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Ojukwu E, Hirani S, Sotindjo T, McKay E, Okedo-Alex I, Magagula P, Pashaei A, Agudosi GM. The Impact of Intersectional Discrimination and Stigma on HIV Care for African, Caribbean, and Black Women Living With HIV During the COVID-19 Pandemic in British Columbia: A Descriptive Study. J Assoc Nurses AIDS Care 2024; 35:175-188. [PMID: 38427789 PMCID: PMC11037459 DOI: 10.1097/jnc.0000000000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
ABSTRACT African, Caribbean, and Black women living with HIV (ACB WWH) in British Columbia experience discrimination on the basis of their race, sex, gender identity, sexual orientation, and HIV status. The various forms of stigma that ACB WWH experience intersect to create a uniquely marginalized experience that has negative consequences for quality of life and overall well-being. Eighteen semistructured interviews were completed with ACB WWH in British Columbia. Interviews were conducted by phone, Zoom, or in-person at the participant's request. Participants consistently reported experiences of various forms of discrimination. There was additional stigmatization due to COVID-19 pandemic that negatively influenced the lives of ACB WWH. Interventions and resources are needed to support ACB WWH in navigating how to work through the multifaceted impacts of intersectional stigmatization. Efforts are needed to identify ways to continue the delivery of resources like social support groups throughout future pandemics.
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Affiliation(s)
| | - Saima Hirani
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Tatiana Sotindjo
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Emily McKay
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Ijeoma Okedo-Alex
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Patience Magagula
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Ava Pashaei
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
| | - Ginikachukwu Marylinda Agudosi
- Emmanuela Ojukwu, PhD, RN, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Saima Hirani, PhD, is an Assistant Professor of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Tatiana Sotindjo, MD, FRCPC, is an Adolescent Medicine Specialist Physician, Division of Paediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Emily McKay, BSN, RN, MSN is Nursing Graduate, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ijeoma Okedo-Alex, MBBS, MSC, MPH, FMCPH, is a Public Health Physician, (1) School of Population and Public Health, University of British Columbia; (2) African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Nigeria
- Patience Magagula, BSN, is a Director, Afro-Canadian Positive Network of British Columbia, Vancouver, British Columbia, Canada
- Ava Pashaei, BSN, MSN, is a PhD Student of Nursing, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Ginikachukwu Marylinda Agudosi, MSN, CRNP, is a MD Candidate, Trinity School of Medicine (MS-3), Warner Robins, Georgia, USA
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Medeiros P, Koebel J, Yu A, Kazemi M, Nicholson V, Frank P, Persad Y, O'Brien N, Bertozzi B, Smith S, Ndung'u M, Fraleigh A, Gagnier B, Cardinal C, Webster K, Sanchez M, Lee M, Lacombe-Duncan A, Logie CH, Gormley R, de Pokomandy A, Kaida A, Loutfy MR. Experiences and resultant care gaps among women with HIV in Canada: concept mapping the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) findings. BMJ Open 2024; 14:e078833. [PMID: 38569698 PMCID: PMC11146408 DOI: 10.1136/bmjopen-2023-078833] [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: 08/13/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES The community-based, longitudinal, Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) explored the experiences of women with HIV in Canada over the past decade. CHIWOS' high-impact publications document significant gaps in the provision of healthcare to women with HIV. We used concept mapping to analyse and present a summary of CHIWOS findings on women's experiences navigating these gaps. DESIGN Concept mapping procedures were performed in two steps between June 2019 and March 2021. First, two reviewers (AY and PM) independently reviewed CHIWOS manuscripts and conference abstracts written before 1 August 2019 to identify main themes and generate individual concept maps. Next, the preliminary results were presented to national experts, including women with HIV, to consolidate findings into visuals summarising the experiences and care gaps of women with HIV in CHIWOS. SETTING British Columbia, Ontario and Quebec, Canada. PARTICIPANTS A total of 18 individual CHIWOS team members participated in this study including six lead investigators of CHIWOS and 12 community researchers. RESULTS Overall, a total of 60 peer-reviewed manuscripts and conference abstracts met the inclusion criteria. Using concept mapping, themes were generated and structured through online meetings. In total, six composite concept maps were co-developed: quality of life, HIV care, psychosocial and mental health, sexual health, reproductive health, and trans women's health. Two summary diagrams were created encompassing the concept map themes, one for all women and one specific to trans women with HIV. Through our analysis, resilience, social support, positive healthy actions and women-centred HIV care were highlighted as strengths leading to well-being for women with HIV. CONCLUSIONS Concept mapping resulted in a composite summary of 60 peer-reviewed CHIWOS publications. This activity allows for priority setting to optimise care and well-being for women with HIV.
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Affiliation(s)
- Priscilla Medeiros
- Women's College Hospital, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Koebel
- Women's College Hospital, Toronto, Ontario, Canada
| | - Amy Yu
- Women's College Hospital, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Hospital, Toronto, Ontario, Canada
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Nadia O'Brien
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Mary Ndung'u
- Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Claudette Cardinal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - A Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mona R Loutfy
- Medicine, University of Toronto, Toronto, Ontario, Canada
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Pakhomova TE, Tam C, Wang L, Salters K, Moore DM, Barath J, Elterman S, Dawydiuk N, Wesseling T, Grieve S, Sereda P, Hogg R, Barrios R. Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada. AIDS Behav 2024; 28:43-58. [PMID: 37632606 DOI: 10.1007/s10461-023-04156-3] [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] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
Depressive symptoms among people living with HIV (PLWH) are associated with poorer overall health outcomes. We characterized depressive symptoms and improvements in symptomology among PLWH (≥ 19 years old) in British Columbia (BC), Canada. We also examined associations between depressive symptomology and antiretroviral therapy (ART) treatment interruptions. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), within a longitudinal cohort study with three surveys administered 18-months apart. We used multivariable logistic regression to model factors associated with improvements in depressive symptoms (CES-D-10 scores from ≥ 10 to < 10). Of the 566 participants eligible for analysis 273 (48.2%) had CES-D scores indicating significant depressive symptoms (score ≥ 10) at enrollment. Improvements in symptoms at first follow-up were associated with greater HIV self-care on the Continuity of Care Scale (adjusted odds ratio: 1.17; 95% CI 1.03-1.32), and not having a previously reported mental health disorder diagnosis (aOR 2.86; 95% CI 1.01-8.13). Those reporting current cocaine use (aOR 0.33; 95% CI 0.12-0.91) and having a high school education, vs. less than, (aOR 0.25; 95% CI 0.08-0.82) had lower odds of improvement in depressive symptomatology. CES-D scores ≥ 10 were not significantly associated with ART treatment interruptions during follow-up (aOR: 1.08; 95% CI:0.65-1.8). Supporting greater self-care and consideration of mental health management strategies in relation to HIV may be useful in promoting the wellbeing of PLWH who experience depressive symptoms.
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Affiliation(s)
- Tatiana E Pakhomova
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada.
| | - Clara Tam
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- University of British Columbia, Vancouver, Canada
| | - Justin Barath
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Simon Elterman
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Nicole Dawydiuk
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Tim Wesseling
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Sean Grieve
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- University of British Columbia, Vancouver, Canada
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Odhiambo AJ, O'Campo P, Nelson LRE, Forman L, Grace D. Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography. Int J Equity Health 2023; 22:33. [PMID: 36797746 PMCID: PMC9935247 DOI: 10.1186/s12939-022-01792-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 02/18/2023] Open
Abstract
Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of 'structural violence' to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n = 20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n = 15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada's social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered "bad" patients while privileged individuals who achieve undetectability are considered "good" patients. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.
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Affiliation(s)
- Apondi J Odhiambo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - La Ron E Nelson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
- Yale School of Nursing, New Haven, CT, USA
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Bradley H, Zhu Y, Duan X, Kang H, Qu B. HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties. JMIR Public Health Surveill 2022; 8:e39015. [PMID: 36222289 PMCID: PMC9782451 DOI: 10.2196/39015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS. OBJECTIVE The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. METHODS This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation. RESULTS A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation). CONCLUSIONS This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.
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Affiliation(s)
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Xiyu Duan
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Hao Kang
- Administration Department of Nosocomial Infection, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China.,School of Public Health, China Medical University, Shenyang, China
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Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018). J Immigr Minor Health 2022; 24:256-299. [PMID: 33811583 PMCID: PMC8487436 DOI: 10.1007/s10903-021-01184-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
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Affiliation(s)
- Stefanie Machado
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Argentina E Servin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
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Khanna AS, Edali M, Ozik J, Collier N, Hotton A, Skwara A, Ardestani BM, Brewer R, Fujimoto K, Harawa N, Schneider JA. Projecting the number of new HIV infections to formulate the "Getting to Zero" strategy in Illinois, USA. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3922-3938. [PMID: 34198418 PMCID: PMC8281377 DOI: 10.3934/mbe.2021196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Getting to Zero (GTZ) initiatives focus on expanding use of antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) to eliminate new HIV infections. Computational models help inform policies for implementation of ART and PrEP continuums. Such models, however, vary in their design, and may yield inconsistent predictions. Using multiple approaches can help assess the consistency in results obtained from varied modeling frameworks, and can inform optimal implementation strategies. METHODS A study using three different modeling approaches is conducted. Two approaches use statistical time series analysis techniques that incorporate temporal HIV incidence data. A third approach uses stochastic stimulation, conducted using an agent-based network model (ABNM). All three approaches are used to project HIV incidence among a key population, young Black MSM (YBMSM), over the course of the GTZ implementation period (2016-2030). RESULTS All three approaches suggest that simultaneously increasing PrEP and ART uptake is likely to be more effective than increasing only one, but increasing ART and PrEP by 20% points may not eliminate new HIV infections among YBMSM. The results further suggest that a 20% increase in ART is likely to be more effective than a 20% increase in PrEP. All three methods consistently project that increasing ART and PrEP by 30% simultaneously can help reach GTZ goals. CONCLUSIONS Increasing PrEP and ART uptake by about 30% might be necessary to accomplish GTZ goals. Such scale-up may require addressing psychosocial and structural barriers to engagement in HIV and PrEP care continuums. ABNMs and other flexible modeling approaches can be extended to examine specific interventions that address these barriers and may provide important data to guide the successful intervention implementation.
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Affiliation(s)
- Aditya Subhash Khanna
- Center for Alcohol and Addiction Studies, Brown University, Providence RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence RI USA
| | - Mert Edali
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Industrial Engineering, Yildiz Technical University, Besiktas, Istanbul 34349, Turkey
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Abigail Skwara
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Babak Mahdavi Ardestani
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Nina Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University, Los Angeles, CA, USA
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - John A. Schneider
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
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Djiadeu P, Yusuf A, Ongolo-Zogo C, Nguemo J, Odhiambo AJ, Mukandoli C, Lightfoot D, Mbuagbaw L, Nelson LE. Barriers in accessing HIV care for Francophone African, Caribbean and Black people living with HIV in Canada: a scoping review. BMJ Open 2020; 10:e036885. [PMID: 32859664 PMCID: PMC7454192 DOI: 10.1136/bmjopen-2020-036885] [Citation(s) in RCA: 12] [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] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In 2001, 50%-55% of French-speaking minority communities did not have access to health services in French in Canada. Although Canada is officially a bilingual country, reports indicate that many healthcare services offered in French in Anglophone provinces are insufficient or substandard, leading to healthcare discrepancies among Canada's minority Francophone communities. OBJECTIVES The primary aim of this scoping systematic review was to identify existing gaps in HIV-care delivery to Francophone minorities living with HIV in Canada. STUDY DESIGN Scoping systematic review. DATA SOURCES Search for studies published between 1990 and November 2019 reporting on health and healthcare in Francophone populations in Canada. Nine databases were searched, including Medline, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the National Health Service Economic Development Database, Global Health, PsychInfo, PubMed, Scopus and Web of Science. STUDY SELECTION English or French language studies that include data on French-speaking people with HIV in an Anglophone majority Canadian province. RESULTS The literature search resulted in 294 studies. A total of 230 studies were excluded after duplicates were removed. The full texts of 43 potentially relevant papers were retrieved for evaluation and data extraction. Forty-one studies were further excluded based on failure to meet the inclusion criteria leaving two qualitative studies that met our inclusion criteria. These two studies reported on barriers on access to specialised care by Francophone and highlighted difficulties experienced by healthcare professionals in providing quality healthcare to Francophone patients in Ontario and Manitoba. CONCLUSION The findings of this scoping systematic review highlight the need for more HIV research on linguistic minority communities and should inform health policymaking and HIV/AIDS community organisations in providing HIV care to Francophone immigrants and Canadians.
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Affiliation(s)
- Pascal Djiadeu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Yale University School of Nursing, Yale University, West Haven, Connecticut, USA
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Abban Yusuf
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Clémence Ongolo-Zogo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Centre Province, Cameroon
| | - Joseph Nguemo
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Apondi J Odhiambo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Chantal Mukandoli
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- AFRICANS IN PARTNERSHIP AGAINST AIDS (APAA), Toronto, Ontario, Canada
| | - David Lightfoot
- St Michael's Health Sciences Library, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Centre Province, Cameroon
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - LaRon E Nelson
- Yale University School of Nursing, Yale University, West Haven, Connecticut, USA
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
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Song Q, Li R, Zhao Y, Zhu Q, Xia B, Chen S, Zhang Y. Evaluating effects of prenatal exposure to phthalates on neonatal birth weight: Structural equation model approaches. CHEMOSPHERE 2018; 205:674-681. [PMID: 29723725 DOI: 10.1016/j.chemosphere.2018.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND A large body of evidence has shown that phthalate exposure can lower birth weight in animals and human beings. However, there are only limited data on whether phthalates could affect birth weight directly or indirectly through gestational age and pregnancy syndrome. OBJECTIVES To evaluate the effects of prenatal exposure to phthalates on birth weight in neonates and the mediation effects of gestational age and pregnancy syndrome on the association between phthalate exposure and birth weight. METHODS In this study, 181 mother-newborn pairs were recruited from Wenzhou city. Maternal urine samples were collected during the third trimester and measured for phthalate metabolites by ESI-MS/MS. Structural equation models (SEMs) were used to evaluate effects of phthalate on birth weight controlling for maternal education, monthly income, nutritional supplements, infant gender, and maternal weight gain per week. The potential mediated effects of phthalate exposure through gestational age and pregnancy syndrome on birth weight were also calculated by structural equation modeling. RESULTS After adjusting for potential confounders, urinary mono-phthalate levels (including MMP, MBP, MEHP, MEOHP, and MEHHP) were negatively associated with birth weight. A ten-fold increase in the concentration of MEOHP and MEHHP would be directly associated with lower birth weights (reduced to 124 g and 107 g, respectively). However, MBP had mediated effects on birth weight through gestational age, which was associated with an 85-g reduction in birth weight for every ten-fold increase in exposure. Both direct and mediated effects on birth weight were found in MMP and MEHP. The indirect effects of MMP and MEHP were mediated through gestational age and pregnancy syndrome. Thus, prenatal MMP and MEHP exposures were associated with decrease in birth weight. CONCLUSIONS A negative association exists between prenatal phthalate exposure and birth weight in Chinese neonates. In addition to direct pathway, phthalate exposures could affect birth weight through the mediated effects of gestational age and pregnancy syndrome.
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Affiliation(s)
- Qi Song
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Ruzhi Li
- Department of Obstetrical, The Obstetrics and Gynecology Hospital of Fudan University, China
| | - Yan Zhao
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingyang Zhu
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Bin Xia
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China
| | - Shangqin Chen
- Department of Neonatology, The 2nd Affiliated Hospital, Wenzhou Medical College, Wenzhou, China
| | - Yunhui Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China.
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