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Valente PK, Neupane R, Eaton L, Watson RJ. Psychosocial Syndemic Burden, Sexual Behaviors, and Engagement in HIV Prevention Care Among Sexual and Gender Minority Youths: United States, 2022. Am J Public Health 2024; 114:892-902. [PMID: 39110931 PMCID: PMC11306613 DOI: 10.2105/ajph.2024.307753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
Objectives. To examine linear and nonlinear associations between psychosocial syndemic factors and HIV risk and engagement in HIV prevention care among sexual and gender minority (SGM) youths. Methods. Between February and October 2022, we recruited 17 578 SGM youths aged 13 to 18 years in the United States for an online survey. We examined the relationship of syndemics (i.e., binge drinking, drug use, sexual victimization, and anti-lesbian, gay, bisexual, and transgender discrimination) with sexual behaviors (i.e., sexual initiation, condomless anal or vaginal sex, and number of sexual partners) and HIV prevention care (i.e., HIV testing, preexposure prophylaxis awareness and utilization) using regression. Results. Psychosocial syndemic burden (number of syndemic factors reported) was linearly and cubically associated with engagement in sexual behaviors. Psychosocial syndemic burden was linearly associated with higher HIV testing and preexposure prophylaxis awareness and cubically associated with higher preexposure prophylaxis utilization. Conclusions. Our findings are evidence of synergism across psychosocial syndemic factors regarding HIV risk and engagement in HIV prevention care among SGM youths in the United States. Public Health Implications. Multicomponent interventions may help reduce HIV risk and promote access to HIV prevention services among SGM individuals aged 13 to 18 years. (Am J Public Health. 2024;114(9):892-902. https://doi.org/10.2105/AJPH.2024.307753).
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Affiliation(s)
- Pablo K Valente
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
| | - Raghavee Neupane
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
| | - Lisa Eaton
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
| | - Ryan J Watson
- Pablo K. Valente is with the Department of Allied Health Sciences, University of Connecticut, Waterbury. Raghavee Neupane was with the Boston University School of Public Health, Boston, MA, at the time of writing of this article. Lisa Eaton and Ryan J. Watson are with the Department of Human Development and Family Studies, University of Connecticut, Storrs
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Lua I, Magno L, Silva A, Pinto P, Bastos JL, Jesus G, Coelho R, Ichihara M, Barreto M, Santos CT, Moucheraud C, Gorbach P, Macinko J, Souza L, Dourado I, Rasella D. The intersecting effects of race, wealth, and education on AIDS incidence, mortality, and case-fatality rate: a Brazilian cohort study of 28.3 million individuals. RESEARCH SQUARE 2024:rs.3.rs-4314004. [PMID: 38766107 PMCID: PMC11100896 DOI: 10.21203/rs.3.rs-4314004/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The relationships between race, education, wealth, their intersections and AIDS morbidity/mortality were analyzed in retrospective cohort of 28.3 million individuals followed for 9 years (2007-2015). Together with several sensitivity analyses, a wide range of interactions on additive and multiplicative scales were estimated. Race, education, and wealth were each strongly associated with all of the AIDS-related outcomes, and the magnitude of the associations increased as intersections were included. A significantly higher risk of illness (aRR: 3.07, 95%CI:2.67-3.53) and death (aRR: 4.96, 95%CI:3.99-6.16) from AIDS was observed at the intersection of Black race, lower educational attainment, and less wealth. A higher case-fatality rate (aRR: 1.62, 95%CI:1.18-2.21) was also seen for the same intersectional group. Historically oppressed groups lying at the intersections of race, education, and wealth, had a considerably higher risk of illness and death from AIDS. AIDS-related interventions will require the implementation of comprehensive intersectoral policies that follow an intersectionality perspective.
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Affiliation(s)
- Iracema Lua
- Institute of Collective Health, Federal University of Bahia (UFBA); Department of Health, State University of Feira de Santana (UEFS)
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB). Institute of Collective Health, Federal University of Bahia (UFBA)
| | - Andréa Silva
- Institute of Collective Health, Federal University of Bahia; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvado
| | - Priscila Pinto
- Institute of Collective Health, Federal University of Bahia; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvado
| | | | | | - Ronaldo Coelho
- Department of Chronic Conditions, Diseases, and Sexually Transmitted Infections at the Brazilian Ministry of Health
| | - Maria Ichihara
- The Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation (FIOCRUZ)
| | - Mauricio Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ)
| | - Carlos Teles Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health
| | - Pamina Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health
| | - James Macinko
- Department of Health Policy and Management, University of California
| | - Luis Souza
- Institute of Collective Health, Federal University of Bahia (UFBA)
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA)
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Eshak TB, Hobkirk AL, Whitener CJ, Conyers LM, Hwang W, Sznajder KK. Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV. AIDS Behav 2024; 28:1612-1620. [PMID: 38281250 DOI: 10.1007/s10461-024-04275-5] [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] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.
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Affiliation(s)
- Tarek B Eshak
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA, USA
| | - Cynthia J Whitener
- Department of Medicine, Penn State University, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Liza M Conyers
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
| | - Kristin K Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
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Mason JA, Friedman EE, Devlin SA, Schneider JA, Ridgway JP. Predictive Modeling of Lapses in Care for People Living with HIV in Chicago: Algorithm Development and Interpretation. JMIR Public Health Surveill 2023; 9:e43017. [PMID: 37195750 PMCID: PMC10233431 DOI: 10.2196/43017] [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: 09/27/2022] [Revised: 03/01/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Reducing care lapses for people living with HIV is critical to ending the HIV epidemic and beneficial for their health. Predictive modeling can identify clinical factors associated with HIV care lapses. Previous studies have identified these factors within a single clinic or using a national network of clinics, but public health strategies to improve retention in care in the United States often occur within a regional jurisdiction (eg, a city or county). OBJECTIVE We sought to build predictive models of HIV care lapses using a large, multisite, noncurated database of electronic health records (EHRs) in Chicago, Illinois. METHODS We used 2011-2019 data from the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN), a database including multiple health systems, covering the majority of 23,580 people with an HIV diagnosis living in Chicago. CAPriCORN uses a hash-based data deduplication method to follow people across multiple Chicago health care systems with different EHRs, providing a unique citywide view of retention in HIV care. From the database, we used diagnosis codes, medications, laboratory tests, demographics, and encounter information to build predictive models. Our primary outcome was lapses in HIV care, defined as having more than 12 months between subsequent HIV care encounters. We built logistic regression, random forest, elastic net logistic regression, and XGBoost models using all variables and compared their performance to a baseline logistic regression model containing only demographics and retention history. RESULTS We included people living with HIV with at least 2 HIV care encounters in the database, yielding 16,930 people living with HIV with 191,492 encounters. All models outperformed the baseline logistic regression model, with the most improvement from the XGBoost model (area under the receiver operating characteristic curve 0.776, 95% CI 0.768-0.784 vs 0.674, 95% CI 0.664-0.683; P<.001). Top predictors included the history of care lapses, being seen by an infectious disease provider (vs a primary care provider), site of care, Hispanic ethnicity, and previous HIV laboratory testing. The random forest model (area under the receiver operating characteristic curve 0.751, 95% CI 0.742-0.759) revealed age, insurance type, and chronic comorbidities (eg, hypertension), as important variables in predicting a care lapse. CONCLUSIONS We used a real-world approach to leverage the full scope of data available in modern EHRs to predict HIV care lapses. Our findings reinforce previously known factors, such as the history of prior care lapses, while also showing the importance of laboratory testing, chronic comorbidities, sociodemographic characteristics, and clinic-specific factors for predicting care lapses for people living with HIV in Chicago. We provide a framework for others to use data from multiple different health care systems within a single city to examine lapses in care using EHR data, which will aid in jurisdictional efforts to improve retention in HIV care.
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Affiliation(s)
- Joseph A Mason
- The Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Eleanor E Friedman
- The Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Samantha A Devlin
- The Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - John A Schneider
- The Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jessica P Ridgway
- The Chicago Center for HIV Elimination, Department of Medicine, University of Chicago, Chicago, IL, United States
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Ridgway JP, Ajith A, Friedman EE, Mugavero MJ, Kitahata MM, Crane HM, Moore RD, Webel A, Cachay ER, Christopoulos KA, Mayer KH, Napravnik S, Mayampurath A. Multicenter Development and Validation of a Model for Predicting Retention in Care Among People with HIV. AIDS Behav 2022; 26:3279-3288. [PMID: 35394586 PMCID: PMC9474706 DOI: 10.1007/s10461-022-03672-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Predictive analytics can be used to identify people with HIV currently retained in care who are at risk for future disengagement from care, allowing for prioritization of retention interventions. We utilized machine learning methods to develop predictive models of retention in care, defined as no more than a 12 month gap between HIV care appointments in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Data were split longitudinally into derivation and validation cohorts. We created logistic regression (LR), random forest (RF), and gradient boosted machine (XGB) models within a discrete-time survival analysis framework and compared their performance to a baseline model that included only demographics, viral suppression, and retention history. 21,267 Patients with 507,687 visits from 2007 to 2018 were included. The LR model outperformed the baseline model (AUC 0.68 [0.67-0.70] vs. 0.60 [0.59-0.62], P < 0.001). RF and XGB models had similar performance to the LR model. Top features in the LR model included retention history, age, and viral suppression.
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Affiliation(s)
- Jessica P Ridgway
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA.
| | - Aswathy Ajith
- Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | - Eleanor E Friedman
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | | | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Edward R Cachay
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | | | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Logie CH, Coelho M, Kohrt B, Tsai AC, Mendenhall E. Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research. Curr Opin HIV AIDS 2022; 17:46-54. [PMID: 35081555 PMCID: PMC11045292 DOI: 10.1097/coh.0000000000000722] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to identify themes across articles that aimed to explore HIV-related syndemics in 2020 and 2021 and to discuss their implications for research on syndemics. RECENT FINDINGS We identified 189 articles on syndemics between 2020 and 2021. Key themes across studies included COVID-19; mental health and psychosocial challenges; substance use; socio-structural factors; protective factors; and methodological approaches. COVID-19's implications for HIV syndemic research were discussed. Mental health and substance use research largely examined linkages with sexual practices or reduced HIV care retention. Researchers examined associations between socio-structural variables (e.g. poverty) and elevated HIV exposure, reduced HIV testing and poorer health. Concepts of water insecurity and 'ecosyndemics' were also raised, as was the importance of attending to noncommunicable diseases and comorbidities. Most studies did not assess interactions between health conditions, signalling the need for methodological grounding in the foundational concepts of syndemic theory. SUMMARY Most studies recommended that HIV prevention and care research attend to the interplay between poor mental health, substance use and multidimensional violence. Increased attention to structural factors, particularly exacerbated poverty in the COVID-19 pandemic, is required. Research can identify protective factors to harness to advance HIV prevention and care.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- United Nations University Institute for Water, Environment & Health, Hamilton, Canada
| | - Madelaine Coelho
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Mendenhall
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
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