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Polonijo AN, Nguyen AL, Greene KY, Lopez JL, Yoo-Jeong M, Ruiz EL, Christensen C, Galea JT, Brown B. Brief virtual intervention associated with increased social engagement and decreased negative affect among people aging with HIV. AIDS Care 2024:1-9. [PMID: 38497407 DOI: 10.1080/09540121.2024.2329644] [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: 10/10/2023] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
Virtual Villages-online communities that deliver supports to promote aging in place-are proposed to mitigate isolation and support the health of aging populations. Using a community-engaged approach, we developed and pilot-tested a Virtual Village intervention tailored for people living with HIV (PLWH) aged 50+ . The intervention employed a Discord server featuring social interaction, regional and national resources, expert presentations, and mindful meditation exercises. In 2022, a sample of PLWH aged 50+ from three U.S. study sites participated in a four-week pilot. Pre- and post-intervention surveys assessed participants' demographic characteristics; degree of loneliness, social connectedness, HIV-related stigma, and technology acceptance; mental wellbeing and physical health outcomes; and user experience. Participants (N = 20) were socioeconomically and racially/ethnically diverse, aged 51-88 years, and predominantly identified as gay or bisexual men (75%). Paired t-tests revealed a significant increase in participants' mean social engagement scores and a significant decrease in participants' mean negative affect scores, following the intervention. User experience scores were acceptable and participants reported a positive sense of connectedness to the Virtual Village community. Results suggest that a virtual community can be accessible to older PLWH and may enhance social engagement and improve aspects of mental wellbeing.
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Affiliation(s)
- Andrea N Polonijo
- Department of Sociology and the Health Sciences Research Institute, University of California, Merced, California, USA
| | - Annie L Nguyen
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California, San Diego, La Jolla, California, USA
| | - Karah Y Greene
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Jasmine L Lopez
- Department of Psychology, University of California, Riverside, California, USA
| | - Moka Yoo-Jeong
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Erik L Ruiz
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Jerome T Galea
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, Florida, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, Riverside, California, USA
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Brennan-Ing M, Mattas E. Aging with HIV: Working to Ensure Equity and Inclusion. Gerontology 2023; 69:946-952. [PMID: 37071979 DOI: 10.1159/000530723] [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: 01/09/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023] Open
Abstract
Due to effective anti-retroviral therapy (ART), the people with HIV are aging, and this is observed globally wherever ART is readily available. While this represents the success of HIV treatment, those aging with HIV face several health challenges that emphasize the importance of access to health care and health equity. These challenges include changes to the immune system, chronic inflammation, and higher rates of multimorbidity at younger ages compared to people without HIV. Intersectional identities impact health care access and health equity and include age, sexual orientation, gender identity, race/ethnicity, socioeconomic position, and HIV serostatus. Intersectional identities are also associated with psychosocial burdens among older adults with HIV such as depression, social isolation, and HIV stigma. Social integration of older people with HIV can mitigate some of these burdens and is associated with better psychological well-being, better physical functioning, and greater sufficiency of informal social supports. There are several grassroots and advocacy initiatives to improve health equity and social integration which bring greater visibility to HIV and aging. These efforts should be coupled with a systematic and sustained policy response to the aging of this population that prioritizes human needs and is grounded in principles of social justice. Action must be taken, and this responsibility falls on policymakers, health care professionals, researchers, and community advocates alike.
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Affiliation(s)
- Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, New York, USA
| | - Eleni Mattas
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, New York, USA
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Rozanova J, Rich KM, Altice FL, Shenoi SV, Zaviryukha I, Kiriazova T, Mamedova E, Shipunov O, Yariy V, Deac A, Zeziulin O. The Initial Response to COVID-19 Disruptions for Older People with HIV in Ukraine. Geriatrics (Basel) 2022; 7:geriatrics7060138. [PMID: 36547274 PMCID: PMC9777936 DOI: 10.3390/geriatrics7060138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Ukraine imposed a COVID-19 lockdown in March 2020. From April to June 2020, we surveyed 123 older people with HIV (OPWH) by phone to assess their mental health, engagement in HIV and other healthcare, and substance use using standardised scales. Variables of key interest were symptoms of depression and symptoms of anxiety. Univariate and multivariable Firth logistic regression models were built to assess factors associated with: (1) symptoms of depression, and (2) symptoms of anxiety. Findings indicated high suicidal ideation (10.6%); 45.5% met the screening criteria for moderate to severe depression; and 35.0% met the criteria for generalised anxiety disorder (GAD). Independent correlates of having moderate to severe depression included being female (AOR: 2.83, 95%CI = 1.19-7.05), having concerns about potential barriers to HIV treatment (AOR: 8.90, 95%CI = 1.31-104.94), and active drug use (AOR: 34.53, 95%CI = 3.02-4885.85). Being female (AOR: 5.30, 95%CI = 2.16-14.30) and having concerns about potential barriers to HIV treatment (AOR: 5.33, 95%CI = 1.22-28.45) were independently correlated with GAD, and over half (58.5%) were willing to provide peer support to other OPWH. These results highlight the impact of the COVID-19 restrictions in Ukraine on mental health for OPWH and support the need to screen for psychiatric and substance use disorders, potentially using telehealth strategies.
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Affiliation(s)
- Julia Rozanova
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
- Centre for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT 06510, USA
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
- Correspondence: ; Tel.: +1-203-824-81-30
| | | | - Frederick L. Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
- Centre for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT 06510, USA
- Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur 59990, Malaysia
- Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT 06510, USA
| | - Sheela V. Shenoi
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA
- Centre for Interdisciplinary Research on AIDS (CIRA), Yale University School of Public Health, New Haven, CT 06510, USA
| | | | | | | | | | - Volodymyr Yariy
- Kyiv Sociotherapy Addiction Treatment Clinic, 03039 Kyiv, Ukraine
| | - Alexandra Deac
- Department of Health Service and Population Research, King’s College London, London SE5 8AF, UK
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Shapiro AE, Ignacio RAB, Whitney BM, Delaney JA, Nance RM, Bamford L, Wooten D, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Webel AR, Kim HN, Van Rompaey SE, Christopoulos K, Jacobson J, Karris M, Smith D, Johnson MO, Willig A, Eron JJ, Hunt P, Moore RD, Saag MS, Mathews WC, Crane HM, Cachay ER, Kitahata MM. Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March-December 2020. J Acquir Immune Defic Syndr 2022; 90:369-376. [PMID: 35364600 PMCID: PMC9246864 DOI: 10.1097/qai.0000000000002989] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/03/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies. SETTING Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care. METHODS We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores. RESULTS Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm 3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm 3 (aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm 3 , diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died. CONCLUSIONS PWH with CD4 count <350 cells/mm 3 , and a history of CD4 count <200 cells/mm 3 , have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
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Affiliation(s)
| | | | | | | | | | - Laura Bamford
- University of California San Diego, San Diego, CA, USA
| | - Darcy Wooten
- University of California San Diego, San Diego, CA, USA
| | | | | | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | - Maile Karris
- University of California San Diego, San Diego, CA, USA
| | - Davey Smith
- University of California San Diego, San Diego, CA, USA
| | | | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peter Hunt
- University of California, San Francisco, San Francisco, CA, USA
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Psychological and Emotional Impact of COVID-19 Pandemic on People Living with Chronic Disease: HIV and Cancer. AIDS Behav 2022; 26:2920-2930. [PMID: 35249178 PMCID: PMC8898333 DOI: 10.1007/s10461-022-03638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/24/2022]
Abstract
People living with chronic disease (PLWCD) are the frailest category, both for the risk of severe COVID-19 illness and for the impact on the care continuum. Aim of this study was to analyze coping strategies and resilience in people living with HIV (PLWH) compared to people living with oncological diseases (PLWOD) during COVID-19 pandemic. We administrated an anonymous questionnaire, which explored the emotional experience, the demographic factors linked to a COVID-19-related stress syndrome, the patient’s perception about the adequacy of clinical undertaking from the hospital and the resilience. We analyzed 324 questionnaires. There were no significant differences in prevalence of psychological distress among the whole cohort; however, PLWOD were calmer, less troubled, and more serene than PLWH. Moreover, PLWH smoked more, ate more, and gained more weight than PLWOD. Most patients didn’t feel lonely and continued to take pleasure from their activities. No differences in resilience were found between the groups. In the whole cohort lower levels of resilience were found in patients that were unemployed, with history of psychological disorders and in those who experienced more feelings of anger, anxiety and concern. In our study, patients seemed to preserve their well-being, and to activate adaptive coping during the pandemic.
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Ruiz EL, Greene KY, Galea JT, Brown B. From surviving to thriving: the current status of the behavioral, social, and psychological issues of aging with HIV. Curr Opin HIV AIDS 2022; 17:55-64. [PMID: 35102052 DOI: 10.1097/coh.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite significant advances in knowledge regarding the biological and clinical issues related to aging with HIV, significantly less research has centered on related psychological, behavioral, and social issues, which are increasingly recognized as important for successfully aging with HIV. RECENT FINDINGS Barriers to successful aging include physical challenges from a sociobehavioral perspective, psychosocial challenges, and system-level challenges. In contrast, several resiliencies and interventions that help facilitate healthy aging with HIV are also emerging. Comprehensive interventions to address the physical, mental, and psychosocial needs of older people living with HIV (OPLWH) are necessary. CONCLUSION To promote healthy aging with HIV, we must utilize both clinical and biopsychosocial interventions. The lack of data on the needs of OPLWH is an important barrier to healthy aging in this population.
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Affiliation(s)
- Erik L Ruiz
- University of South Florida, College of Public Health
| | - Karah Y Greene
- University of South Florida, School of Social Work, Tampa, Florida
| | - Jerome T Galea
- University of South Florida, College of Public Health
- University of South Florida, School of Social Work, Tampa, Florida
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California, USA
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Shapiro AE, Bender Ignacio RA, Whitney BM, Delaney JA, Nance RM, Bamford L, Wooten D, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Webel AR, Kim HN, Van Rompaey SE, Christopoulos K, Jacobson J, Karris M, Smith D, Johnson MO, Willig A, Eron JJ, Hunt P, Moore RD, Saag MS, Mathews WC, Crane HM, Cachay ER, Kitahata MM. Factors associated with severity of COVID-19 disease in a multicenter cohort of people with HIV in the United States, March-December 2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.10.15.21265063. [PMID: 34704092 PMCID: PMC8547524 DOI: 10.1101/2021.10.15.21265063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Understanding the spectrum of SARS-CoV-2 infection and COVID-19 disease in people with HIV (PWH) is critical to provide clinical guidance and implement risk-reduction strategies. OBJECTIVE To characterize COVID-19 in PWH in the United States and identify predictors of disease severity. DESIGN Observational cohort study. SETTING Geographically diverse clinical sites in the CFAR Network of Integrated Clinical Systems (CNICS). PARTICIPANTS Adults receiving HIV care through December 31, 2020. MEASUREMENTS COVID-19 cases and severity (hospitalization, intensive care, death). RESULTS Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March-December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized and 12 died. PWH with current CD4 count <350 cells/mm 3 (aRR 2.68; 95%CI 1.93-3.71; P<.001) or lowest recorded CD4 count <200 (aRR 1.67; 95%CI 1.18-2.36; P<.005) had greater risk of hospitalization. HIV viral load suppression and antiretroviral therapy (ART) status were not associated with hospitalization, although the majority of PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared to other racial/ethnic groups (aRR 1.51; 95%CI 1.04-2.19, P=.03). Chronic kidney disease (CKD), chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher risk of hospitalization. PWH who were older, not on ART, with current CD4 <350, diabetes, and CKD were overrepresented amongst PWH who required intubation or died. LIMITATIONS Unable to compare directly to persons without HIV; underestimate of total COVID-19 cases. CONCLUSIONS PWH with CD4 <350 cells/mm 3 , low CD4/CD8 ratio, and history of CD4 <200, have a clear excess risk of severe COVID-19, after accounting for comorbidities also associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination, early treatment, and monitored closely for worsening illness.
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