to these populations. Pharmacist-led PrEP programs may be a feasible option to combat this attrition, as they have shown high rates of patient satisfaction and pharmacist comfortability in other populations. OBJECTIVES To evaluate PrEP uptake and the continuum of care before and after a Clinical Pharmacy Specialist (CPS) expanded HIV prevention services within a primary care setting for persons experiencing homelessness. METHODS We compared a retrospective cohort of patients experiencing homelessness who received an initial PrEP prescription during a pre-CPS period and those with an initial PrEP prescription after CPS. Charts were reviewed through the surrounding time period of a 3-month and a 6-month PrEP follow-up appointment. Outcomes evaluated included number of initial PrEP prescriptions, dispensations of PrEP, PrEP discontinuations, patient retention in PrEP care, and new HIV diagnoses. RESULTS A total of 40 patients were included, with 10 initial PrEP prescriptions in the pre-CPS population and 30 in the post-CPS one. Both groups largely represented those disproportionately impacted by HIV. After CPS, more patients were enrolled in patient assistance programs (100% vs. 44%; P < 0.01), and more patients picked up the first PrEP dispensation (80% vs. 40%; P = 0.04). The overall population had low dispensation rates and retention to care. Having no CPS management and a lack of medical appointment attendance trended toward attrition of care, and having no patient assistance program enrollment significantly led to attrition of care. CONCLUSION These findings may prompt further studies and adaptations to PrEP care among persons experiencing homelessness, including the utilization of pharmacists to improve patient outcomes.
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Eastwood EA, Nace AJ, Hirshfield S, Birnbaum JM. Young Transgender Women of Color: Homelessness, Poverty, Childhood Sexual Abuse and Implications for HIV Care. AIDS Behav 2021; 25:96-106. [PMID: 31865517 DOI: 10.1007/s10461-019-02753-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study describes a sample of HIV+ young transgender women of color aged 18-24 and their experience with homelessness as part of a demonstration project of engagement and retention in HIV medical care funded by Health Resources and Services Administration. The study engaged transgender women of color in HIV care in nine sites across the US between 2012 and 2017. This analysis describes and compares transwomen who had been homeless in the last 6 months to those not homeless. We hypothesized that homelessness would compete with HIV care, food, shelter, and be associated with poverty. Variable domains included sociodemographic, mental health and substance use, HIV care, sexual risk behavior, social support from transgender and other friends, and childhood sexual abuse. There were 102 youth enrolled, 77 (75.5%) who had been homeless, and 25 (24.5%) who had not been homeless. Bivariate analyses showed that low income, sex work as source of income, inability to afford food, lack of viral load (VL) suppression, childhood sexual abuse, lower levels of social support, and higher levels of depression were associated with homelessness. A logistic regression model showed that being unable to afford food (AOR = 9.24, 95% CI 2.13-40.16), lack of VL suppression in last 6 months (AOR = 0.10, 95% CI .02-.57), and lack of transgender friend support (AOR = 0.09, 95% CI .02-.53) was associated with homelessness. Programs that place basic needs first-food and shelter-may be able to engage and assist young transgender women of color with HIV to survive and live healthier lives.
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Affiliation(s)
- Elizabeth A Eastwood
- Department of Health Policy, CUNY School of Public Health, 55 W. 125th St, New York, NY, 10027, USA.
| | - Amanda J Nace
- Department of Health Policy, CUNY School of Public Health, 55 W. 125th St, New York, NY, 10027, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeffrey M Birnbaum
- Department of Pediatrics, SUNY Downstate Health Sciences University and SUNY Downstate School of Public Health, Brooklyn, NY, USA
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Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open 2021; 11:e040061. [PMID: 33622940 PMCID: PMC7907847 DOI: 10.1136/bmjopen-2020-040061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.
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Affiliation(s)
- Getinet Ayano
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
- Department of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Asmare Belete
- Department of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Duko
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | - Berihun Assefa Dachew
- Department of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
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Thompson RG, Aivadyan C, Stohl M, Aharonovich E, Hasin DS. Smartphone application plus brief motivational intervention reduces substance use and sexual risk behaviors among homeless young adults: Results from a randomized controlled trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:641-649. [PMID: 32175752 PMCID: PMC9997652 DOI: 10.1037/adb0000570] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Homeless young adults are more likely than their never-homeless counterparts to abuse substances and engage in sexual risk behaviors. This study evaluated the feasibility and preliminary effectiveness of OnTrack, a smartphone application to self-monitor substance use and sexual risk behaviors, plus a brief motivational intervention (BMI), in reducing substance use and sexual risk among homeless young adults. A randomized controlled pilot trial (N = 60) compared OnTrack + BMI to treatment as usual (TAU) at an inner-city crisis shelter for homeless young adults (aged 18-21 years). Participants were assessed at baseline and 2 weeks, 4 weeks, and 6 weeks after baseline to evaluate substance use and sexual risk behaviors. Kruskal-Wallis tests determined differences between baseline and postintervention assessments. Logistic regression models examined treatment effect on change in outcomes between baseline and postintervention follow-up assessment, controlling for baseline levels. Participants in OnTrack + BMI significantly reduced past 2-week number of drinks (p = .023), times used marijuana (p = .046), times engaged in unprotected sex (p = .012), and times used drugs before sexual activity (p = .019). No reductions of substance use or sexual risk behaviors were found among participants in TAU (all ps > .05). After adjusting for baseline levels of substance use and sexual risk, participants in OnTrack + BMI had significantly lower odds than those in TAU for drinking alcohol (adjusted OR = 0.14; p = .01) and having unprotected sex (adjusted OR = 0.151; p = .032). OnTrack + BMI is feasible and effective in reducing past 2-week alcohol use and unprotected sex among homeless young adults. A larger randomized trial is warranted to replicate and extend present results. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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McCumber M, Cain D, LeGrand S, Mayer KH, Murphy DA, Psioda MA, Seña AC, Starks TJ, Hudgens M. Adolescent Medicine Trials Network for HIV/AIDS Interventions Data Harmonization: Rationale and Development of Guidelines. JMIR Res Protoc 2018; 7:e11207. [PMID: 30578242 PMCID: PMC6320398 DOI: 10.2196/11207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program aims to defeat the rising HIV epidemic among adolescents and young adults in the United States. Objective This study aims to optimize cross-study analyses and comparisons of standardized measures (variables) collected in the ATN. Methods Guidelines were developed for harmonizing measures to be collected across ATN studies. Results Eight domains were identified for harmonization—Demographics and Socioeconomic Characteristics, Sexual Behavior and Risk, Substance Use and Abuse, HIV-Positive Cascade, HIV-Negative Cascade, Mental Health, Social Support and Isolation, and Pre-exposure Prophylaxis Cascade. Conclusions The collection of selected key measures in a uniform manner across studies facilitates the characterization of participant populations, comparisons between studies, and pooled analysis of data from multiple studies.
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Affiliation(s)
- Micah McCumber
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Demetria Cain
- Center for HIV Educational Studies & Training, Hunter College, New York, NY, United States
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Debra A Murphy
- Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, United States
| | - Matthew A Psioda
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tyrel J Starks
- Center for HIV Educational Studies & Training, Hunter College, New York, NY, United States.,Department of Psychology, Hunter College, New York, NY, United States
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Lee CT, Winquist A, Wiewel EW, Braunstein S, Jordan HT, Gould LH, Gwynn RC, Lim S. Long-Term Supportive Housing is Associated with Decreased Risk for New HIV Diagnoses Among a Large Cohort of Homeless Persons in New York City. AIDS Behav 2018; 22:3083-3090. [PMID: 29737441 DOI: 10.1007/s10461-018-2138-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing. We linked data from a cohort of 21,689 persons without a previous HIV diagnosis who applied to a supportive housing program in New York City (NYC) during 2007-2013 to the NYC HIV surveillance registry. We used time-dependent Cox modeling to compare new HIV diagnoses among recipients of supportive housing (defined a priori, for program evaluation purposes, as persons who spent > 7 days in supportive housing; n = 6447) and unplaced applicants (remainder of cohort), after balancing the groups on baseline characteristics with propensity score weights. Compared with unplaced applicants, persons who received ≥ 3 continuous years of supportive housing had decreased risk for new HIV diagnosis (HR 0.10; CI 0.01-0.99). Risk of new HIV diagnosis decreased with longer duration placement in supportive housing. Supportive housing might aid in primary HIV prevention.
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Abstract
Rigorous HIV-related data for the homeless population in Jamaica is limited. A cross-sectional survey using a venue-based sampling approach was conducted in 2015 to derive HIV prevalence and associated risk factors. Three hundred twenty-three homeless persons from the parishes of St. James, St. Ann, Kingston, and St. Andrew (the main urban centers) participated. HIV prevalence was 13.8%, with a difference in gender (males 11.6%, females 26.7%, P = .007). Sex work, multiple partnerships, incarceration, non-injecting drug use, and female rape were common among the participants. Long-term, multilayered, HIV-specific, female-focused interventions are required for the population, along with additional female-centric research.
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Affiliation(s)
- Nicola Skyers
- HIV/STI/Tb Unit, Ministry of Health, Kingston, Jamaica.
| | | | - Willi McFarland
- University of California, San Francisco, San Francisco, CA, USA
| | - Dahlia Cole
- National Council of Drug Abuse, Kingston, Jamaica
| | - Uki Atkinson
- National Council of Drug Abuse, Kingston, Jamaica
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Thompson RG, Elliott JC, Hu MC, Aivadyan C, Aharonovich E, Hasin DS. Short-term effects of a brief intervention to reduce alcohol use and sexual risk among homeless young adults: Results from a randomized controlled trial. ADDICTION RESEARCH & THEORY 2016; 25:24-31. [PMID: 28620272 PMCID: PMC5467538 DOI: 10.1080/16066359.2016.1193165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Homeless young adults are more likely than their never-homeless counterparts to abuse alcohol and engage in risky sexual behaviors, yet no interventions to simultaneously reduce both these behaviors among this vulnerable population have been systematically designed and evaluated. We therefore developed a brief intervention (BI) to reduce both alcohol use and sexual risk behaviors among homeless young adults. The results of a randomized trial testing the BI against an education comparison (EC) are presented. METHOD Young adults (N=61; age 17-22 years) from an urban, Northeastern crisis shelter were randomly assigned to either the 2-session, individual-level BI or a time-matched, 2-session, individual-level EC. Generalized linear mixed models for repeated measures determined effects of treatment condition on outcomes. RESULTS The BI significantly increased participant readiness to change alcohol use. However, it did not significantly decrease primary alcohol or HIV sexual risk outcomes, independently or relative to EC (all ps>.05). Participants in the EC reduced times engaged in unprotected sex between baseline and post-intervention to a significantly greater extent (p<.01) than those in the BI condition. Participants in both conditions reported satisfaction with respective interventions. CONCLUSIONS Findings suggest that the BI was acceptable and successful in getting participants to consider changing their drinking. However, lack of change in alcohol and sexual behavior outcomes indicates the need for further research to determine how to translate readiness to change into actual behavioral change among homeless young adults.
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Affiliation(s)
- Ronald G. Thompson
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
| | - Jennifer C. Elliott
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
| | | | - Efrat Aharonovich
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
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